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Question:

Is my lifestyle a significant contributory factor in/to my enlarged ascending aorta?

My diagnosis consists of a moderate to heavy regurgitating aortic valve with a dilated ascending aorta (5.1 cm). Near term surgery being planned. My lifestyle is active; daily moderate to intense cardio visiting the anaerobic zone several times a week. This lifestyle extends back 35+ years. What is the probability this lifestyle is a significant contributory factor in/to my current condition? 2) Assuming a tissue valve replacement (bovine) and an aortic root replacement, how would you assess the percentage catastrophic risk increase with a redo operation down the road? Current age 59; 5'9" 160 lbs, resting heart rate upper 40's; symptoms of current condition restricted to occasional light headedness after squatting down.

submitted by Mark from St. Louis, Missouri on 6/24/2014

Answer:

by Texas Heart Institute cardiologist, Michael J. Mihalick, MD  

Michael J. Mihalick, MD

Although an enlarged ascending aorta can be seen in those who participate in chronic extreme physical activity, I would consider it highly unlikely in the absence of co-existing aortic valve disease, structural abnormalities of the aorta, or hypertension. This is especially true if there is underlying aortic valve disease such as you describe.

A Bentall operation is the appropriate treatment with a combined ascending aortic graft and mechanical valve. Mechanical valves have the best track record, but currently require lifelong anticoagulation with warfarin. Tissue valves are not as durable, especially in those under 70, but do not require warfarin. It appears that you need surgery, but the exact valve used will need to be chosen by you and your surgeon.

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Updated July 2014
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