Sunday, July 15, 2012

Aortic Aneurysms, Bicuspid Aortic Valves, and The Sword of Damocles

Sword of Damocles, Richard Westall, Ackland Art Museum
"...the presence of a bicuspid aortic valve appears to indicate, at least in a portion of the cases in which it occurs, a tendency to spontaneous rupture of the aorta, which hangs always, like a Sword of Damocles, above the unsuspecting subjects of this type of coarctation, for this anomaly occurred in quite half the cases so terminating." M.E. Abbott, Coarctation of the Aorta, The American Heart Journal, 1928.

Among those born with bicuspid aortic valves are a group of individuals that are athletically gifted, with tremendous focus and stamina. They pursue amazing athletic goals with exceptional physical strength, endurance, and intelligence. They appear the picture of health, and in many ways their bodies are in excellent condition. However, life-threatening danger may hang over them, sometimes undetected. I recognized those traits in John Marschall, known as Coach Jay, who is interviewed below.

I was struck again by Dr. Abbott's wisdom, published over eighty years ago, as I read about this man's experience:  Go Hard or Go Home: Determination Despite Cardiovascular Disease .  However much others might admire his extraordinary athletic ability, no one would wish to walk in his shoes between 2008 and 2010, years when he first had his bicuspid aortic valve replaced, later contracted endocarditis, and then went under the knife again when a large aortic aneurysm was discovered. Coach Jay tells about his last race, and new beginning, in this post, Monday, June 27, 2011, The end and the Beginning . 

In Dr. Abbott's day, surgery and antibiotics did not exist. The sword, hanging by only the thinnest of threads, was out of reach and would eventually fall. Today surgery and antibiotics do exist, but the sword still hangs there, the dangers remain for those with BAV and TAD. There is still a great deal that is not understood. Controversies exist about the timing and methods of treatment and surgery. Individuals, families, and physicians have a great deal to ponder as they make decisions about first finding the sword, and then deciding when and how to remove it. 

Seemingly healthy, 
extraordinarily gifted people
 with BAV and TAD
 may be under life-threatening risks.

As we share their stories, 
we expose those risks 
and raise awareness,
creating a climate of hope.

Arlys Velebir
President and Chairman
Bicuspid Aortic Foundation

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