Thoracic AA 7.3cms: Bristol Royal Infirmary

Hi Mim66,

To answer your question, I'm 67 years old.

I believe that for most complex, open operations there is more than one surgeon in the theatre, a multi-disciplne team in fact. One might be a specialist in one particlar aspect of the procedure, another in a different aspect. However the most important and tricky part of the operation I would expect to be performed by the lead surgeon who should have the most experience and appropriate skills for that task.

I am asking about Mr. Cha Rajakaruna specifically because for me I need to understand, as far as my non-medical background will allow, as much as possible about my condition and the operation. To do this I need to develop a good rapport with the surgeon and be able to ask any question and know that he/she will take the time and make the effort to ensure that I understand to my satisfaction. Not all doctors like that. I nearly walked out on a consultant surgeon once because he really was not forthcoming and didn't want to answer the more difficult questions.

Thanks for that.

I guess 96% is reassuring but it still means that of the 462 cases (2013 to 2016) 18 were unsuccesssful ... whatever unsuccesssful means!

It's a sobering thought that with aortic aneurysms there is not much scope for getting it nearly right, either the repair works or you die!

Since I last posted I have had a further CT scan at the BRI and I now have an appointment with the consultant for the 28th September which seems to be a long time hence to me. Especially as I was given to believe that I’d be operated on quite quickly.

Yes, the non-invasive technique does seem like best approach, however … I have been told that the “neck of the aneurysm” is too narrow to let the collapsed stent through and so this technique is not an option.

Frankly I either don’t understand that or I don’t believe that.

If the rest of the aorta, the healthy bit, is of nominal size then the collapsed stent should be able to get through to the enlarged bit i.e. the aneurysm. If it’s collapsed surely the stent should be smaller in diameter than a normal aorta otherwise no one would be able to have a stent fitted! … what would be the point of a producing a stent that couldn’t travel up a nominally sized aorta!

The only interpretation I can put on this is that my aorta narrows as it approaches the aneurysm which seems unlikely to me.

The other thing that occurs to me is that the aneurysm is in the region of the ascending aorta as it comes out from the aortic valve rather than below the descending aorta. I can see that potentially might be a more complex procedure since there are three major arteries branching out to other parts of the body at that point.

I guess these are is just some of the many questions I need to ask the consultant. My main worry is, just how urgent is the situation? I have seen it stated that if the aorta is over 6cms then it’s time to consider a repair. Well mine is 7.3cms but they don’t seem in too much of a hurry to get me on the slab.

Meanwhile my partner is following me around expecting me to drop at any minute … I’m exaggerating but it would freak me out if I were to take her seriously. She’s just understandably concerned, bless her.

Anyway, thanks for your interest Suzanne.

Regards, Phil.

Hi Phil,

Did you get the surgery yet?

Regards,

Dan.

Hi Dan,

Yes I have had surgery since last I posted to this thread.

To cut a long story short; since the BRI seemed so slow at responding, given I was told this was quite an acute situation, I did a bit of research into the best hospitals/surgeons in the UK to deal with Thoracic Aortic Aneurysms (i.e. TAA and not AAA) and found the BRI did not seem to be amongst them. The ones I came up with are The Royal Brompton, Papworth and the Liverpool Heart and Chest Hospital (LHCH).

Well I’ve been to the Brompton before in 1995 to have the remains of a cancerous tumour removed from between my lungs but the Quality Care Commission (CQC) gives them a rating of “Requires Improvement” so I ruled them out. The LHCH however have a rating of “Outstanding” with the CQC and they also have a team that specialises in TAAs.

I suppose I should mention at this stage that it is part of the NHS constitution that one has the right to choose where and by whom one is treated, so I did. I asked my GP to refer me to the lead surgeon for TAAs at the LHCH which is Mr. Mark Field.

Mr Field was very quick off the mark and after a consultation said we should operate as soon as we could and certainly before Christmas 2018. He also said that I didn’t have a thoracic aortic aneurysm per se but I did in fact have a pseudo thoracic aortic aneurysm. This turns out to be where the aneurysm has already burst but by some mechanism the rupture is contained by surrounding tissue, in this case the scar tissue from the cancerous tumour that they removed in 1995. So, I’m one of the few people who can say that cancer saved my life!

Mr Field operated on me on the 5th of November 2018. I had my aortic root completely replaced with a Dacron tube and an integral mechanical aortic valve and a portion of my hemi-arch was replaced with a Dacron tube as well. It was very major surgery and I was in the operating theatre for just over 12 hours.

I am now well on my way to full recovery and about to start cardiac-rehab. Mr Field tells me that I won’t feel like the old “me” again until the spring, so maybe March/April will see me returning to a full active life……. I’m not saying there have not been any challenges along the way and I’m sure there will be a few more yet but I’m still here and kicking!!!

Regards,

Phil.