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Aneurysm Part II???

Hi-  About 14 years ago(age20) I had a dissection of the ascending aorta(ruptured into the pericardial(sp) sac), they fitted me with a St Judes valve and a Dacron graft.  Everything has been fine since then -  No problems -  I even ran a half marathon 3 years ago and then a full marathon just last January.

Fast forward to this week-  I went for a run Tuesday night -  and after I came back in I noticed some mild discomfort whenever I took a deep breath.  And then last night I was having some trouble sleeping on my left side- as well as the deep breathing mild discomfort-  Nothing too terribly painful I would say a 2 to 4 out of 10 (where 10 is having your chest cracked open and your heart played around with).  So I went to the emergency room- given my history I wanted to rule out another aneurysm.  They did blood work and and EKG-  Blood came back with one level slightly elevated so that sent me in for a CT w/dye contrast.  The doctor kept saying stuff like I wish I had a comparable to correlate this with.- And now I have to go and see my cardiologist for a follow up.

What were the results you might ask-
I had an aneurysmal dilation of the Ascending Thoracic Aorta measuring apporximately 3.9 Cm in AP dimension near the level of the aortic arch just distal to the graft or postsurgical change.  When I had the surgery done 14 years ago my doctor at the time said that he had covered my aorta where all of the weak parts were- (and that if I ever needed to have more surgery on it-  I could get a freebie or a refund)-  My question to you is should I try and collect on this promise (just joking or course).  No what I'm really concerned about is having to go through a similar surgery and recovery like I did before (last time I was 20 years old and in college-  I missed half of a semester, but now that I'm an adult I have real job w/ and family responsibilities) -  Now I realize that this could be potentially life threatening-  So I guess work and family take a back seat to that-  But what are the chances that I might need more surgery in the next couple of years or so?  And should I cancel my 5K race in less than a month?  Is there a correlation between running a lot and the reoccurance of aneurysms?  Or am I just one of the lucky ones with weak aortic walls or something?  

P.S.- I don't have Marfans syndrome- My grandfather had the same surgery but he was 80 years old when he had his,  I used to joke that I just got my out of the way early(But now I'm not so sure if I'm done with the surgery)
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Avatar universal
No restrictions is good.  Hopefully you will be able to go a long time until you need surgery again, and when you get there, you will sail through it.
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Avatar universal
Hi Everybody-

Well I met with my cardiologist yesterday, and I had a stress test with the nuclear contrast, and an echo done today.  The good news is that I have no restrictions at this time a 3.9cm dilation is something that they plan to monitor, but my valve is in great shape and my heart is in great shape.-  I don't think that I'll stop running at this point, but I think that I may try and slow down a bit (ie I don't think another marathon is in my future) -  I figure if I cut back my training a bit I can still do 5K's on weekends occasionally (not to win-just for fun) for many more years to come.  FYI I made it to 12 minutes today on my stress test which is about 4-5 minutes better than the typical person-(Depending on who you talk to)- and it was about 3 minutes better than before I ran the marathon last year.  Thanks for all of your advice & support everyone
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Avatar universal
First of all, congratulations on surviving your dissection.  You've already foiled death once.  If you lived through that, and you are in good enough health to run marathons, you had a fantastic outcome.  Now the bad news.  With your history, your young age, and a 3.9cm bulge in your aorta, it will be very surprising if you do not have to go under the knife again.  Sorry for that.  As for when, I don't know if even the doctors can tell you that.  They will monitor you, and when it gets close to time, then they will tell you that your surgery is not far off.  

It sounds like you had your aorta wrapped where the doctor could see some "weak spots," plus you had your ascending aorta replaced with a dacron graft.   Unfortunately, sometimes another aneurysm does form at the end of the wrapping or at the juncture between the dacron graft and the distal aorta.  It's a combination of the tissue being funky to start with, and then the stress on the tissue of having someone (unavoidably) handling it during surgery doesn't help it any, either.  So it is not unheard of to develop a second dissection or aneurysm.  

You don't have to have Marfan's to have a weak aorta.  A lot of people with bicuspid aortic valves have bad aortas.  There is also a disorder called TAD (thoracic aortic disease) or TAAD (thoracic aortic aneurysm disease) in which the affected people have recurrent aortic dissections or aneurysms without any other known connective tissue disorder and without any valve abnormality.   BAV, TAD/TAAD, and some of the as-yet-unnamed aortic syndromes run in families.  Marfans is better known than a lot of other causes of aortic disease, because more research has been done on it.

I don't know the answer to your question about competitive racing.  Recreational jogging is generally okay with a pre-surgical aortic dilation, but marathon running is something that is on another level.  I don't know what to tell you about your training habits or about the upcoming 5K.  That's something else that you've got to ask a knowledgable doctor about.  

One thing I can tell you with total confidence is that your running did not cause your aorta problems.  These kinds of recurrent aortic problems are thought to be genetic.  Your aortic disease is something you were born with.  The only question about your running is how hard can you train now, as you are in the process of getting worked up for this new aortic problem, and you'll need to ask the doctor's advice on that.  Genetic research is being done on this stuff right now.  (Look up the GENTAC project.)  Aortic disease is an emerging area of medicine.

I happen to be in that lucky group of people with weak aortas.  I would have to say that anyone with a history of a dissection, AVR, ascending aorta graft, miscellaneous weak spots in the aorta, and now a 3.9cm aortic dilation is in the club, too.  Welcome.

I'm sorry that this new thing happened, but you can get through this one, too.  Use this time to make plans.  The next surgery may not be as bad as the first one.  You will have more time to plan and schedule it.  You are fit, which helps.  But any OHS means a good couple of months off from work, even under the best of circumstances.  I think you have enough time between now and your surgery to figure out how to manage it.  I wish you didn't have to, but things could be worse.   Good luck.
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