Another Aneurysm

[srbolton]

about two years ago my dad, at 59 years old,  had a thoracic aortic aneurysm dissection. He was rushed into surgery, and the surgery was complicated. he went back to OR a few times. first there was clotting in the chest cavity that had to be cleaned out, then he had an embolism, and after being given heparin he began to bleed a lot, then ended up with a cardiac tamponade, followed by a major cerebellar stroke. He was kept on propofol for about 3 weeks and there was difficulty weening him off the ventilator. his entire time in ICU was about a month, with another month of inpatient rehab. He survived and actually has made quite a remarkable recovery, having now been back to work for over a year. Now, just a couple of weeks shy of his 2 year anniversary of the original surgery, a ct scan has shown another thoracic aortic aneurysm. I do not yet know the size of it or the doc's plan of action- we have an appointment on monday (which was moved up a couple of weeks because the doc wanted to get him in asap). I am just wondering how worried should I be? After how harrowing the first time was (dad was quite close to death numerous times and then was very dependent for several months) I am just having difficulty sleeping due to worry. I guess my real question is, how much of an indication is the first experience as to how this current situation is likely to go? I do understand that a dissecting aneurysm is quite a bit more extreme than just an aneurysm, but I'm guessing that the fact the doc called me personally, as dad's emergency contact, after trying to reach dad for a day and a half- I'm guessing that means it isn't small potatoes either.

[skydnsr]

The coughing and hoarseness are probably not related to this new aneurysm, then.  The pain might be, but it sounds like his doctor is on top of things.  I had chest pain prior to my thoracic aortic aneurysm repair, and I'm still here and am doing well.  I'll keep your dad in my thoughts.

[srbolton]

Thank you so much for your reply- this helps me to relax with it a bit. I don't know the size of it yet, but dad has been having some transient but severe chest pain. He is always hoarse & coughs a lot because the last time left him with a paralyzed vocal cord. The doctor sounded like he doesn't want to waste any time with it so i imagine we'll be looking at surgery pretty soon. We'll know more on monday, when we are scheduled to go in and meet with the cardiologist. Thanks again for your kind and informative answer! We are praying for the best.

[skydnsr]

Repairing an aneurysm before it dissects is nowhere near as risky as repairing a dissection.  The vast majority of people who dissect like your father did end up dying, unfortunately.  I have seen a 90% estimate of mortality for those who have an acute dissection outside of a hospital setting.  Your father is one of the lucky ones, especially with as complete a recovery as he has made.  This new aneurysm must come as really difficult news for all concerned, but it is a completely different situation.  With a good surgeon and a good team, the chances may be as high as 99% for surviving an "elective" thoracic aneurysm repair.  (I put the word elective in quotation marks, because it's not really like it's optional, but elective is the medical term for a surgery that is planned ahead of time.)  It's not small potatoes, but it's not anything like the previous experience that he had.  The urgency of this new situation depends on how large the new aneurysm is and whether your father is having pain or other symptoms.  If the aneurysm is very large (5cm in diameter or greater) or if your father has any symptoms (pain, hoarseness, cough, or really anything in the chest area), then the surgery does need to be done ASAP.  Even under those circumstances, his chances of surviving the procedure, having minimal complications, and making a full recovery are excellent.