enlarged aortic root

I just received the results of a CT scan which shows my aortic root measuring 4.7 cm.  I am going to follow up with a specialist, but I do have a few questions.
1.)  Does it matter where in the aortic root the enlargement is present?
2.)  Is the 5.0 cm guideline for recommending surgery for everybody?  (For instance, I am 42 years old, 6'2'', 200 lbs, non-smoker in otherwise good health.)
3.)  Are beta-blockers often prescribed right away as a precaution?

Thank you for your time.

brian5231  

[nickppatel]

1) It makes some degree of difference.  If your annulus is severely dilated, your valve might not close properly and you might have aortic regurgitation or insufficiency.  If your sinus of valsalva is dilated, then you might not.

2) 5.0 for "normal" people; 4.5 for people with connective tissue disease.  If you are 42 and have an aneurysm, I would guess that you have a connective tissue problem.  The likelihood of success in pre-emptive surgery is great.

3) They can be, but many studies show ARBs or ARBs + beta blockers to be more helpful than beta blockers alone.  It is possible that if you go on an exceptionally high dose of ARB (such as candesartan or telmisartan - and for someone your size, we are talking about 2-4 times the maximum FDA-approved dose), your aortic root might shrink dramatically and you might avoid the need for surgery altogether.  I would recommend that you seek out evaluation from a cardiologist who is very knowledgeable about ARB research (it is new).  You might contact Hal Dietz at Johns Hopkins or John Elefteriades as a start for suggestions.

Either way, I believe your prospects to be good if you follow up aggressively.

Jesus bless you.
Nick