Dilated Aortic Root

I was recently diagnosed with having a dilated aortic root at 4.5cm.  Previous MRI said it was a dilated ascending thoracic aorta at 4.2cm.  I was also told I have aortic insufficiency.  I would like to know why two different descriptions and measurements?  Also, I have uncontrolled HBP (170/110) I try taking medication but I end up feeling sick.  When I don't take them I feel fine.  However for the past few months, I keep getting this burning kind of pain in my chest and shoulder/neck pain, accompanied by headache and nausea.  Anything I do around the house causes me to get lightheaded and very tired.  Is this all related? My stress test said something about ischemia.  I really don't understand all of this.  My legs and ankles get very swollen especially at night. I am very unruly and chances are I wont go back to see the cardiologist for a while.  Is this serious?

[kenkeith]

An aortic root greater than 4.0 cm is considered an aneurysm, and if and when it reaches 5.0 cm there begins an assessment whether to operate or not.  The risk is a rupture.  Marfan disorder is a connective tissue condition that often effects the aorta valve (bicuspid) as well as the ascending aorta. The difference for root and ascending aorta are two different locations.  The root is close to the valve and the ascending aorta follows.

For a perspective:
•5 cm in non-Marfan patient
•4.5 cm in Marfan or other connective tissue disorder (Ehlers-Danlos or bicuspid aortic disease with severe aortic insufficiency)

•5.0 to 5.5 cm is the accepted range presently, in an average risk patient with no connective tissue disorder
•4.5 to 5.0 cm when severe connective tissue disorder is present
•5.0 cm when chronic Type B dissection is present
•6.0 cm in a high risk, morbid patient

[nickppatel]

Time to get your unruliness in check.  You have serious problems.  You need to see your cardiologist, pronto.  

You have two different measurements but sometimes the "ascending aorta" can also be a synonym for the aortic root.  So, like kenkeith said, the tests may be talking about two different points, which would explain why measurements are different.  But they could be talking about the aortic root, and if that's the case, then a difference of 0.3cm is not a big difference between tests - normal variation.

Read some of my old posts by clicking on my screenname (about aortic root dilatation and ARB medication).  Hopefully you are not allergic to these drugs and they may be of some help to you in reducing the size of your aortic root without surgery.  If you want to know more from me, post a note to me.

[acer3times]

If surgery is needed for aortic stem dilation, is it oen chest as it was when my aortic valve was replaced?  Does the artificial valve aggravate the issue?

[skydnsr]

Yes, it is open chest surgery.  If the surgeon has to work on the area where the valve is seated, he almost certainly will put in a new valve as part of the operation.  But these are questions that relate to the surgical plan, and they really should be addressed to the surgeon.  Only he can tell you exactly how he plans to repair your aneurysm.  Good luck.