Slightly Enlarged Aortic Root

[chris]

An echocardiogram revealed that I have a slightly enlarged Aortic root. The doctor said it is "4.2"cm in size. What does this mean? Are there symptoms associated with this? At what rate will it grow? Does it ever get smaller? How? What are my options? Where can I get more information? I am a 42 year old male in good health and have no symptoms that I know of.  Is this related to pulmonary sarcoidosis? Thanks for the help.

Chris Daniels
1762 Whitehaven RD.
PO Box 1212
Grand Island, NY
14072
716 773-6983 Home
716 278-5233 Work

[Cleveland Clinic, MD]

The aortic root is the portion of the aorta just above the heart.  It is normally 2-3 cm.  Surgery is usually considered at about 5cm but possibly before if it is enlarging.  The only way to know if it is enlarging is to follow with serial echos usually 6 mo to a year apart.  There are no associated symptoms and it is not related to pulmonary sarcoidosis.  Where is Grand Island NY?

[ed]

The way I understand is that aorta can be measured in various places along its course like at leaflet level and above. What I don't understand is where would aortic root be(located),at leaflets level at aortic arch..where?Are the normal limits(2.0-3.7cm) the same for aorta(at leaflets), aortic root, ascending and descending aorta?If not what would the normal limits be in an middle age male adult?Thank you.Ed

[Cleveland Clinic, MD]

You are correct that measurements are made at at different locations.  There is some variability but most lay within 2 - 3.7 cm in diameter.

[ed]

Where would aortic root be (located), at leaflet level.. aortic arch...where?You said aortic root is normally 2-3cm.What about if there is a change (up) in aorta and aortic root size from 2.9cm to 3.3cm in a year time,would the increase of .4cm in a year be normal or significant enlargement?Thank you.Ed

[Geo]

If aortic root enlargement or dialation is caused by infections.....can aorta or aortic root infections be seen on an echo.....if not on what tests can it be seen ekg,mri.....how can it be known if aortic root is enlarging because of infections,high blood pressure,heart disease etc.Thank you.Geo

[Cleveland Clinic, MD]

Infections usually cannot be visualized on echo and require blood cultures to detect.

[chris]

Thank you for your responses.  My first echo was done in March 1999 because I was having slight interment dull pain and discomfort in my chest. (the conclusion seems to be that the chest discomfort is of a muscular / skelton nature???) That report said the size was 4.1. The doctor who issued the report never called me to say that this could be a problem.

A follow up echo in October of 1999, with a different doctor showed the the size to be 4.3. He recommends that I have a scan of the chest, which I will be having. He says that this will serve as a base line. He also says that the scan is more accurate that the echo.

The whole thing makes me nervous. Especially when you look up these things on the internet and all I can find is Marfan Syndrome. Could this be Marfan Syndrome?

If I never had any discomfort in my chest, I would have never know about this slightly enlarged aortic root condition. How would I ever have of found out about it? How fast does the aortic root grow?  If it became a problem, would it just burst and I would die? Are there any early warning signs before it bursts?

If  I do have to have surgery, what does it consist of and what are the chances of survival and leading a normal life?

I have attached the echo reports for your review. Thanks for the help.

Who ever was interested in Grand Island……. it is a large island in the Niagara river between Buffalo, Niagara Falls, NY and Canada (between Lake Erie and Lake Ontario). Thank you for your help.


Chris

March 1999

MEASUREMENTS: I NORMAL
        IVSd    10      mm 6.0-11 mm
        LVIDd 5.0     cm 3.7-5.7 cm
        LVPWd   10      mm 5.0-13 mm
LAd 3.0 cm 2.0-3.7cm
ACS 1.7 cm
AOd 4.1 cm 2.5-4.0cm


CONCLUSION : Nornml left ventricular internal dimension. Normal left ventricular wall thickness. Normal size left atrium. Upper normal to slightly increased aortic root size (when ~ absolute size corrected for increased body surface area). No pericardial effusion. Two dimensional echocardiography shows normal left ventricular internal dimension/wall thickness.  Normal estimated ejection fraction (LVEF 50-55%). Mild distal/basal septal, basal inferior and distal posterolateral hypokinesis.  Normal RV size and contractility. Normal size left atrium. No pericardial effusion/thickening.

SUMMARY: Normal left ventricular systolic function. Left ventricular wall motion abnormality (see above). Upper normal to slightly increased root size s above. No pericardial effusion /  thickening. Normal color flow and doppler exam except for notation of pulmonary regurgitation.



*****************************************************************
October 1999

ECHOCARDIOGRAM REPORT
        Measurements:                 Normal Range:
Left ventricle:   4.8 cm diastole 3.5 — 5.7 cm
  2.8 cm systole 2.3 — 3.9 cm
LV wall thickness:0.9 cm         0.6 — 1.1 cm
IVS thickness   1.0 cm         0.6—1.1 cm
Ejection fraction:55-60 %         55 — 70%
E wave:           8.7 M/sec         0.70 — 1.00 M/sec
A wave:           6.3 M/sec         0.48 — 0.70 M/sec
IV relaxation time:70 msec         60 - 109 msec
Deceleration time:240 msec         151 - 239 msec

Right ventricle:  NL                 2.6 — 4.3 cm
RV wall thickness:cm                 0.3 — 0.6 cm
Left atrium:   3 4 cm         1.9 — 4.0 cm
Right atiium:   NL                 3.0 — 4.6 cm
Aorta:           4.3 cm         2.0 — 3.7 cm
Pulmonary artery:25 mmHg systolic 20 - 35 mmHg

Chambers:

Left ventricle: The left ventricle is normal size and function. No definite segmental ventricular wall motion abnormalities identified.

Right ventricle: Normal size and function. Right ventricular pressure 25 mmHg.

Left atrium: Normal.

Right atiium: Normal.

Valves:

Aortic valve: Mild degenerative change; normal motion pattern.

Mitral valve: Mild degenerative change; normal motion pattern.

Pulmonic valve: Normal.

Tricuspid valve: Normal.

Great Vessels. Pericardium & Miscellaneous:

Aorta: Prominent super valvular aorta. No definite abnormal intraaortic cusp was identified.


Pericardium: No effusion noted.

Miscellaneous:

CONCLUSION:

1. Normal left ventricular systolic function with no definite segmental left ventricular wall motion abnormality identified. The estimated LVEF 55-60%.

2. The aortic valve show mitral degenerative change of mild degree associated with mitral regurgitation mild degree by Doppler criteria.

3. Tricuspid regurgitation with associated normal right ventricular systolic pressure.

4. Pulmonic insufficiency by Doppler criteria.

5. Enlargement of the ascending thoracic aorta. No definite abnormal intraaortic cusp was (echoes) identified.

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