aortic root

[long]

I am in process of scheduling aortic root mra and have few questions about aortic root. 1. What's the normal (upper lmits) size of aortic root measured in greatest diameter by mra in a 5' 11" 52 year old male? 2. At what size does aortic root aneurysmal dilatation starts? 3. Is it possible to have aortic root measured in greatest diameter by mra over 4 cm and not have any evidence for aneurysmal dilatation?If yes how and would you explain? 4. Does phillips infinion mra underestimates or overestimates aortic root measurement compared to siemens mra and other imaging and are there different (aortic root) normal limits for each? 5.What's a normal ratio between aortic root (measured in greatest diameter) and ascending aorta? For instance if ascending aorta measures 2.9 to 3 cm in greatest diameter up to what (highest) number can aortic root measure and still be considered normal? 6.What are aortic root normal limits for former athletes and usually why do athletes and former athletes (soccer players) have enlarged aortic root if excesive and streneous exercise is good and healthy?Thank you

[Cleveland Clinic]

long,

The questions you ask are a little too specific to give exact answers.

1) The aortic root is measured at different places.  The radiologist/cardiologist that will interpret your scan will be able o give your measurements and if you lie in the range of normal. Generally, The mean normal value for the aortic root annulus in men is 2.6 cm and for the proximal ascending aorta 2.9 cm . The upper normal limit for the ascending aorta is 2.1 cm/m2. A value beyond 4 cm is regarded as an aneurysm, a lower value as ectasia. The normal value for the descending aorta is 1.6 cm/m2 for BSA, and aneurysm is present when a value of 3 cm is exceeded.

The aortic diameter gradually increases over time. The normal expansion rate over a period of about 10 years is between 1-2 mm and the expansion may be greater for patients with an aorta that is larger than normal

2) An anuerysm is usually defined by a dimension greater than 4 cm.

3) This number is the general cutoff. If defined on a reliable imaging modality with good images, I cant think of an alternative explanation.

4) No Idea.  There probably isnt a difference between the 2.

5) No idea.  The ratio we do sometimes refer to would be the ascending aorta and descending aorta.  The descending aorta is smaller then the ascending aorta because it contains less blood after the branches from the aorta that go to the head come off. The ratio of ascending to descending aorta should normally be about 3:2 but the descending aorta can become relatively larger with age in comparison to the ascending.

6) They are the same for the general population.

[Dave 1652]

Your situation sounds like my husbands'.  Ten years ago, an echo showed his aortic root at 4.7.  However, MRA's  showed it at 4.0. We found a lot of research saying that in athletes (because of thickened heart muscle), the echo reading will not be accurate.  For ten years, he thought he had Marfan, but now it is very likely a 4 cm aortic root is normal for him.  His descending is 2.5.  If yours is larger,  your normal root size is larger, too.  

Good luck.  There is really no way a Dr. can know what is normal for you.  Watch it, and if it doesn't get larger, you could be perfectly fine.

[long]

If descending aorta measures 2.5 cm would aortic root measuring 4 cm than be normal? If normal aortic root at annulus is 2.6 cm what would normal aortic root at sinus of valsalva be?At what size in cm would aortic root measured at sinus of valsalva be considered abnormal?Thank you

[Dave 1652]

No Dr. is ever going to tell you 4 cm is normal. If you look at your echo report, 3.7 is the high end of normal.  But, if you go to Google, or Alta Vista, you can find lots of research where cardiologists have varying opinions on what is normal.One report went up to 4.4!!  If you find research with Richard Devereaux's name on it, you can be sure he knows what he is talking about.  He was or is on the board of the Marfan group.  And, aorta's are the BIG thing with them.  

I know EXACTLY what you are going through.  We were going to go to Cleveland Clinic last summer to see someone who specialized in this.  But, a person would have to be God to know what really is normal for a person. Doctors have their general guidelines, but there are occasions where normal is above 3.7.  

Seriously, read the research and you will feel a whole lot better.  But, you will not really know until you have stayed at 4.0 for a long time with no change.  I'm no Dr., but I've been to numerous Marfan conferences while we thought my husband had Marfan.  He spent TEN years of his life thinking he had Marfan, when he just had a larger aorta than what most people have, but it is normal for him.

How old are you and how did you discover your aorta size??

[long]

I am 52 and echo showed aortic root to be enlarged at 3.9 cm,but it did not specify where (annulus,sinus of valsalva) this enlargement is.Where was 4 cm measured at? In your husband case echo overestimated aortic root by 0.7cm,but does echo uderestimates aortic root measurement? Which mra model was used to measure aortic root(ge,siemens,phillips) and does it uderestimates or overestimates? Where is worse to have aortic root enlagement at: annulus or sinus of valsalva?

[long]

If descending aorta measures 2.5 cm would aortic root measuring 4 cm than be normal? If normal aortic root at annulus is 2.6 cm what would normal aortic root at sinus of valsalva be?At what size in cm would aortic root measured at sinus of valsalva be considered abnormal?Thank you

[Dave 1652]

The mra reading is the gold standard.  An echo can be inaccurate.  It even depends on the angle the technician holds the wand at.  In my ten years with Marfan, I have never heard of a difference between Siemens and Phillips equipment.

If 3.7 is the high end of normal, 2cm more at age 52 is NOT that big of a deal.  If you do not have any characteristics of Marfan, or if aortic dilitation/dissection doesn't run in you family, I really believe you are worrying about nothing.  

If your valve is fine and you don't have symptoms, you are probably normal.  If you are concerned, have your Dr. put you on a low dose of beta blocker, to keep your BP low.  And, avoid heavy lifting.  If you have high blood pressure or use cocaine, this could also cause the aorta to enlarge.

My husband is 53 and has had the same measurement for over 10 years!!   If they are telling you the root is 3.9, that is where it is at the ascending aorta, on the way to the arch.  There, the high end normal number is 3.7.  You are very close---don't worry!!  I believe that part is valsalva.

This is when people should worry.....when it gets to 5.0!!   And even then, a few years back, they wouldn't consider doing surgery until 5.5-6cm.  You will be long gone before yours gets to that point!

[long]

On my echo report the normal limits for aortic root is written as 2.0 -- 3.7 cm. I do not know what would normal limits  be for (phillips infinion) mra next month. Are aortic root normal limits for above mra the same as for echo (2.0-3.7 cm)? If mra reading measurement turns out to be the same as echo reading,that is 3.9 cm, would than mra measurement of 3.9 cm be considered normal,ectasia,aneurysm etc(if a person has normal aortic valve without stenosis or regurgitation and a normal blood pressure)? BTW Would you please list the websites of the doctors that you mentioned before?Thank you

[Dave 1652]

Go to Medscape.  You will have to register.  Then, search "Interpretation of echocardiographic measurements".

[long]

Where can research with Richard Devereaux name be found?Thank you.

[smitty70]

Ok i had aortic heart valve replacement 12 yrs ago at the age of 24. I just went and had a echo cardio gram done and my doctor also sent me for a cat scan which is showing that i have a aorta aneurysum at the the aortic heart valve measuring 6.2? how serious is this? What are the risk factors of this kind of surgery?

[pbanders]

long, get regular MRA monitoring and see if it progresses - try NOT to obsess about it, which is a big issue with dilated aortas. Yours is still well below the accepted surgical threshold.

smitty70, if your ascending aorta is at 6.2 cm, according to everything I have read (I'm no doctor), you are at high risk for aortic dissection. I'm certain your cardiologist knows this and will advise you appropriately. If surgery is indicated, make certain you get a surgeon with a great deal of experience in aortic aneurysm repair. Cleveland Clinic is a good place to start.

[smitty70]

My cardiologist has me scheduled to meet with a specialist surgeon in this matter next week. From what i am being told by my cardiologist is that the aneurysm is at the aortic heart valve. It has been wrapped once when they done the aortic valve replacement 12 yrs ago. If it is very serious i wonder why the cardiologist didnt send me right away to the surgon? I am not sure how long it has been this way and i felt fine over the years and still do other that the occasional heart flutter. I just went to the cardiologist for a good check up and got all this bad news. Now i am scared to death.

[pbanders]

Hang in there, I know how you feel. I'm 49. In Jan '04 I went in for some minor arrhythmia issues. I was a bicycle racer for years and had no symptoms, even in 192 bpm sprints! Next thing I knew, a month later I was on the table getting my 5 cm ascending aortic aneurysm grafted. Good thing was I only worried about it for a month - if I'd had it caught when I was at 4.0 cm, I'd have been in the same situation as "long" here. I made a full recovery and while I haven't raced in years, I still ride my bike hard over 100 miles a week. Be glad they caught it before it dissected - unfortunately, most people never know they have a problem until they dissect.

[raj_malhotra]

A related discussion, Aortic Root was started.