enlarged aortic root

[kathy58]

Hi, I am 50 year old female, whose doctor noticed a heart mumur on reg. check up. md ordered echo which shows
ascending aortic diamenter above the sinotubular junction is 43mm. There is evidence of trace aortic insufficiency.
My doctor does not appear too worried. I have not seen a cardiologist or had a ct or mri. My doctor has me
have a echo yearly and my last one showed an increase . He has now started me on a beta blocker toprol 25mg daily even thought my hr is usually less than 60 and bp 110/60. He told me no weight lifting of any kind but states
i can do as much areobics as wanted. should i be seen by cardiologist and have ct or mri. when do i get worried about the size?  thanks

[nickppatel]

43mm=4.3cm>4.0cm.

[milo_1]

Kathy~What country do you live in. Usually in the U.S., the enlargement of an aortic root is given in centimeters.  Having said that, I recently (August this year) had ascending thoracic aneurysm surgery with a st jude valve implantation.  If they told you that you have an enlarged aortic root....that, translated is ANEURYSM.  If it is 4cms or larger, surgery is usually indicated if it is an ascending (on the way up to the aorta).  My comedian, I mean cardiologist (sarcasm intended) wrote me a LETTER telling me I had an "enlarged aortic root."  So what I thought, I knew I had surgery for a leaky valve in '97 and that I get echo's every year, so I thought, no big deal.  We moved, I lost track of the last echo and my last one was I think in 2006. That was when I got the aforementioned letter telling me about the "4cm aortic root."  THEY NEED TO START TELLING PEOPLE, IN ENGLISH, THAT THIS IS AN  A N E U R Y S M!!!  By the time I went for my 2008 echo, it had enlarged to 7 cm's!!!  I had surgery on Aug 29, 2008. The surgeon was world reknowned and thankfully, in network.  (JOHNS HOPKINS in BALTIMORE).  He said that was the largest he'd ever seen in a person still walking around!
Sorry for the rant, but to answer your question....YES YOU NEED AN ECHO, YES YOU SHOULD BE WORRIED IF THAT NUMBER YOU GAVE ME TRANSLATES INTO 4CM's or more!!!
Colleen
my story click here       www.medhelp.org/personal_pages/user/552012

[nickppatel]

THIS is the problem with most cardiologists today.  They routinely prescribe beta blockers for patients with aortic root dilatation, even though the most recent studies have shown that they DO NOT HELP YOU.  Beta blockers are prescribed because they make sense on paper, but in practice, they are absolutely useless.

These doctors are also grossly behind the times.  I don't know whether they are ignorant of the latest, big-news breakthroughs or just unwilling to try them.

Listen, you need to educate yourself on a class of drugs called angiotensin receptor blockers (ARB for short).  They include drugs such as losartan, irbesartan, valsartan, telmisartan, etc. (anything ending in "-sartan").  The most cutting-edge studies coming out of Johns Hopkins have shown that these drugs HALT and/or REVERSE aortic root dilatation.  It appears that a maximal dose is required.

Although you may or may not have Marfan syndrome, I strongly encourage you to visit www.marfanlife.net/bb3.  Find the forums that have discussed ARBs at length.  Then find a cardiologist who actually reads the New England Journal of Medicine and knows about the latest studies on ARBs, and how they outperform beta blockers in every way.  

It will save your life.

PS - I don't know your height and weight, but if you are the average-sized 50 year old female, I would already be worried about 43 mm above the sinotubular junction.

Also, if you need proof besides what you read on that website above, just do a google search for "losartan" and "enlarged aorta," or heck, check out the June 26 2008 issue of the New England Journal of Medicine.

[Darcy Green Conaway, MD]

You follow the size and the rate of change of the size. It varies on your body size also. At 43 cm it is likely that you can still follow it as you are doing.