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Aortic root dilatation 4,8
Hello, I am 35 years old (male) and I have had a repair of the coarctation of the aorta at the age of 3 and an aortic valve replacement at 22. Now I have been diagnosed with an aortic root aneurysm (4,8) and I would like to ask your opininon on when do you think a surgery should be done.
“The investigators found that creating a ratio between maximum aortic diameter and body surface area was more accurate at predicting adverse aortic events than maximum aortic diameter alone. Specifically, an Aortic Size Index of 2.75cm/m2 or greater conferred a yearly risk of 8% of the cumulative end point of rupture, dissection and confirmed aneurysm-related death.”
I just came across the above, according to which I am at danger for dissection since I am 5,8ft and 132lbs with max. diam. of my root aneurysm 4,8cm. That gives me an aortic size index of 2.79 cm/m2. What is your opinion about this?
Have you come across the following link: http://valleyheartandvascular.com/Thoracic-Aneurysm-Program/Calculate-Your-Relative-Aortic-Size.aspx
I just came across the above, according to which I am at danger for dissection since I am 5,8ft and 132lbs with max. diam. of my root aneurysm 4,8cm. That gives me an aortic size index of 2.79 cm/m2. What is your opinion about this?
Have you come across the following link: http://valleyheartandvascular.com/Thoracic-Aneurysm-Program/Calculate-Your-Relative-Aortic-Size.aspx
Back again. I think that when he says "we'll start thinking..." he means the team of the doctors involved in my case (consultants, surgeons). I am visiting the American Heart Institute and there things function through team work. However, my thoughts will be apprciated I beleive. To be honest I am completely neutral about the issue. I am ready to follow their suggestions.
Okay, let us know how things go. You can just come back to this thread, if you want to. If you post again on this same thread, it will be bumped up to the top, plus I will get an update email. If you can't find this thread at the time, you can start a new one.
It sounds like, when something gets to 5.0, your surgeon is going to take your wishes into account. So if you want to continue to postpone surgery, your surgeon will probably listen, and if you can't stand the suspense of just waiting, the surgeon will probably listen to that also. Your feelings won't be the only factor that he will be thinking about, but for him to say to you now that when it gets to 5.0 "we'll start thinking about what needs to be done," it sounds like you are going to be able to have some input into the decison.
It sounds like, when something gets to 5.0, your surgeon is going to take your wishes into account. So if you want to continue to postpone surgery, your surgeon will probably listen, and if you can't stand the suspense of just waiting, the surgeon will probably listen to that also. Your feelings won't be the only factor that he will be thinking about, but for him to say to you now that when it gets to 5.0 "we'll start thinking about what needs to be done," it sounds like you are going to be able to have some input into the decison.
Well, thank you for everything. I think that for the time being you have given me all the answers I was looking for. I will let you know how things are after my next follow-up in May. Take care.
If a blood vessel ruptures, that means that the vessel wall tears all the way through. If it ruptures where there is an aneursym, it can burst like a balloon. Naturally, blood will escape from the vessel at that point. So in case of a rupture, there is bleeding. Actually, with the aorta, ruptures are not usual. When disaster strikes the aorta, it is usually in the form of a dissection, which means a separation develops between the layers of the vessel wall. Either a rupture or a dissection is very bad.
No, I don't necessarily think it is worth trying to find your records from the 2000 operation. You asked a question about whether you had an aneurysm at that time, and I'm just saying that the only way to know would be to check those records and see if there was a CT done. However, if you have not seen a doctor in that country in many years, my guess is that the records no longer exist. In the US, medical records are usually destroyed after seven years unless the same doctor is still seeing the patient, in which case a continuous record will be maintained. The only reason to try to find those old records would be to satisfy your curiosity, so it's up to you.
Yes, the root and ascending aneurysm will be repaired at the same time.
When I mentioned that I had heard of people whose aneurysms stayed stable for many years, that was on another forum, and it has been quite a while since I read those posts, so I do not recall how many years it was that the people were reporting. In any case, your aneurysm is growing, so yours is not stable. Whether you consider that you have one aneurysm or two, the whole root and ascending is going to have to be fixed at the same time. The root and ascending are one continuous structure. In practical terms, you have one aneursym, and it does seem to be slowly growing. In fact, at the mid-ascending it is growing at just about the expected rate of 1 mm per year.
No, I don't necessarily think it is worth trying to find your records from the 2000 operation. You asked a question about whether you had an aneurysm at that time, and I'm just saying that the only way to know would be to check those records and see if there was a CT done. However, if you have not seen a doctor in that country in many years, my guess is that the records no longer exist. In the US, medical records are usually destroyed after seven years unless the same doctor is still seeing the patient, in which case a continuous record will be maintained. The only reason to try to find those old records would be to satisfy your curiosity, so it's up to you.
Yes, the root and ascending aneurysm will be repaired at the same time.
When I mentioned that I had heard of people whose aneurysms stayed stable for many years, that was on another forum, and it has been quite a while since I read those posts, so I do not recall how many years it was that the people were reporting. In any case, your aneurysm is growing, so yours is not stable. Whether you consider that you have one aneurysm or two, the whole root and ascending is going to have to be fixed at the same time. The root and ascending are one continuous structure. In practical terms, you have one aneursym, and it does seem to be slowly growing. In fact, at the mid-ascending it is growing at just about the expected rate of 1 mm per year.
My surgeon hasn’t told me clearly the number he’s looking for. Just that if we reach 5,0 we will then start thinking about what needs to be done, bearing in mind all the other factors of my situation (that is, I guess, my valve’s functioning, my repaired coarctation etc.).
In your answer regarding Coumadin you say “If the aneurysm should start bleeding, the coumadin will slow down clotting, and you will bleed more on coumadin than you would otherwise”. What does bleeding mean? Is it something different than rupturing?
Do you think it worth anything trying to find out whether a presurgical CT record still exists from my valve replacement operation on 2000? I had that operation in London by the surgeon of whom I was followed by until then. However after my operation, until now, I am being followed by a different surgeon here in my country. So, do you think it would help if I knew what was going on at that time?
Now, there’s another thing. Besides my 4,8 root I have also a mid-ascending aortic aneurysm. This one was not so “sleepy” as the other one! At 2007 it was 3,8 and now is 4.5cm. So, the question can they fix 2 aneurysms at one operation, or even more?
When you say “I have heard of people whose thoracic aortic aneurysms stayed "stable" for many years and then suddenly grew very fast”, what do you mean by “many years”?
In your answer regarding Coumadin you say “If the aneurysm should start bleeding, the coumadin will slow down clotting, and you will bleed more on coumadin than you would otherwise”. What does bleeding mean? Is it something different than rupturing?
Do you think it worth anything trying to find out whether a presurgical CT record still exists from my valve replacement operation on 2000? I had that operation in London by the surgeon of whom I was followed by until then. However after my operation, until now, I am being followed by a different surgeon here in my country. So, do you think it would help if I knew what was going on at that time?
Now, there’s another thing. Besides my 4,8 root I have also a mid-ascending aortic aneurysm. This one was not so “sleepy” as the other one! At 2007 it was 3,8 and now is 4.5cm. So, the question can they fix 2 aneurysms at one operation, or even more?
When you say “I have heard of people whose thoracic aortic aneurysms stayed "stable" for many years and then suddenly grew very fast”, what do you mean by “many years”?
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If your doctors are telling you to wait to have the aneurysm repaired, it's because, in their judgment, the risk of surgery is not yet justified. They have data about the risks of different courses of action. The data that they use has been derived from the outcomes of many, many patients over the years. Again, the doctors' strategy is to wait until the risk of doing surgery is less than the risk of not doing surgery. Their judgment in most cases is that, at 4.8, it is still riskier to operate than it is to do nothing.
Thoracic aortic aneurysm repair is a very complex operation in which a small but significant number of people will either die or have life-changing comlications such as a stroke. You don't want to take that risk until you absolutely have to. If the aneurysm should start to grow faster than expected, the odds change. If you should start to have chest pain that is thought to be related to the aneursym, the odds change.
I'm sorry you have this aneurysm, and I do know what it feels like to get this news. When I was told I had an aortic aneurysm, my only thought was, "get it out." But if your doctors are telling you to wait until 5.0 or even 5.5, you are getting standard advice. If you have not yet talked to a surgeon, it would be fine to go ahead and do that, just to get the additional imput.
While you are "in the waiting room" for surgery, it is important to control blood pressure, because hypertension puts excessive stress on the vessel walls. It's important to keep your monitoring appointments, so you know what is up with the aneurysm. It's also important, and perhaps this is even the most important thing, to find a way to keep calm and be peaceful and enjoy your life.
Post again, any time you want. I will be thinking about you.