Aortic Dilation

[KLB32]

I am being evaluated for possible Ehlers Danlos or Marfan's.

I have had 3 echos in the past 3 years (2005, May of this year and one just a few days ago).  I am told the one I just had was abnormal.  

Below are the values that I am told are abnormal:

Aortic Root (M-Mode):  3.4cm
Aortic Root (2-D):  3.54cm
Sinotubular junction:  2.76cm
Ascending Aorta:  2.64cm

*The report states that there is a dilated aortic root, sinotubular junction and ascending aorta.  It says the rest of my heart is structurally normal.

It also says I have Trivial Mitral Regurgitation.

I am a 33 year old female ,121 lbs,  5' 7.5", don't smoke.

I can't find anywhere on the internet that provides normal values for the
sinotubular junction and ascending aorta.  From two past echo reports, I have
values for the aortic root but not the other two.  Both reports say an aortic
root is normal all the way up to 3.7 cm so I am not sure why I am now told 3.4
is abnormal. I am also not sure which aortic root measurement is accurate since it was given in both M-Mode and 2-D.

My echo from 2005 says my Aortic root is 3.3cm.  The one from May of this year has it measured at 2.6.

I have suffered from dizzy spells and palpitations for about 3 years now. I was
told back in May that I likely suffered from Neurocardiogenic Syncope after an
echo, nuclear stress test and Holter came back normal.   I was taking Lisinopril
for HBP but just switched yesterday at my doctor's recommendation to Toprol XL
25 mg (generic form).

Do you think these measurements are abnormal?  I am starting to think perhaps they compared the recent test with the one I had back in May where it was measured at 2.6 and that's why they are saying it's enlarged.  I didn't provide them with the 2005 report but will when I see the cardiologist next month.  

I am really concerned about this since my maternal grandfather died at my age of an aneursym.  He was a heavy smoker, though.

Can you offer any opinions?  Thanks!

[healingheart]

I am not sure of all the measurements you gave, however it has been suggested me me that I may have Marfan's. The surgeons recently replaced my aortic valve and ascending aorta when the ascending aortic aneursym reached the size of 5.0.

I hope this helps a little bit.

[nickppatel]

Just my opinion, I'm not a doctor, don't follow my advice without talking to a doctor, etc. etc. etc...

I would throw out the 2.6 measurement. It seems off from the other three (including M-mode). M-mode is generally less accurate than 2-d. Your aortic root is probably around 3.3-3.5. There's a +/- 2mm margin of error with echocardiograms.

I'm surprised your doctor took you off of the ACEi. Recent studies have shown perindopril to be powerful in controlling and even reversing aortic root dilatation. Beta blockers ARE the current gold standard for aortic root dilatation, but that is almost certainly about to change -- it will become either ARBs, ACEis or some combination of the two. Look up perindopril and losartan and then talk to your cardiologist about which meds are best. Find a doc that is up-to-date on the latest research. That's most important.

[Cleveland Clinic]

Anything greater than 3.5 for aortic root is considered abnormal so you barely made that cut-off for barely abnormal.  Your ascending aorta is normal.  Now, keep in mind that these measurements are not always done the right way and often times they are taken off axis.  This may be the reason why there is so much fluctuation in the measurements.  The other imprtant thing to keep in mind is that it is not always the size but more so the progression of dilation.  So if there is a large change in the diameter over a period of, lets say, 12 months, then that is also concerning.  The problem is that when these measurements are not compared in the identical axis, then of course, that can lead to error and unneccessary consequences.  My advice to you is to go see someone more experienced who will sit down, look at everything and make some sense out of it.  Bring your old studies, the actual films because the doctors can often take their own measurements in the right views.  Either way, even in the worst case scenario, there is no need for any invasive procedures or surgery at this point.