Ascending aorta aneurysm?

[Alexa1978]

I need to know what is the normal diameter for an ascending aorta for a 55 yera old female, 5'0 height, small frame and weight between 115 & 125 pounds. She has a high blood pressure history and recently studies showed that her ascending aorta diameters were between 3.8 cm to 3.9 cm. She also has a family history of coronary disease. At the moment the patient is going through a really stressful situation. Does she has an aneurysm? Is she in risk? What are the recommendations in situations like this?

Thank you....

[chezza22]

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[premkrip]

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[cardiacjohn]

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[cbarker]

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[KARSAN]

I AM A 49 YEAR OLD FEMALE AND JUST DIAGNOSED WITH A 4.0 CM ASCENDING AORTA DILATION. TWO YEARS AGO MY MOM(74) HAD A 7.0 CM ASCENDING AORTA ANEURYSM AND WAS OPERATED ON AT CORNELL HOSPITAL, SHE IS DOING GREAT. (MY MONS DAD DIED AT AGE 52 FROM A ANEURYSM.) BECAUSE OF OUR FINDINGS, OUR DOCTOR WANTS TO CHECK BOTH MY SISTER(50) AND BROTHER(47) FOR THE SAME.  TO DATE MY SISTER JUST FOUND OUT THAT SHE ALSO HAS A 3.6 CM DILATION AND WE ARE STILL WAITING ON MY BROTHERS CT W/ CONTRAST RESULTS. I ALSO HAD A ECHO CARDIOGRAM AND WAS TOLD THAT I HAVE MILD LEAKAGE IN MY VALVES.  MY CHOLESTEROL IS 247 BUT MY LDL WAS 171 WAY TO HIGH.  I AM NOW ON VYTORIN 10/20 AND MY BLOOD PRESSER IS PERFECT AND ALWAYS WAS 110/70.

I HAVE A FEW QUESTIONS-

1. I STARTED EXERCISING REGULARLY SINCE SEPTEMBER 2006-
   AT LEAST 7 DAYS A WEEK- I DO EVERY OTHER DAY 60 MIN
   ON THE TREADMILL ALTERNATING 35 MIN CARDIO AND WEIGHT
   MACHINES. IS THIS DOING TO MUCH?

2. MY DOCTOR SAYS THAT OPERATING IS NOT DONE UNTILL THE
   ANEURYSM IS AT 5.0 CM. WHY IF THE END RESULTS IS
   SURGERY? ALSO CAN THEY DILATE AGAIN?

3. IS THIS A COINCIDENCE? WE ALL HAVE CHILDREN- FROM
   AGES 21 TO 3 SHOULD THEY ALSO BE CHECKED AND AT
   WHAT AGE?  

THANK YOU- FOR YOUR HELP

KARSAN

  
  

[pbanders]

Bob, good to hear from you, I'm doing fine, just had my yearly MRA yesterday. I think it would be highly unlikely for you to progress in two years to a full-blown aneurysm, but if you have any doubts, you should meet with your cardiologist and get a new MRA. I've not heard anything about the kind of throat symptoms you describe as being indicators of an aneurysm in the arch. Let me know what you end up doing.

[bob_sixsix]

PBanders,

How are you?

I am due for a two year follow-up exam for my aorta.  If you remember, we spoke a couple of years ago about a possible aneurysm on my aortic arch.  I had an aorta-gram, MRI w/contrast and multiple echocardiograms performed and all have shown that the ascending aorta is slightly larger than average.  The aorta-gram was to rule out what a "shadow" on the aortic arch noticed on an echocardiogram which was thought to be a "bulge" or aneurysm.  The aortagram was negative two years ago.  I have been having a pulsating feeling deep in the back of my throat that has been keeping me awake nights.  It comes and goes and my voice gets hoarse very easily because the muscles in my throat seem very weak.  These symptoms sound like an aortic arch aneurysm to me.  I respect your opinion because you have been through an aortic root/valve replacement.

Thanks for any info.

~Bob

[CCF-M.D.-MJM]

Hello,



Does she has an aneurysm?

1) The aortic root is measured at different places. The radiologist/cardiologist that will interpret your scan will be able to give your measurements and if you lie in the range of normal.  Keep in mind that normal values may slightly vary between different labs.  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 . A value beyond 4 cm is regarded as an aneurysm, a lower value as ectasia. The upper normal limit for the ascending aorta is 2.1 cm/m2. A calculation using the parameters you gave me above is 2.48 cm/m2.  My guess is the reason you have questions is because the measurements are boarderline for an aneurysm.  This is where you start seeing that medicine is not black or white, often having shades of gray.

Is she in risk?

She is at higher risk than someone with a normal sized aorta and lower risk than someone with a larger aorta.

What are the recommendations in situations like this?

Controlling blood pressure is the always the first step.  There should be a work up to determine possible causes for why it is enlarged.  If it is decided that she needs surgery, she will need a cardiac cath to make sure she does not have any blockages in her arteries.  If she does need surgery, an experienced center is always best.

I hope this answers your questions.  Thanks for posting.

[Alexa1978]

The patient is my mother. Im really worried.

[pbanders]

She should get that information from either her cardiologist or from her PCP. What she wants to know is what her "Z score" is - how many standard deviations from norm her aorta is, and what course of treatment the cardiologist recommends. Generally, for a moderately to mildly dilitated aorta, she will be put on a beta blocker to reduce peak arterial stresses, and she will be monitored for progression (by either CT with contrast or by MRA). In most cases, the surgical threshold is about 5.0 cm. She should also find out how her aortic valve is doing, if there is significant regurgitation, or if she has a bicuspid aortic valve (often associated with ascending aortic aneurysm).

Be glad that she's aware she has this condition and that it is under treatment and monitoring. Most people with aortic aneurysms never know they have a problem until it dissects, which is often fatal and has a much poorer prognosis for those that survive. The surgery is much better for this condition than it was 20 years ago, and once repaired, she should have an excellent prognosis.