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Avatar universal

Enlarged Aorta

37 years old, 6'6" tall, 220lbs, no history of heart problems.
I've been going through quite a few tests to rule out Marfan Syndrome. It has been 3 years of tests and I haven't recieved a definitive answer on Marfan!
My doctor at Yale Medical Center put me through fifth ECG and noticed what appeared to be a "bulge" on aortic arch. This bulge was never picked up on previous ECG's or CT scans. He wanted to get a more definitive image of bulge so MRA was ordered. MRA results:
-heart normal in size
-great vessels origin unremarkable
-aorta measured: aortic root 3.8cm,ascending aorta at level of right pulmonary artery 3.7cm,descending aorta at level of left pulmonary artery 2.2cm and descending aorta at level of diaphragmatic crus 1.5cm.
Aortic root is minimally ectatic. No evidence of aneurysmal dilatation seen in remainder of ascending aorta, aortic arch or descending thoracic aorta. No evidence of aortic dissection.

My doctor then ordered an aortogram to get a definitive image of the aortic arch.  I had that done Thursday and preliminary results:
-slightly generous proportions at end of ascending aorta.  No evidence of aneurysm or artherosclerotic disease.
The interventional cardioligist asked me if I wanted hime to "shoot coronaries" while in there, I said no.

1)CT scan measured as high as 4.5cm in ascending aorta. Why is MRA so different?
2)Is ascending aorta normally this large compared to descending?
3)Should I've had coronaries imaged?
4)Femostop used for femoral closure. Is brusing around site and base of scrotum normal?
5)Do I have Marfan?
Thank you!
30 Responses
74076 tn?1189759432
Hi Bob,

Sorry to about your medical concerns.  Marfan's can be a tough diagnosis to make.

1. CT scan measured as high as 4.5cm in ascending aorta. Why is MRA so different?

I can't give you a good answer for this.  They should read about the same.

2)Is ascending aorta normally this large compared to descending?
It sounds like your ascending aorta is a bit large.  They usually are not that different.

3)Should I've had coronaries imaged?
I wouldn't have.  If you ever need your aorta replaced, you will likely need to have your coronaries imaged, but you are not there yet and it is hard to say if you will ever need it replaced.

4)Femostop used for femoral closure. Is brusing around site and base of scrotum normal?
No it isn't normal to have bruising around your scrotum.  there must have been some bleeding but if it is not getting larger it should not be a concern.  It may expand a little and turn a greenish-blue color, this is normal.

5. I can't answer this one.  This is a tough questions and would require a thorough history and physical with test review, but even then it sounds like you are borderline at most.

I hope this helps and good luck.
Avatar universal
Bob, glad to see that the MRA provided you with good news. You will need to have your aorta monitored to make sure that the dilation does not progress to dangerous levels. Talk to your cardiologist about how often he wants follow-up MRA's. CT's expose you to a considerable amount of X-radiation that the MRA's avoid.
Avatar universal
Thanks for your concerns and comments pbanders.

Did you have your aorta monitored with the MRI or ECG?  I not only had the MRI completed, I also had an aortogram last week.  I still have bruises from some blood loss but the procedure was fairly quick and simple.  I haven't heard back from my cardiologist as to how I will be monitored.  I am hoping it will be with the MRI because the invasive approach of the aortogram(angiogram) is not my first choice.
The interventional cardiologist who did the aortogram Thursday commented on the initial report that there were no aneurysms and no artheroscerotic disease present but that the end of the ascending aorta had "slightly generous proportions".  I have seen this "larger" measurement in this area of the aorta three years ago on a CT scan.  It doesn't appear to have gotten larger over three years but I have not received a final report for the aortogram which I assume will have measurements of this area.  Have you ever had an aortogram done for your aortic root?

Thanks again!

~Bob
Avatar universal
Bob and everyone Do you know what are normal ranges in cm for aortic root,ascending and descending thoracic aorta in average middle age men by mri/mra?What iv contrast was injected during mri/mra test and how did it feel,any allergy?Was your aorta imaging done as heart mri/mra or as chest mri/mra?Thanks
Avatar universal
I've been trying to post a question for quite some time, however when I heard of this situation I just wanted to provide some feedback.  My condition is like yours, I have an enlarged Aortic valve and arch.  My valve is at 4.5 and my arch is at 5.2, I have been told that I have to have my aortic valve and part of the arch replaced.  I am 39 years old and quite active, needless to say that has come to a halt.  I hope you find out what's going on because I'm going stir crazy and I just found out my situation 3 weeks ago.
Avatar universal
I'm due for my first follow-up MRA on 2/1, so I'll post again in the comments to this question and let you know what type of contrast was used, if any.

As for "normal" sizes, your cardiologist should be your first source for that information. In my case, a 5.0 cm dilation of my ascending aorta by CT w/contrast was sufficient to warrant surgery.
Avatar universal
My situation is very similar to yours, TKK.  I am a very active and otherwise healthy 42 year old and I was diagnosed with a 4.7cm or 4.8 cm ascending aortic aneurysm about 4 weeks ago along with a moderately leaky (but not enlarged) "pseudo-bicuspid" aortic valve.  I have had a consultation with one surgeon and am in the process of setting up a consultation with a genetic counselor as well as a second opinion with a surgeon.  I too am going crazy--spending lots of time researching online and as little time as possible imagining symptoms and worrying about whether I should lift that 20lb. bucket of kitty litter.  I am still running 3 miles a day, 5 days a week.  What is your plan for surgery, TKK?
Avatar universal
I am supposed to have thoracic aorta imaged by mri/mra but don't know how it is done. For better accuracy should person stop all aerobic exercise for at least 2-3 weeks prior mri/mra test?Are pulmonary arteries and veins also imaged and measured with thoracic aorta?Thanks
Avatar universal
Your situation sounds similar to mine of last year, when I found out by chance that my ascending aorta was dilated to 5.0 cm. I am 46 and very active, so I know just how you feel, it's a real shocker, as there are no symptoms from this condition - until it eventually dissects, which is an extremely serious condition.

In non-Marfan's patients, dilation of the ascending aorta and/or arch of over 5.0 cm is usually the point where surgery is indicated. Your situation is more complicated than mine in that you are being told that your valve needs replacement, in my case, it did not. Because your arch is involved, there are additional complications, but great progress has been made in recent years with this surgery that minimizes complications.

I would strongly suggest that you contact a leading institution for a consultation if you haven't already. The Cleveland Clinic would be a good bet. I had my surgery done in CA and I was extremely pleased with my surgeon and my care. If you want details on my surgical experience, you can find it and contact information for me at http://members.rennlist.com/pbanders/heart.htm .

It will be a year next month since I had my surgery. I have a fully active life and in general, cannot tell I ever had the surgery. The beta blockers I'm on take a bit of the edge off of my aerobic performance, and I am not supposed to lift very heavy weights, but other than that, I'm the same as I was before. My long-term prognosis is also excellent. The odds are that you'll come out of this just fine, too.
Avatar universal
In response to "pbanders" and "pjmomrunner" I was told by my cardiologist and surgeon that surgery should take place soon.  That scared me to death, so I personally took my recoprds to Cleveland Clinc and I'm waiting for the Doctors to review my chart and schedule my appointment and surgery.  I was told by my local surgeon not to do any weight-lifting or running.  I guess by doing all of my research on the web I'm still a little confused as to how serious my situation really is.  From my understanding, my regurgitation on a level of 1-5 is 4.5.  Let me know your thoughts.
Avatar universal
Hey, TKK, I truly DO understand how you are feeling.  My understanding is that standards for operating on the ascending aorta vary some, but not much.  Most seem to operate at either 5cm or 5.5cm, although I have seen criteria beyond both ends of that spectrum.  Valve leakiness is usually measured on a scale of one to six (I to VI, actually).  Mine is a II or III.  My understanding is that the leakier one's aortic valve is, the harder the left ventrical has to work to keep up with both the volume coming into it from the left atrium and the volume being spit back into it from the leaky valve.  This work overload causes enlargement of the ventrical which will eventually lead to heart failure if left untreated.  I believe that determining when to operate on the valve is also tied to one's symptoms--shortness of breath, dizziness, fainting.  At my level of leakiness I have no symptoms and "no significant enlargement" of the ventrical, so my surgery is driven soley by the size of my anyeurism, although both issues will be addressed at the same time.  I would welcome talking with you directly if you are interested.  It's somehow comforting to find someone else in this same little boat!  ***@****
Avatar universal
I have been going through tests to rule out Marfan Syndrome for three years now and still do not have a definitive answer.  I have had 2 CT scans, 6 echocardiograms(at rest and stress), a 24 hour holter, nucleur stress test and just last week an aortogram(angiogram).
The MRA and then the aortogram were ordered by my doctor because he noticed what appeared to be a "bulge" on my aortic arch.  The MRA did not confirm the bulge and neither did the aortogram.  Both tests did note that the end of the ascending aorta, which I assume is the beginning of the aortic arch, was slightly larger than average.  I am hoping once my doctor reviews the aortogram images that he will say the "slightly larger" area is due to my height and weight which is far above average too.  I am 37 years old, 6'6" tall and weigh 220lb.  The results from the 2 CT scans that I have had gave measurements around 4.5cm in the area of the end of the ascending aorta.  The MRA and aortogram did not record a measurement above 3.7 cm in this area.  The aortic root was 3.8cm which has remained this size over the past three years from ECG's, CT scans and the MRA.  My doctor explained to me that the CT scan is not an accurate means of measuring the ascending aorta because the ascending aorta comes off of the heart at an angle unlike the descending aorta which runs axially through the body.  The CT scan captures images that are perpendicular "slices" of the aorta.  Imagine cutting off your neck and look straight down into the aorta.  This would cause an elliptical shape/measurement of the ascending aorta which would result in a larger measurement.  I, like pbanders, am a design engineer and have been over analyzing this too.  I will keep you posted on the final results of my aortogram.  Sorry if I was so long-winded here.

Good luck.

~Bob
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