Aa
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!
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!
I was recently diagnosed with an Aortic aneurisym at 4.5 cm with a leaky valve. I am very athletic 35 years old and over the past 3-4 months have been experiencing quite a bit of pain starting in the front upper part of my chest and radiating around the back, get tired very easily. Monday and I am having a stress test and being sent straight to the thoracic surgeon. Do you think they will operate on me...the diagnosis has been confirmed by a CT scan and echo. Thanks for any advice.
The ECG was my mistake of calling an echocardiogram and ECG - sorry for the confusion.
As far as the "shadow" - I never asked or my doctor never gave me a measurement for the "shadow". He did look into it more closely by ordering the MRA and then the aortogram. Neither of these tests showed this "shadow". My doctor, actually surgeon, is the Chief of Thoracic Surgery at Yale Medical Center in New Haven. He really is one of the best around for aortic complications. He explained that many other medical centers contact his facility for advice and data concerning the aorta.
I work for a medical company that produces medical instruments for surgery and I get out to different medical centers to see a variety of procedures. I met this surgeon and watched him perform heart valve replacements and ascending aortic graft procedures. I really do trust him and his diagnosis.
As I posted earlier - My doctor explained that the CT scan w/contrast is not exactly the best method of measuring the ascending aorta. It is good for aortic root and the descending aorta measurements because these areas of the aorta run axially through your body. The images captured from the CT scan, if you can imagine, are "slices". These slices are as if you were to, excuse the graphic visual, cut-off your head and look down into your body cavity. Therefore the aortic root and the descending aorta will give you an accurate measurement because you are "looking" straight through them. The ascending aorta and the aortic arch are not situated axially through the body and will give you an "elliptical" type cross section which will produce an inaccurate measurement.
My doctor explained that they don't only look at the size of the aorta they also monitor the expansion rate of the area in question. The aorta normally does and will expand over time. Your doctor should monitor the expansion rate as well as the condition of the aorta. If it is not expanding at an abnormal rate (I am not sure on the expansion rate value) then it might not be a problem.
One thing that I have found working in this field is that no two bodies are the same. There is so much variation from person to person that each case should be treated on an individual basis.
My aortic root measured 3.8cm three years ago and it still measures 3.8cm. The ascending aorta at the beginning of the aortic arch has measured around 4.0cm for that same time period. My doctor didn't have an explanation for that "shadow" that was seen on the echocardiogram but feels confident that there isn't a problem after the aortogram, which does give the most definitive images/measurements. He told me to schedule an echocardiogram in two years and to get back to playing basketball and enjoying life.
What exactly is your diagnosis? What are your physical characteristics? How old are you?
As far as the "shadow" - I never asked or my doctor never gave me a measurement for the "shadow". He did look into it more closely by ordering the MRA and then the aortogram. Neither of these tests showed this "shadow". My doctor, actually surgeon, is the Chief of Thoracic Surgery at Yale Medical Center in New Haven. He really is one of the best around for aortic complications. He explained that many other medical centers contact his facility for advice and data concerning the aorta.
I work for a medical company that produces medical instruments for surgery and I get out to different medical centers to see a variety of procedures. I met this surgeon and watched him perform heart valve replacements and ascending aortic graft procedures. I really do trust him and his diagnosis.
As I posted earlier - My doctor explained that the CT scan w/contrast is not exactly the best method of measuring the ascending aorta. It is good for aortic root and the descending aorta measurements because these areas of the aorta run axially through your body. The images captured from the CT scan, if you can imagine, are "slices". These slices are as if you were to, excuse the graphic visual, cut-off your head and look down into your body cavity. Therefore the aortic root and the descending aorta will give you an accurate measurement because you are "looking" straight through them. The ascending aorta and the aortic arch are not situated axially through the body and will give you an "elliptical" type cross section which will produce an inaccurate measurement.
My doctor explained that they don't only look at the size of the aorta they also monitor the expansion rate of the area in question. The aorta normally does and will expand over time. Your doctor should monitor the expansion rate as well as the condition of the aorta. If it is not expanding at an abnormal rate (I am not sure on the expansion rate value) then it might not be a problem.
One thing that I have found working in this field is that no two bodies are the same. There is so much variation from person to person that each case should be treated on an individual basis.
My aortic root measured 3.8cm three years ago and it still measures 3.8cm. The ascending aorta at the beginning of the aortic arch has measured around 4.0cm for that same time period. My doctor didn't have an explanation for that "shadow" that was seen on the echocardiogram but feels confident that there isn't a problem after the aortogram, which does give the most definitive images/measurements. He told me to schedule an echocardiogram in two years and to get back to playing basketball and enjoying life.
What exactly is your diagnosis? What are your physical characteristics? How old are you?
If in this study the 95% confidence limits are 2.5 to 3.5 cm for a person whose BSA is 2.1 m^2.At what number in the above study does ectasia enlargement starts and ends and than at what number does aneurysmal dilatation starts? Bob, How did you monitor your aorta by ECG?Which ECG leads usually show up aortic root abnormality.Was the "shadow" that appeared during echo measured?
Billy, you should post your questions to the doctor or talk with your cardiologist and/or surgeon. I'm an engineer, so any interpretations of the data in the paper that I make are from my experience with statistical information.
I have access to the full-text version of the paper. Figure 1 shows a statistical plot of aortic root dimension vs. body surface area for all 1,929 athletes in the study. The large sample size implies that the distribution would represent the general population statistics quite well, with the qualifier that the study group are all athletes and are all Japanese. The data show a main distribution of 1,922 points and 7 clear outliers, with the outliers ranging from 4.2 cm to 5.8 cm. The range of BSA covered is from about 1.35 to 2.6 m^2. All readings over 4.0 cm are clearly outliers for any BSA. The mean of the distribution does not exceed 3.3 cm for even the largest BSA's in the study. The 95% confidence limit does not exceed 3.7 cm even for a BSA of 2.6 m^2.
The authors state, "Regardless of the phenotype, the clinical diagnosis of aortic dilation was based solely on morphologic analysis of the aorta, and dilation was suspected when the aortic root dimension was more than 40 mm".
Hope this information is useful to you.
I have access to the full-text version of the paper. Figure 1 shows a statistical plot of aortic root dimension vs. body surface area for all 1,929 athletes in the study. The large sample size implies that the distribution would represent the general population statistics quite well, with the qualifier that the study group are all athletes and are all Japanese. The data show a main distribution of 1,922 points and 7 clear outliers, with the outliers ranging from 4.2 cm to 5.8 cm. The range of BSA covered is from about 1.35 to 2.6 m^2. All readings over 4.0 cm are clearly outliers for any BSA. The mean of the distribution does not exceed 3.3 cm for even the largest BSA's in the study. The 95% confidence limit does not exceed 3.7 cm even for a BSA of 2.6 m^2.
The authors state, "Regardless of the phenotype, the clinical diagnosis of aortic dilation was based solely on morphologic analysis of the aorta, and dilation was suspected when the aortic root dimension was more than 40 mm".
Hope this information is useful to you.
Are these athletes who have aortic root diameter over 4 cm candidates for surgery or is the size of aortic root in the range of 4 to 4.5 cm normal for them and not pathology? Is it possible for a normal middle age man whose BSA is 2.1 to have aortic root (measured in greatest diameter by mra) in the ranges of 4 to 4.5 cm and yet not have any evidence of aortic root enlargement(ecstasia) or dilatation?If yes how and in this instance at what size would aortic root be considered pathology?Does anyone know what would normal(mean) limits be of aortic arch in a normal middle age men?
Bob, glad to hear your aortogram looked normal, nothing better than good news. My MRA turned out fine. I'm getting yearly MRA's now, but that may increase to longer intervals if they keep looking OK.
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