Enlarged Aorta

[bob_sixsix]

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!

[bob_sixsix]

pbanders,

Did you get results back from the MRA?  How often do you have your dacron implant monitored?
I received results from my doctor on the aortogram and he told me everything looked perfectly normal.  He had no explanation for the "shadow" that appeared during the echocardiogram which led me to have the MRA and the aortogram.  He told me to schedule an appointment in two years for an echocardiogram and enjoy life.
That "burning" or "flushing" feeling you described during the CT scan is slightly more intense during an aortogram.  They explained to me that patients who have undergone angiograms describe it as "peeing your pants".  The warm feeling starts from your chest and ends around your femoral arteries.  I am still bruised up for the procedure but I am glad I had it done.

Take it easy and thanks again for your information on this matter.

~Bob

[pbanders]

Regarding your MRA questions, I had one yesterday. Yes, they use contrast, it's gadolinium, it's nowhere near as problematic as iodine is with CT. I didn't feel any heat or burning sensation when it was injected, as opposed to iodine, which makes you feel warm all over. While it's cramped, noisy, and somewhat unpleasant, MRA beats getting a big ionizing radiation dose, a la CT.

[pbanders]

Sorry, make that 0.4% of the group showed significant aortic root dilation.

[pbanders]

Bob, you might want your cardiologist to look at this article on Medline, "Aortic Root Dilatation Among Young Competitive Athletes: Echocardiographic Screening of 1929 Athletes Between 15 and 34 Years of Age". Figure 1 of the article the relationship between body surface area (BSA, indicator of physical size) and aortic root dimensions for the study group. The figure provides a way of determining if for a particular BSA value, a person's aortic root dimension is within the range of normal dimensions. For example, for a BSA of 2.1 m^2, the 95% confidence limits were about 2.5 to 3.5 cm.

Of the study group of 1929 athletes, 7 of them had readings of aortic root dimensions that were clearly off the norm (0.04%), with dimensions of 4.2 to about 5.8 cm. These were people that were identified as needing additonal followup and treatment.

[pbanders]

The reference is from the year 2000. It's "1,929 athletes", not "Athletes from 1929". Sorry for any confusion, that's the way the title of the article is written.

[bob_sixsix]

When I started going through the plethora of cardio tests that I listed earlier my BSA was 2.48m^2.  I lost about 20lbs since so I'm sure it's a little lower.  My aortic root has been measured about 8 times with different tests: ECG,CT scan, MRA and now aortogram.  All of the tests have repeated a measurement of 3.8cm.  I am not too concerned that I have a problem in this area.  I am more concerned that in the area at the "end" of the ascending aorta where it transforms to the aortic arch.  This area seems to have inconsistent results.  I have had the echocardiograms measure around 4.0cm, the MRA measure 3.7cm, the CT scan measure 4.4cm.  I have not received measurements back from the aortogram but the initial report read that "there is no evidence of aneurysms or atherosclerotic disease."  It did say "slightly generous proportions at end of ascending aorta."  When they say "end of ascending aorta" they are referring to the transition of the ascending aorta and the aortic arch.  I'm curious to see what the measurements will be in this area from this aortogram.  Supposedly, the aortogram gives the most definitive images so I will trust this over the other tests.
I just read the post from CCF-MD from "Billy's" on the aorta thread and the doc claims that anything over 4.0cm is considered an aneurysm.  This doesn't make sense with his information on aorta size to BSA ratio.  Is there a "cut-off" of 4.0cm regardless of the person's height and weight?  A little confusing.  I will run all these questions by my cardiologist.  I was corrected the other day when I called him a cardiologist to a member of the cardiac catheter lab.  He explained that my doctor is not a cardiologist he is a thoracic surgeon, chief thoracic surgeon actually, at Yale.  He is one of the best around and I will trust him totally.
Thanks for the info pbanders.  Let me know what you think about this BSA to aorta size ratio in the latest post.

~Bob