Newly diagnosed and/or living with ascending aortic aneurysm…anxiety

Posted by ginnycake @ginnycake, Apr 11, 2023

How do you guys cope with the knowledge? My 4.2 CM ascending aortic aneurysm showed up incidentally on a CT scan for a back sprain.
I haven’t had follow up as I write this. It is scheduled for the 11th with my primary care Dr. Will I get another scan of my chest to confirm it???I live in Hawaii… fearful of it not being taken seriously and having spiked high blood pressure from Stress and anxiety cause more damage. I would appreciate your insights… thank you in advance.

Interested in more discussions like this? Go to the Aortic Aneurysms Support Group.

mdw100 | @mdw100 | Jul 16 8:34am

In reply to @david63 "My ascending aortic aneurysm is 4.8. I am coming up on my 6 month CT scan...." + (show)

Start walking even if you have to start small and get up to half hour every day. I’m at 4.3, play pickleball and walk as many days as I can. I try not to carry heavy loads but otherwise pretty active. For me it’s not a death sentence, just a warning for me to take better care of my body. I’ll be 70 this week and by Gods grace I’m in the best of my health. My mom has had an aneurysm in her brain for the last thirteen years and still alive at 93. So, trust God that all the days ordained for you were written in His book before any one of them came into being, but do what’s needed for you to fare better.

booklover71 | @booklover71 | Jul 16 10:08am

In reply to @moonboy "An aortic dissection is a serious condition where the inner layer of the aorta tears, causing..." + (show)

@moonboy

An aortic dissection is a serious condition where the inner layer of the aorta tears, causing blood to flow between the layers of the wall of the aorta and forcing the layers apart. This condition requires immediate attention, particularly when it occurs in the ascending aorta, which is the section of the aorta that rises from the heart.

Here is a detailed explanation of why open heart surgery is necessary for repairing an ascending aortic dissection:

Explanation for Open Heart Surgery in Repairing an Ascending Aortic Aneurysm
**1. Complexity and Severity of the Condition

Critical Location: The ascending aorta is a crucial part of the heart’s anatomy. It is close to the heart and the aortic valve, and any complications in this area can affect the entire circulatory system.
High Risk of Rupture: The ascending aorta is under significant pressure due to its proximity to the heart. If a dissection occurs here, the risk of rupture is extremely high, which can be life-threatening.
**2. Need for Direct Visualization and Control

Direct Access: Open heart surgery allows surgeons to have direct access to the aorta and the heart, providing a clear view of the affected area.
Precise Repair: The surgeon can precisely repair the tear in the aorta, ensuring that the new lining is secure and the blood flow is restored properly.
**3. Comprehensive Repair

Grafting: During open heart surgery, a synthetic graft can be used to replace the damaged section of the aorta. This graft reinforces the aorta, preventing further dissection and reducing the risk of future complications.
Valve Involvement: Sometimes, an aortic dissection can affect the aortic valve. Open heart surgery allows for the repair or replacement of the aortic valve if necessary.
**4. Immediate Management of Complications

Controlling Bleeding: Open heart surgery provides the best opportunity to control any bleeding that might occur during the repair of the dissection.
Cardiopulmonary Bypass: The use of a heart-lung machine during open heart surgery helps maintain circulation and oxygenation while the heart is stopped, allowing for a controlled and safe environment for the repair.
**5. Long-term Outcomes

Durability: The repairs made during open heart surgery are generally more durable and have better long-term outcomes compared to less invasive methods.
Comprehensive Treatment: This method ensures that any potential issues that could arise in the future are addressed during the surgery, reducing the need for additional procedures.
Less Invasive Methods: Limitations
While less invasive methods, such as endovascular repair, are effective for some conditions of the aorta, they are not suitable for an ascending aortic dissection due to:

Limited Access: These methods do not provide the same level of access and visibility to the ascending aorta as open heart surgery does.
Complex Anatomy: The complex anatomy of the ascending aorta and its proximity to the heart make it difficult to achieve a reliable and durable repair with less invasive techniques.
Higher Risk of Complications: Less invasive methods have a higher risk of complications in this area due to the high pressure and dynamic movement of the ascending aorta.
Conclusion
In summary, open heart surgery is necessary for repairing an ascending aortic dissection due to the complexity and severity of the condition, the need for direct visualization and control, the ability to perform a comprehensive and precise repair, the immediate management of complications, and the better long-term outcomes. While less invasive methods have their place, they are not suitable for this critical and high-risk area of the heart.

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Thank you for the best explanation I have ever read.

pamela78 | @pamela78 | Jul 16 11:19am

In reply to @moonboy "An aortic dissection is a serious condition where the inner layer of the aorta tears, causing..." + (show)

@moonboy

Here is a detailed explanation of why open heart surgery is necessary for repairing an ascending aortic dissection:

Explanation for Open Heart Surgery in Repairing an Ascending Aortic Aneurysm
**1. Complexity and Severity of the Condition

Jump to this post

This is helpful but scary. I guess there's no way for this not to be scary. I was just diagnosed last week and am still wrapping my mind around it. It's as if I've entered a new country. I have a 4.2 ascending aneurysm and a valve insufficiency. Also a Bovine heart. This group is helpful. It's nice to have company.--P.

moonboy | @moonboy | Jul 16 2:29pm

When you survive an aortic dissection, it turns you into an expert. Thank you. it brings me total joy to help other people going through this. I had no one to talk to about it and was really scared for a long time after my emergency open heart surgeries in 2015. I only wished I had had this resource back then. Good news is that you can survive a dissection if you're smart and proactive. I was just lucky! (This is me with my grandnieces on Saturday--peace)

chrisn61 | @chrisn61 | Jul 17 6:40am

In reply to @david63 "My ascending aortic aneurysm is 4.8. I am coming up on my 6 month CT scan...." + (show)

Cleveland Clinic offers a virtual 2nd opinion as to timing. There is no other option than open heart surgery for repair.

houston13 | @houston13 | Jul 17 8:29pm

Excellent explanation, just one clarification everything you described regarding the details of the surgery is true not only for an emergency disection but for an ascending aneurysm repair in general (you do say that right above item 1). I had an ascending aortic aneurysm repair in 2020 and followed pretty much what you explained, open heart surgery, and replacement of the section of the aorta where the aneurym was with an artificial graft, mine had not disected it was just large enough that needed repair.

As always, you provide excellent explanations that benefit evryone

houston13 | @houston13 | Jul 18 1:34pm

In reply to @houston13 "Excellent explanation, just one clarification everything you described regarding the details of the surgery is true..." + (show)

Just as an anecdote, the surgeon closed my chest with glue, you can barely see the scar, below it of course there’s wire that held the sternum together. That’s not an issue in the US and most western countries but I was traveling through India a couple of years ago and In most airports there, they use manual wands besides the normal pass through metal detectors, the wands did go off with the wire so I had to open my shirt every time to show them the scar ( they also went off with my titanium rods in my leg so also had to lift my pant leg)

bitsygirl | @bitsygirl | Jul 18 1:55pm

In reply to @chrisn61 "Cleveland Clinic offers a virtual 2nd opinion as to timing. There is no other option than..." + (show)

@chrisn61 - Have you consulted Cleveland Clinic? If so, how did you get access to the second opinion? Was it covered by your insurance? Did you find it to be worthwhile?

hsminc | @hsminc | Jul 19 12:50pm

In reply to @chrisn61 "Cleveland Clinic offers a virtual 2nd opinion as to timing. There is no other option than..." + (show)

Chris61 is correct - there is no other practical option other than open heart surgery at this time. However, this article below by Houston Methodist suggests that it may not be long before endovascular stent repair will be available for ascending aortic aneurysms.
https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1173
You may well be able to wait. Your ascending aortic aneurysm is 4.8 cm. I do not know information regarding the general health of your vessels; your age; etc.. BUT my husband has had a 4.8 cm aneurysm unchanged since January 2021, when it was first discovered by Mayo in Rochester. He keeps his blood pressure below 130/80; does not lift over 30 lbs; and otherwise tries to behave himself. He is 80 now; he was 78 at diagnosis. He has always been very active and still is.
We saw in an old CT record that this aneurysm was first noted in 2007 at 4.3 cm - 14 years prior. And during that time, he lifted all sorts of heavy furniture, overhead beams, dock boards, etc.. (You name it: He lifted it!) So aneurysms can be slow or fast growing - as his clearly indicates. Yours may also be slow growing. The best way to know is to have it measured frequently on the same CT machine. (We had his measured every three months for the first year.)
There are many risks associated with open repair. Be sure you are cognizant of all those risks before making any decision. Remember that mortality can be 5 percent (depending on patient risk factors) even when done by excellent experienced surgeons practicing at state of the art facilities. Your risk of dissectionor rupture may be much lower.
Blood perfusion to the brain during surgery is important. While various methods of perfusing blood to the drain during open heart surgery are now "state of the art" not all surgeons do this -- or even think it is necessary. (Physician practices at a hospital can vary. Make sure you know about the specific practices of the surgeon you select.) But, to us, if you are concerned about cognition, blood perfusion to the brain during surgery is very important. Coming out of surgery with extra cognitive defects is not a goal.
Best wishes!

dianeflorida | @dianeflorida | Jul 20 9:26am

Make an appointment with the cardiologist and follow their advice. Don’t strain, pick up heavy objects or exercise hard until you see the cardiologist. Most of them will say that until you get up past five don’t really have to worry.

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