Ascending Aorta Size vs Descending Aorta Size Cause for Surgery

From what I understand, he’s telling you that your ascending aorta is dilated more than 1.5 times your descending aorta although I’m not aware of that dimension being significant for doing surgery. Almost every cardiovascular surgeon recommends repairing it when it gets to be 5.0. According to the latest by the American heart Association guidelines in 2021, until it gets to be 5.0 it’s not a huge chance of an issue in one year (less than 1% of dissecting or rupturing) however, once you get to 5.0 it jumps up to 10% ( like your surgeon recommending the surgery said)…
I don’t know the initial size of your aneurysm, but assumming it was diagnosed at 4.1 cm
the risk of dissection and rupture increases by approximately 400% when the aneurysm grows from 4.1 cm to 5.0 cm, according to the AHA guidelines for monitoring an ascending aneurysm (if you have a descending aneurysm, I think they allow it to get a little bit bigger before they operate. (It’s just that the velocity and pressure of the blood coming out of your heart right there is critical )If you have a bicuspid aortic valve (instead of tricuspid), Marfans or several genetic variations, it becomes super urgent to do it at 5.0( because with the the aforementioned variations, they frequently do it at 4.5cm). Also if you’re in relatively good health, with no other major issues, it’s safer to do it. True, it’s not an easy surgery, But that’s why they wait until it does get to be 5.0 or larger because at that point, the risk of the surgery is outweighed by the risk of the dissection or rupture. The recommendations your surgeon is making are based on the standard of care for a 5.0 ascending aortic aneurysm.

Sorry I dictated that last posting and there are some typos that hopefully don’t change the meaning of what I was trying to say I hope it’s understandable. I’m so sorry.

You are very lucky!

I have read and heard several times that it 5.5 cm is cause for surgery

Thankfully,
You got help !!

What often gets over looked is that nearly 50% of ascending aorta/root disect or rupture between 5 and 5.5. Mine was at 4.8 when the root ruptured during surgery for resection of aneurysm on the Right Coronary artery, ligation of complex coronary fistula and double bypass of the LAD. Fortunately the surgeon and I had a discussion of 3 different scenarios to deal with it either that day if necessary or in the future. The decision was made for us and it was over a 14 hour surgery that day and evening. Turns out the tissue was fragile and that wasn't something that showed up in CT with contrast or angiograms with catheter procedure.