Your aorta is a thick, three-layered tube that carries all the blood pumped out of your heart to the rest of your body. An aortic dissection happens when one of those layers—usually the inner layer—tears away from the middle layer, creating a space where blood starts to flow in the wrong place, called a "false lumen." It’s kind of like when the tread starts to peel off a tire but hasn’t completely blown out yet. That separation can be dangerous because it weakens the structure of the aorta and puts you at risk for a full rupture if not treated. It is a life threatening emergency if it happens. But since you know you have an issue, you're not going to let that happen because you're monitoring it and you will deal with it by listening to your thoracic surgeon.

You mentioned that your aorta measured 4.5 “cc” — I’m guessing you meant cm, which is the standard way to measure the diameter of the aorta. A normal descending thoracic aorta is usually around 2.5 to 3.5 cm, so 4.5 cm is definitely enlarged, but it’s not panic territory. Think of it like a garden hose that’s a little over-pressurized but hasn’t burst — it needs watching, but it’s not a 911 call. A finding like this is often totally silent — no symptoms — and it's great that it was caught early. Many of us don’t find out until it's an emergency. You’re ahead of the game.

Now, the “borderline” part means you're near the range where doctors will start tracking it more closely. Most cardiologists or aortic specialists will want to repeat imaging every 6 to 12 months to see if it's stable or growing. Growth rate matters a lot more than just the number. If it’s been the same size for years, that’s a different conversation than if it jumps from 4.5 to 4.9 cm in a year.

You said you're 63 and haven’t had heart issues — that’s good, and it's also why it's so important to check in with a cardiologist now. Ask them if you can see someone who specializes in aortic disease specifically. General cardiologists are great, but this is a niche area, and trust me — the right specialist makes all the difference.

In the meantime, a few tips:

1. Avoid heavy lifting and straining — anything that causes a Valsalva maneuver (like holding your breath and pushing hard) spikes your blood pressure and stresses the aortic wall.

2. Monitor your blood pressure carefully. Lower and stable is the goal.

3. Ask your doctor if genetic testing or screening might be helpful — some aortic issues run in families, even if you’ve never had symptoms. I have all of my kids tested after I had a dissection.

I was 50 when my aorta dissected, and it changed my life in every way. But knowing about this before something happens? That’s power. It gives you the chance to act, track, and protect yourself. You’re not alone in this — a lot of us are walking around with “borderline” aortas. With good imaging, careful monitoring, and lifestyle adjustments, many people live long, full lives without ever needing surgery. Peace.