Should I be concerned about how at risk I am for rupture with a 4.2 cm

Posted by rascal1 @rascal1, 2 days ago

June 1, 2025 I was diagnosed with a 4.2 cm ascending aortic artery aneurysm. I went to my cardiologist who found that I also have high blood pressure and very high cholesterol. He told me it was not a concern for surgery now as it is too small, but I am worried about rupture, especially with the high blood pressure. Is it wise to have surgery now with the fear of it bursting? Much anxiety around this.

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@houston13

At 4.2 the likelihood of rupture is close to 0, your aneurysm is in the “small range”. Surgeons normally won’t consider surgery until the aneurysm approaches 5.0 and above, depending on other factors, like body size, family history, other health conditions, etc

You do have to control your BP, my recommendation is to find a cardiologist who is an aortic disease specialist (not all of them are and it makes a difference) to guide you and monitor you. It is important to monitor growth rate and your cardiologist will do that. Although you are far from critical size, find the best surgeon, someone who has done hundreds/thousands of these type of surgeries, in a major medical center near you and get an initial assessment by him/her also

Also, keep your body healthy, (if you smoke, stop) exercise but do not lift heavy weights or do any exercises that leads you to hold your breath while exerting, your BP rises significantly in those moments. You want your body to be at its best if you ever need surgery.

Mine was repaired at 5.2cm, 2 months after it was found after an MTB accident. I was in good shape and the surgery went as well as it could have, my recovery was fairly quick.

I know it creates anxiety when they first tell you, everyone in this forum has gone or is going through the same. Lots of conversations about how to keep stress down and at the top is to find the right care.

All the best

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So pleased you had such success! May I ask your age and where you had the surgery performed?

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@lori555

I am curious as to what you want a second opinion on?
Do you want measurements done more frequently? Do you want surgery earlier than the current guidelines?

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Second opinion as the cardiologist I’m now seeing leaves a bit to be desired. He is not choosing to control my blood pressure and arrhythmia, but is helping with high cholesterol. I need some peace of mind that this is being diagnosed and monitored by the very best.

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@rascal1

So pleased you had such success! May I ask your age and where you had the surgery performed?

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I was 54 when I had my surgery 5 years ago, I live in Houston and had my surgery at the Texas Medical Center, my surgeon was Dr Anthony Estrera (probably the best in Houston) and my cardiologist Dr Siddharth Prakash, an absolute expert in aortic diseases, all his research is in the subject, both part of the UT Health group. I still see Dr Prakash every year. Hope that helps!!

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Thanks! I’m in Florida.
What size was you aneurysm when first diagnosed and then at surgery?

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@rascal1

Thanks! I’m in Florida.
What size was you aneurysm when first diagnosed and then at surgery?

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My aneurysm was found after an MTB accident, I broke my leg and needed surgery to repair the fracture. It was already at 5.2 cm when found, so the Drs that found it recommended I saw a specialist surgeon ASAP as in their opinion I needed to have it repaired. The surgeon agreed, his take was it was very large for my body size (I’m 5’6”), I had family history of ruptured aneurysms and based on my general physical condition surgery was very low risk. I needed to be able to walk through so I had to wait a couple of months and had the surgery. So I don’t have a growth history, in my mind the accident saved my life. The only reference I have is that I had an echocardiogram in 2011 and they told me I had a bicuspid aortic valve but there was no mention of aortic dilation, they either didn’t see it or it didn’t exist back then. That was 9 years before it was found

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@rascal1

Hi. I live in The Villages, Florida near Ocala Florida. The size of my ascending aorta aneurysm is 4.2 cm.
Where do you live?
I’ve called Mayo in Rochester and Mayo in Florida and Cleveland clinic and had difficulty seeing a cardiologist or vascular surgeon. I’m ending up with an appointment at Advent health Waterman in Tavares Florida. People tell me this is a small aneurysm and they don’t do anything until it gets to 5 cm but I keep wondering how they test the growth other than having you re-image in six months. Yes this could make us very anxious. I support you in what you find for yourself. Please keep in touch. Nancy

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If you are willing to travel further, Mayo Phoenix may be easier to get into. The saw me right away and scheduled surgery within a week. 4.9 root and 4.5 Assending. Though I prior had a cerebral Aneurysm repaired, which sped up my timeline for my chest.

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@rascal1

I feel the same as you and checking out a second opinion, but having difficulty getting into major hospital system with a good cardiology department specializing in aortic aneurysms. Are you on a blood pressure medication?

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I am not on medication. I am trying to lower it on my own by changing my diet and doing light exercise. It does seem to be working so hopefully I can avoid medication. Lowering my stress level though has been hard because I am worried about this getting larger.

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@stevgood

If you are willing to travel further, Mayo Phoenix may be easier to get into. The saw me right away and scheduled surgery within a week. 4.9 root and 4.5 Assending. Though I prior had a cerebral Aneurysm repaired, which sped up my timeline for my chest.

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What was recovery like?

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@barbaracv

What was recovery like?

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I'll let ya know. Surgery is July 8th. They scheduled it within the week, the date was a month out. Wish me luck!

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@barbaracv

Mine is 4.8 and I also have one on my aortic root measuring at 4. And I will be at Rochester. I live in Wisconsin. All of my research has turned up Mayo or Cleveland Clinic with some of the top surgeons for this type of surgery. I completely understand your concerns and fears… It was a complete shock to find out that I have these. I am 69 in very good health, walk 2 miles everyday and eat right. However, my father had a descending aneurysm in his 70s… and heredity can play a factor. I am trusting that God will take care of me and pray He gives me wisdom and peace with what I should do.

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Thanks for your response. I wonder what factors make them decide to see a patient. Maybe it's the size? I live in the UP of Michigan. I can only hope that they would consider me for surgery if and when it is required. There are other options, but they are all significantly further from where I live. I think/hope I can get in somewhere.

Good luck in your journey. I exercise, eat well and maintain a normal BMI as well, and have for decades. Yet, I smoked for a few years in my early 20's so this may be of my own doing. Who knows.

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