Thoracic aortic aneurysm: Anyone had surgery?

I hear you. And I feel the weight of your question in my chest, because I asked the same thing when I was 50 in 2015 and told I had a dissecting aorta and needed emergency open-heart surgery.

I had no warning. It was about 42 minutes between the first pain that I had and being cracked open. I had just finished teaching on my feet for 13 hours and was alone in a hotel room in San Diego when my Type A dissection happened. I didn’t think, “this might be dangerous” before that day. I didn’t feel fragile. But I was. Frankly, it was a ticking time bomb that I knew nothing about.

You’re in a unique position right now because you know you have a 4.2 cm ascending thoracic aortic aneurysm (ATAA). Surgeries typically not implicated until you get to 5.0. That means you have the gift of foresight—something I didn’t get. And that gives you power.

The short answer is: no, you probably shouldn’t be doing that job without serious modifications. Anything that involves intense straining, lifting, or spikes of stress—especially if you’re holding your breath while pushing or lifting (what’s called a Valsalva maneuver)—can increase intrathoracic pressure and put dangerous strain on your aorta. That’s not a scare tactic. That’s physics and physiology. It’s possible that the kind of work you do exacerbated or even caused the condition that you have. It’s really hard to say and I’ve spent the past 10 years racking my brain trying to figure out what caused mine and I’ve concluded that being overweight, hypertensive, and stressed out as a trial lawyer all were huge contributors to my condition.

We both know that life doesn’t always make it easy to walk away from a job. I did not walk away from mine, but I have made very serious modifications to how I live in my life. No more 13 hour teaching stints two days in a row. this is about survival and quality of life. You need to take this seriously and talk to your cardiologist and thoracic aortic surgeon—not just your primary care doc. Show them exactly what your workday looks like. Be very specific about the kinds of lifting, postures, stressors, and rest you get. Get their recommendation in writing if you can. That may help with your work.

You may need restrictions. You may need a new role. But what you don’t need is to go through what I did—the pain, the surgery, the risk of death—just to find out the hard way that your body had been trying to warn you all along.

You’re not weak. You’re informed. You’re strong enough to advocate for yourself and choose a safer path. And I’ll tell you from one patient to another: knowing is a gift because you can do something about it.

Let me leave you with this. I spent the entire day yesterday staining my cedar fence here in St. Paul. The sun was out. It was clear and dry and I just went to town on the fence. It was lots of repetitive, but not particularly heavy work to hold the paint sprayer. I try to avoid anything which involves grunting or straining. If it’s more than 30 pounds, I’ll leave leave it to the folks at Home Depot to load and unload. It’s not that I can’t do it. It’s that the hidden strain on a Dacron aorta is nothing I want to risk. Peace.

PS. Here’s what my morning looks like today and I’m thankful every day for every one I get.

Thanks for this question and the opportunity to hear about other’s experiences! I have not had surgery, but just got a new opinion from a highly experienced and respected vascular surgeon and also his team at UF-Gainesville. My former vascular surgeon measured the largest part of my descending thoracic aorta dilation at 4.2 cm and the new team, three different ones measured and they came up with 3.5-3.6. So, yeah. Go figure. The surgeon said if I was ready to have endo stent graft surgery he would do it, as long as I was fully aware of the “small (~1%) but real risks from the surgery itself.” Then there’s the risk of dissection or rupture, they are guessing maybe 1%? Maybe all this is to say, that “watching waiting” can be a real mind f$*k.” This stuff is scary but 17 years since mine was discovered, I’ve lived a super full life with basically no restrictions. You will get through this too and this group is super helpful. I REALLY appreciate @moonboy again for describing what the dissection pain felt like. For some reason, I’ve never asked anyone! I’ve just sat inside my head this whole time thinking every time I get a muscle spasm, that I’m dissecting—at least the first few years I thought that which led to lots of ED visits and extra scans. No one seemed to ever be able to tell me what I needed to watch out for. So, I’m really glad so joined this forum and am no longer alone with this!

You are an inspiration. Thank you so much for sharing your story. God bless and keep you!

I'm so sorry. This is very scary but everything is going to be okay. You're fortunate to have been healthy for 83 years. I hope you have a few more. I'm almost 80, so I'm right there with you, more-or-less. I always thought I was very healthy too until my aortic aneurysm was found a year ago. Gives things a different perspective, doesn't it?

Hello
I wish everyone will tell me that I am going to be OK.
By a MRI they found an aneurysm in my brain.
I have an appointment for August 28th. Doctor said that it could irrupt. I could die or be paralyzed honestly I rather die if it Gods plan.
I am 83. I thought healthy old lady..
Thank you
Carry

Carry: You are not alone in how you feel. I remember those same fears—wishing someone could just look me in the eyes and tell me I would be OK. When I was 50, I had an aortic dissection in the middle of the night while on a work trip. It ripped open my aorta, and the doctors told me later that most people don’t survive. But here I am, nearly 10 years later. That night changed everything, and I know what it’s like to stare down your mortality.

You are still here. And the fact that they found the aneurysm by MRI means you have a head start. You’re not waiting for a disaster to happen in the dark—you are in the light, working with real information, with doctors who can help. August 28th might feel far away, but you have time. If anything changes before then, you go to the ER. But in the meantime, you breathe. You keep showing up. You are stronger than you know.

I also hear what you said about God's plan. If this were your time, you wouldn’t be reading this. But you are. That means there’s still work to do, people who need your voice, your stories, your light. From one survivor to another: You are going to be OK today. And tomorrow. And the day after that. One sunrise at a time. Peace.

The important thing is to make sure it is within reach at surgery. I am 80yrs and in 2014 I had 3 A-V fistulas embolized in my brain with awake anesthesia. It was done at Mayo in Jacksonville and I was very scared also. They reached the area thru my groin and I had no pain. I was told they do a similar procedure for aneurysms. I did well and have enjoyed many years after.Now they even have more advanced equipment and technology so be at peace, it will go well. Make sure you are referred to a reputable medical center. Good luck, the Lord will be with you
Dr. Picardi

Very helpful, thank you so much
Your advise is very consolatory

Amen