Aortic Aneurysm or Enlarged Aorta

Thanks for posting this inquiry. I have the same condition, and don't know whether it's anything to be of concern until I see my cardiologist next January. In addition, I just found out that my heartbeat is irregular, so I will be wearing a heart monitor for two weeks to see whether I need to have a pacemaker.

George's Wife

@georgescraftjr I wore one of those monitors also. Mine was called a “Zio Patch “. It confirmed that I had AFIB, which I was pretty sure about, but needed it, I guess, to convince my insurance that I should get an ablation. I got it and it resolved the AFIB.

@beebo Also- My next Echo to check the aneurysm is tomorrow. I’m looking at my Echo report from last year ( 90% of which I don’t understand) and it states “Ascending aorta measures 4.00 cm and Sinotubular Junction measures 3.7 cm. Not sure which is the most important to my Doctor. None of it seemed to be of any concern to him when we discussed it last year.

@beebo
Mine AAA is also 4.0 and has been stable for over 20 years. I’m 77 now. My cardiologist isn’t concerned unless it grows to 5.0

I know this all is very confusing. In the heart scan I had for looking at calcium scores, they discovered this and called it an ectasia (widening of aorta), but when I went in to see the cardiologist to follow up he referred to it as an aneurysm. Still don't have a clear explanation.

To my understanding, the characterization of an aorta as an "aneurysm" versus a "dilation" refers to how much greater the diameter of the aorta is than normal. The exact numbers depend on which part of the aorta is being evaluated. I believe the term "aneurysm" is used when the ascending aorta is greater than 4.5 cm and "dilated" when it's between 4.0 and 4.5 cm

You can try to unravel it here: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106. This document is very technical and directed at physicians though. I'd have to guess that "enlarged" is ... high end of normal? Slightly above normal?

@bitsygirl
I have seen doctors refer to thins in the 4.3 to 4.5 range as moderate.

I have a thoracic ascending aortic aneurysm and at 4.8 cm, I am in the monitoring stage. In my efforts to get smarter about the TAAA, I came across a risk chart in one medical research paper that may be useful in answering your question.

The risk chart at the following link (from a medical research paper) may be useful to you in categorizing where you are in terms of relative risk. My understanding is a larger person generally has proportionately a larger aorta than a small person, e.g., a 61 inch tall petite female as compared to a 235 pound, 74” tall male. I also understand that body surface area has been used in the past by the medical field as factor in estimating risk for a patient; but newer research shows simply using body height is as good or better factor; which is the factor used in the following chart.

How to interpret: Using the chart at the link, the relative risk level is indicated by the diameter of your aorta dilation (in cm) versus your height (in inches). The risk value listed where the corresponding row/column intersect, is the average patient’s risk per year; i.e., the chance of the patient having an aortic event during the year. Example: a 59-inch tall person with a 4.5 cm aortic aneurysm has a 3% chance of an event this year and, being yellow shaded, is categorized as a moderate level of risk. Whereas, a 65-inch tall person, on average, doesn’t reach a 3% level of risk until the dilation diameter is close to 5 cm.

Note that the chart values are population averages; thus, your real risk could vary (e.g., be larger) from the indicated value depending on other health factors (conditions) you may have.
https://ars.els-cdn.com/content/image/1-s2.0-S0022522317327691-fx1_lrg.jpg

It’s easy to get lost in charts, indices, and population-level risk curves when you’re sitting with an aneurysm in your chest. I’ve been there. As someone who survived a completely sudden and utterly unexpected Type A dissection in 2015, I can tell you that no amount of analysis or intellectual modeling will save you in the moment when the aorta gives way. Once it happens, you are in a fight of your life that you can’t think your way out of, and it is extremely hard to survive and even harder to recover from when it’s emergent. My advice: Don't wait. Get surgery when you're advised to after understanding the risks and having your affairs in order. The 42 minutes I had from the start of the dissection to being cracked open were not sufficient to prepare my family, my doctors, or me.

If you’re living with an ascending or arch aneurysm, the two most valuable things you can do are simple. First, only take guidance from people who truly know this terrain: survivors of an ascending or arch dissection, and thoracic surgeons who repair these every week. @houston is awesome on this list. Second, keep your blood pressure and stress as low as possible while you move toward definitive surgical repair. That alone materially reduces your risk while you wait.

The best approach isn’t trying to out-analyze the condition. It’s building your care around a thoracic aortic surgical specialist and following their advice about timing. Their experience is far more reliable than any chart, index, or generalized risk metric. You don’t want this to become the kind of sudden emergency I went through. Peace.

What I still struggle with is some distinction between a relatively uniform enlargement versus bulged area in terms of risk and treatment.