Newly Diagnosed: 4.9 cm ascending aortic looking for support

@moonboy oh yeah this is the one crucial point.
Time seems to be on your side.
Going to see a cardiologist for the first time months or years away from any intervention is vastly different from "5 minutes from emergency surgery".
But use your time well and get solid advice.

@breick Cleveland Clinic is a great choice. I’m curious if anyone knows how to get data on the number of cases each “high volume” hospital handles vs other hospitals that do it with less frequency.

My 4.8 has been unchanged for 18 months. Similar to you I had no symptoms or reason to think I had a problem. I got a thorough check up after my 65 yr old brother died unexpectedly of a heart event. Unfortunately, my request for an autopsy for him got lost in the whirlwind of grief and we will never know what his heart problem was as he had never had symptoms or testing. I was initially terrified as I am 64 and we also had an uncle who died from a heart event at age 45 (also no autopsy). I have no other heart issues(blood pressure is good, valves are good, etc) so they initially thought it was genetic which would put the “trigger” for surgery at 4.5. I’ve been to both Mayo and Cleveland Clinic and I am now comfortable with a “wait and keep monitoring” approach as that is what they both recommend. They both have determined that mine is not likely genetic and that doing the surgery before it reaches 5.0 has greater risk than continuing to monitor it. Initially for me the uncertainty was overwhelming. But I've come to peace with it now, and am grateful that I’m in the fortunate position of being able to monitor it (Moonboy’s story of his dissection is proof enough that this is something to take seriously!) If i were you I would ask for a more definitive measurement than a normal CT scan can provide. It was hard for me to see initially, but i feel very lucky to be forewarned as this is generally a very treatable issue with a very high success rate if handled by experienced medical teams🙏

People mentioned cleveland clinic for high volume, but which location are they talking about?

I discovered I had an enlarged aorta when I was getting a cardiac clearance for prostate cancer surgery. The ascending aorta was 4.1 and the aortic root was 4.3. That was 2 years ago. At my yearly CT, this time my ascending is 4.0 but the root has grown to 4.8. The cardiologist has ordered an echo in 3 months. He said at 5.0 we will talk about surgery. I was walk/running 3 days a week (3 miles), doing planks 3 days a week, and lifting weights 2 days a week. At my most recent cardiology visit, the nurse practitioner alerted me to the possible problems with weight lifting and aortic aneurysms. The doctor did not give any clear guidelines. That is when I started looking here. I have stopped the weights and planks for now. I’m not running but still do brisk walking 3 miles x 3days weekly. Any suggestions about exercise? I’d like to continue with strength and cardio exercise. Should I be seeing a surgeon or is my doctor right to wait unless/until the root reaches 5?

@dg72454 normally you should be ok doing reps with lower weight, something you can lift without major effort and can maintain full breaths through every single rep. I’m not a Dr and you should confirm with yours but that worked for me. Cardio (swimming, etc) should be ok as long as you monitor your HR, your cardiologist should also give you guidance as to your do not exceed HR

You should stay active and maintain your body healthy , it will pay dividends when and if you ever need surgery, but be mindful about the limits

@moonboy
I appreciate you comments on lmcfalnads post. I have a 4.7 cm dilated ascending aorta and my cardiologist called it moderate and re-image in 6-12 months. I have read about the exercise limitations that include no high intensity exercise, competitive sports, contact sports and no valsalvas. I read your post and saw you said "no twisting", does that include golf? That is a rotating sport but lower intensity. If my lifestyle is completely limited from what I am used to is it reasonable to inquire about surgery? I was told > 5 cm we start talking about it and that it may take 10-15 years to grow to the point of surgery. Your thoughts are appreciated. JZ

When I mention “no twisting,” I’m primarily referring to forceful, loaded, end-range twisting, especially when combined with breath-holding or sudden exertion. Golf sits in a gray area. It is rotational, but for many people it is lower intensity, rhythmic, and controllable. The concern is not rotation itself, but explosive torque, over-swinging, and holding your breath through the swing. Many cardiologists will allow golf with modifications: smooth swings, reduced power, no maximal drives, relaxed breathing throughout, and stopping immediately if you feel strain. This is very different from heavy medicine-ball twists, aggressive yoga binds, or powerlifting-style rotation under load. TRUTH: I golf with my 91-year old father. I took him for his bachelor party to Torrey Pines this year.

As for surgery, it is absolutely reasonable to ask the question, even if the answer today is “not yet.” For most people without a connective tissue disorder, bicuspid valve, or rapid growth, 5.0–5.5 cm is the usual threshold where surgery becomes a serious discussion. The estimate that it may take many years to reach that size is plausible, but growth rates are unpredictable, which is why surveillance matters so much. What is often underappreciated is quality of life. If someone feels that their life has become unrecognizably constrained, it is fair to have a candid conversation with an experienced aortic specialist about long-term strategy, risks, and timing, even if surgery is not imminent.

One thing I can say from the other side is that knowing about the condition gives you power. You can avoid the specific things that truly raise risk, stay conditioned in safe ways, and monitor changes before they become emergencies. Many people live for years, even decades, with stable measurements and full, active lives with thoughtful adjustments rather than total restriction. You’re asking exactly the right questions, and it’s clear you’re approaching this carefully and intelligently. Peace.

I’m new to the support group just an hour ago .. haven’t even told my story yet but I just read your post . I’m thinking maybe suggest getting checked for a connective tissue disorder that may be causing a weak aorta making you destined for something like this . I found I have one and that’s what caused my dissection from my right leg all the way up my aorta to the arch where because of the dissection that occurred in 2022 showed a 4.8 cm aneurysm in my aortic arch .. it’s an easy test done my a geneotologist .. could save any siblings or children you have in the future if it’s hereditary .. just a thought

I also live in the mitten state and I was diagnosed with a thoracic ascending aortic aneurysm in May 2023 of initially 4.2 but with additional diagnostic testing it was determined to be 3.8.

The discrepancy was because the first measurement was done with a non gated CT. You must insist you have a gated CT with contrast. When the CT is gated the imaging works with the electrical activity of the heart to capture images that are not blurred by the motion. You will not feel any difference during the actual test but the images with the gated CT will be easier for the radiologist to read and very often the measurements with a gated CT are lower.

Additionally, I have obtained second opinions from both Cleveland Clinic and Mayo Clinic. I was seen in person for both of these evaluations but I do know they offer virtual second opinions if you are not up for the traveling. The downside is you may have to pay out of pocket but they offer detailed review of your records and the option for a zoom call with a specialist.

I was seen by Dr. Kim Eagle the Director of Cardiology at U of M but ultimately decided to have surveillance care at Mayo Clinic but again I am at 3.8.

Finally, you question the reason for the development of the condition. This is completely normal but you did the right thing but seeking education on your condition. The knowledge will calm the anxiety and help you focus on the present and the actions that need to be taken. One thing I have found based on my research is that people who have elevated Lp(a) a genetic condition and some history of hypertension even mild tend to develop more thoracic ascending aneurysms. It has to do with how the Lp(a) forms plaque and how it attacks the interior lining of the vessels. Lp(a) is an independent risk factor and is something your surgeons should be aware of based on your aneurysm diagnosis. A simple blood test can reveal this result.