Ascending Aortic Dilation - Ascending Aortic Aneurysm

Posted by rory @rory, Apr 2, 2018

I was diagnosed in 2012 with ascending aorta dialation of 4.1 cm. In 2013 no change. Finally went back to dr in 2017 and echo showed 4.3 cm. 2 months later dr made me have a chest scan which read 4.5 cm. which is correct? Echo or scan? Dr wants me to have another in 6 months. Very stressful.

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Thanks for the kind words to all. Canada has really good heart surgeons. But they have only one procedure here, full chest sternotomy. I am looking for that miracle with getting the 4-5 inch incision vs. full breast bone incision. I have read a lot about this. Less invasive as possible, but I think I have no prayers to finding alternative due to also having BAV. Its a long story as to why I want this, serious car accident 20 years ago. But for the time being, I am staying active. I have been very sports active all my life and at 57 years of age, I toned down the muscle building by cutting heavy weights and aggressive workouts. Everyday doing anywhere from 45 mins to 1.5 hours exercise, walk, bike, lite weights etc.... My BP has always been perfect. I have always eaten well, so no issues. Funny how that works, stay healthy all your life but you still get something like this. I read that about 6.5% of ascending Aneurysm at about 5.8cm rupture.Well lets see what I decide to do. I will still do the exercise of seeing if I can get what I want for operation. Cheers to all. Stay safe . Really need this support. Any other hopeful and kind words are always welcomed.

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@cass57

Thanks for the kind words to all. Canada has really good heart surgeons. But they have only one procedure here, full chest sternotomy. I am looking for that miracle with getting the 4-5 inch incision vs. full breast bone incision. I have read a lot about this. Less invasive as possible, but I think I have no prayers to finding alternative due to also having BAV. Its a long story as to why I want this, serious car accident 20 years ago. But for the time being, I am staying active. I have been very sports active all my life and at 57 years of age, I toned down the muscle building by cutting heavy weights and aggressive workouts. Everyday doing anywhere from 45 mins to 1.5 hours exercise, walk, bike, lite weights etc.... My BP has always been perfect. I have always eaten well, so no issues. Funny how that works, stay healthy all your life but you still get something like this. I read that about 6.5% of ascending Aneurysm at about 5.8cm rupture.Well lets see what I decide to do. I will still do the exercise of seeing if I can get what I want for operation. Cheers to all. Stay safe . Really need this support. Any other hopeful and kind words are always welcomed.

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@cass57 Hi. My understanding is that those being offered the less invasive repair of an ascending aortic aneurysm (the endovascular stent) are patients who for age or other health issues are thought to be unable to tolerate the full open chest surgery and recovery. There must be reasons why this procedure is not the gold standard for repair but I haven't been able to find that specific discussion in my searches. I do wonder if the endovascular stent repair has a shorter lifespan than the full open chest repair so is offered to older patients who likely won't outlive the repair.

It is possible that during a full open chest repair that the BAV will also be replaced. I know, this is mind boggling to even think about.

My hope is that if I can maintain my current situation that I will live long enough for a new easier procedure to be developed or I will qualify for the endovascular stent repair. My concern is that the aortic valve is leaky and the surgeon will want to replace that at the same surgery and therefore I will be required to have the full open chest surgery. But who knows -- I might be able to avoid any kind of repair and die from something else entirely, at a very advanced age.

In the meantime, I live my life mindful of the recommended limitations on lifting and other exercises or activities that might strain the aneurysm and then I just carry on. Beyond that, I won't let these conditions control me. However, you are significantly younger than I am and if your aneurysm is growing you may be more likely to need this surgery. I suggest you connect with an outstanding vascular surgeon so if the time comes that surgery is recommended, you will have faith in the person advising you and providing your care.

I send you all good wishes.
Donna

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@cass57

Thanks for the kind words to all. Canada has really good heart surgeons. But they have only one procedure here, full chest sternotomy. I am looking for that miracle with getting the 4-5 inch incision vs. full breast bone incision. I have read a lot about this. Less invasive as possible, but I think I have no prayers to finding alternative due to also having BAV. Its a long story as to why I want this, serious car accident 20 years ago. But for the time being, I am staying active. I have been very sports active all my life and at 57 years of age, I toned down the muscle building by cutting heavy weights and aggressive workouts. Everyday doing anywhere from 45 mins to 1.5 hours exercise, walk, bike, lite weights etc.... My BP has always been perfect. I have always eaten well, so no issues. Funny how that works, stay healthy all your life but you still get something like this. I read that about 6.5% of ascending Aneurysm at about 5.8cm rupture.Well lets see what I decide to do. I will still do the exercise of seeing if I can get what I want for operation. Cheers to all. Stay safe . Really need this support. Any other hopeful and kind words are always welcomed.

Jump to this post

Hi @cass57 and others. I've been reading Mayo Clinic comments for 4 months and have found them very helpful; now it's my turn to tell you about my experience and hope you get something from it.

Two years ago my family doctor heard a murmur and sent me for an echo. In those 2 years I had more echos, a stress test, a TEE and a heart cath. (TEE is an echo down the throat) The conclusion was that I had a bicuspid aortic valve (BAV) and an aneurysm on my ascending aorta. The aneurysm was first measured at 4.4, then 4.6 Because I was 67, female, and weighed only 117 pounds, they told me I needed to have surgery.

In those 2 years I went through a whole lot of emotions, I lost sleep - I was also in serious denial (I felt good - I worked out - my blood pressure was good, I ate well. How could I have a problem?) And the thought of open heart surgery was Really Scary. So I did a lot of research and talked to my family.

Bicuspid Aortic Valves are inherited. Two percent of the population is born with a BAV. I found out they show up in my family quite often. BAVs seem to work well until we get older. They are associated with "connective tissue disorder" so that as we age, the tissue doesn't take the stress as well. If you want more information on BAVs (and a better explanation than mine), a really good website is bicuspidfoundation.org. You'll find lots of information on BAVs and aneurysms.

So - after research and serious thought I decided I would have the surgery to repair or replace the BAV and to repair the aneurysm. I knew it would be the full chest incision. I had read many positive comments on these pages from people who had had surgery and were doing well; I also knew about 7 people who had undergone surgery and were walking around today - just fine. (My brother and aunt included.) Those comments encouraged me to have the surgery. I also knew I would go to one of the best hospitals I could. Since I'm from Ohio originally, I went to the Cleveland Clinic.

I called them, got connected and had very good instructions on what to do (I had to get medical records and test results sent to them). I started the process in the fall; I had surgery 4 months later. They assigned me to a wonderful surgeon.

The thought of open heart surgery is very scary. It really makes you review your life and think about who and what is really important. But I felt I was going to one of the best places I could. I put my trust in them and they came through beautifully.

The whole procedure at Cleveland Clinic is very organized - I went up a week early and had tests (CT scan, echo, EKG, lab work, etc). On Monday I had surgery. The surgeon was able to repair the BAV, not replace it. He also repaired the aneurysm. I left the hospital on Friday.

I want to say as far as credit - the surgeon is very important. But - so is the rest of the staff. There is the anesthesiologist, there is the person who opens you and closes you up, the person who puts in all the tubes, people are monitoring your heart rate and other systems. The nurse I had in ICU made me feel so positive that all was well. The whole team is very critical and I thank Cleveland Clinic for being outstanding.

btw, I'm sure Mayo Clinic and other hospitals also do great work. It is important to go to a very good hospital.

As far as recovery, I'm amazed at how well and how fast I have healed. I think a lot of credit goes to Cleveland Clinic. I was also in good shape before the surgery, I eat well, I had very few other problems. I think that helped. Because of COVID19 I have had to skip in person appointments with the doctor - we've had phone calls. I also have not started the cardiac rehab - but hopefully I can get to that next month.

I wish you the best of luck, cass57. It is a hard decision but keep talking to people and do the research. And do know that test results can vary depending on who is interpreting it, and that doctors may have different opinions on how to proceed. Take it all in and hopefully you can come to a good decision (although the virus has changed surgery scheduling).

One last comment - as suggested earlier, I also do meditation. The app Calm is wonderful.
Best of luck to you.

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Hello gaile19. Very nice and encouraging post here. I am indeed in the situation where I don't accept this. I have always enjoyed great health. Not because I wanted to live longer, but just because I enjoyed it. Controls stress and also controls my pain i have daily due to car accident from 20 years ago. My pickup truck hit a 1900/lb moose at 65mhr. I need these stories to help get through this unexpected issue. I am one who deals with his own pains and problems. This is more difficult in regards to the family and the emotions they will be going through again. In Canada its slow process. Not really much compassion from my experiences. I know of several people that have had open heart, they all have great lives. When I see the test reports changing from one to the other, I question a lot. We will see what will happen as I move forward. Looking at the US clinics for options. Only issue is the extreme cost for this operation. But whats money if you can't live your life. Thanks again for your story, I needed this to help since I talk very little with people around me. Everybody has their only problems. You stay safe and healthy.

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@gaile19

Hi @cass57 and others. I've been reading Mayo Clinic comments for 4 months and have found them very helpful; now it's my turn to tell you about my experience and hope you get something from it.

Two years ago my family doctor heard a murmur and sent me for an echo. In those 2 years I had more echos, a stress test, a TEE and a heart cath. (TEE is an echo down the throat) The conclusion was that I had a bicuspid aortic valve (BAV) and an aneurysm on my ascending aorta. The aneurysm was first measured at 4.4, then 4.6 Because I was 67, female, and weighed only 117 pounds, they told me I needed to have surgery.

In those 2 years I went through a whole lot of emotions, I lost sleep - I was also in serious denial (I felt good - I worked out - my blood pressure was good, I ate well. How could I have a problem?) And the thought of open heart surgery was Really Scary. So I did a lot of research and talked to my family.

Bicuspid Aortic Valves are inherited. Two percent of the population is born with a BAV. I found out they show up in my family quite often. BAVs seem to work well until we get older. They are associated with "connective tissue disorder" so that as we age, the tissue doesn't take the stress as well. If you want more information on BAVs (and a better explanation than mine), a really good website is bicuspidfoundation.org. You'll find lots of information on BAVs and aneurysms.

So - after research and serious thought I decided I would have the surgery to repair or replace the BAV and to repair the aneurysm. I knew it would be the full chest incision. I had read many positive comments on these pages from people who had had surgery and were doing well; I also knew about 7 people who had undergone surgery and were walking around today - just fine. (My brother and aunt included.) Those comments encouraged me to have the surgery. I also knew I would go to one of the best hospitals I could. Since I'm from Ohio originally, I went to the Cleveland Clinic.

I called them, got connected and had very good instructions on what to do (I had to get medical records and test results sent to them). I started the process in the fall; I had surgery 4 months later. They assigned me to a wonderful surgeon.

The thought of open heart surgery is very scary. It really makes you review your life and think about who and what is really important. But I felt I was going to one of the best places I could. I put my trust in them and they came through beautifully.

The whole procedure at Cleveland Clinic is very organized - I went up a week early and had tests (CT scan, echo, EKG, lab work, etc). On Monday I had surgery. The surgeon was able to repair the BAV, not replace it. He also repaired the aneurysm. I left the hospital on Friday.

I want to say as far as credit - the surgeon is very important. But - so is the rest of the staff. There is the anesthesiologist, there is the person who opens you and closes you up, the person who puts in all the tubes, people are monitoring your heart rate and other systems. The nurse I had in ICU made me feel so positive that all was well. The whole team is very critical and I thank Cleveland Clinic for being outstanding.

btw, I'm sure Mayo Clinic and other hospitals also do great work. It is important to go to a very good hospital.

As far as recovery, I'm amazed at how well and how fast I have healed. I think a lot of credit goes to Cleveland Clinic. I was also in good shape before the surgery, I eat well, I had very few other problems. I think that helped. Because of COVID19 I have had to skip in person appointments with the doctor - we've had phone calls. I also have not started the cardiac rehab - but hopefully I can get to that next month.

I wish you the best of luck, cass57. It is a hard decision but keep talking to people and do the research. And do know that test results can vary depending on who is interpreting it, and that doctors may have different opinions on how to proceed. Take it all in and hopefully you can come to a good decision (although the virus has changed surgery scheduling).

One last comment - as suggested earlier, I also do meditation. The app Calm is wonderful.
Best of luck to you.

Jump to this post

Allow me to share my experience to, I hope, alleviate some of your very reasonable concerns.
At age 71 ( healthy and in good condition), an echo identified a 49mm dilated aortic root. After doing a lot of due diligence, I decided on surgery. The surgery entailed radical thoracic resection, a reconstruction of the aortic valve, and a radical graft of the ascending aorta up to the aortic arch. While “under the hood” my surgeon also performed a maze ablation. My aorta diameter turned out to be an actual 55mm. I was on bypass for almost 8 hours. I spent 4 days in cardio ICU and 1 day and overnight on a ward. I started taking short walks the day after I returned home and, despite a few “kerfufels” was pretty much recovered in 30 days. I am now approaching 75 years old and doing well. So, my advice is that if you need the surgery ( a BAV and your current diameter seems to indicate) don’t let the seriousness deter you. Get a good surgeon and a top notch hospital ( I think the latter is more important than the former) and go for it.. It is not a “stroll in the park” but it’s not as bad as you fear. You can do it. Good luck and God Bless.

REPLY
@gaile19

Hi @cass57 and others. I've been reading Mayo Clinic comments for 4 months and have found them very helpful; now it's my turn to tell you about my experience and hope you get something from it.

Two years ago my family doctor heard a murmur and sent me for an echo. In those 2 years I had more echos, a stress test, a TEE and a heart cath. (TEE is an echo down the throat) The conclusion was that I had a bicuspid aortic valve (BAV) and an aneurysm on my ascending aorta. The aneurysm was first measured at 4.4, then 4.6 Because I was 67, female, and weighed only 117 pounds, they told me I needed to have surgery.

In those 2 years I went through a whole lot of emotions, I lost sleep - I was also in serious denial (I felt good - I worked out - my blood pressure was good, I ate well. How could I have a problem?) And the thought of open heart surgery was Really Scary. So I did a lot of research and talked to my family.

Bicuspid Aortic Valves are inherited. Two percent of the population is born with a BAV. I found out they show up in my family quite often. BAVs seem to work well until we get older. They are associated with "connective tissue disorder" so that as we age, the tissue doesn't take the stress as well. If you want more information on BAVs (and a better explanation than mine), a really good website is bicuspidfoundation.org. You'll find lots of information on BAVs and aneurysms.

So - after research and serious thought I decided I would have the surgery to repair or replace the BAV and to repair the aneurysm. I knew it would be the full chest incision. I had read many positive comments on these pages from people who had had surgery and were doing well; I also knew about 7 people who had undergone surgery and were walking around today - just fine. (My brother and aunt included.) Those comments encouraged me to have the surgery. I also knew I would go to one of the best hospitals I could. Since I'm from Ohio originally, I went to the Cleveland Clinic.

I called them, got connected and had very good instructions on what to do (I had to get medical records and test results sent to them). I started the process in the fall; I had surgery 4 months later. They assigned me to a wonderful surgeon.

The thought of open heart surgery is very scary. It really makes you review your life and think about who and what is really important. But I felt I was going to one of the best places I could. I put my trust in them and they came through beautifully.

The whole procedure at Cleveland Clinic is very organized - I went up a week early and had tests (CT scan, echo, EKG, lab work, etc). On Monday I had surgery. The surgeon was able to repair the BAV, not replace it. He also repaired the aneurysm. I left the hospital on Friday.

I want to say as far as credit - the surgeon is very important. But - so is the rest of the staff. There is the anesthesiologist, there is the person who opens you and closes you up, the person who puts in all the tubes, people are monitoring your heart rate and other systems. The nurse I had in ICU made me feel so positive that all was well. The whole team is very critical and I thank Cleveland Clinic for being outstanding.

btw, I'm sure Mayo Clinic and other hospitals also do great work. It is important to go to a very good hospital.

As far as recovery, I'm amazed at how well and how fast I have healed. I think a lot of credit goes to Cleveland Clinic. I was also in good shape before the surgery, I eat well, I had very few other problems. I think that helped. Because of COVID19 I have had to skip in person appointments with the doctor - we've had phone calls. I also have not started the cardiac rehab - but hopefully I can get to that next month.

I wish you the best of luck, cass57. It is a hard decision but keep talking to people and do the research. And do know that test results can vary depending on who is interpreting it, and that doctors may have different opinions on how to proceed. Take it all in and hopefully you can come to a good decision (although the virus has changed surgery scheduling).

One last comment - as suggested earlier, I also do meditation. The app Calm is wonderful.
Best of luck to you.

Jump to this post

May I ask who was your surgeon in Cleveland? Thank you so much.

REPLY
@yurkosolhan

Allow me to share my experience to, I hope, alleviate some of your very reasonable concerns.
At age 71 ( healthy and in good condition), an echo identified a 49mm dilated aortic root. After doing a lot of due diligence, I decided on surgery. The surgery entailed radical thoracic resection, a reconstruction of the aortic valve, and a radical graft of the ascending aorta up to the aortic arch. While “under the hood” my surgeon also performed a maze ablation. My aorta diameter turned out to be an actual 55mm. I was on bypass for almost 8 hours. I spent 4 days in cardio ICU and 1 day and overnight on a ward. I started taking short walks the day after I returned home and, despite a few “kerfufels” was pretty much recovered in 30 days. I am now approaching 75 years old and doing well. So, my advice is that if you need the surgery ( a BAV and your current diameter seems to indicate) don’t let the seriousness deter you. Get a good surgeon and a top notch hospital ( I think the latter is more important than the former) and go for it.. It is not a “stroll in the park” but it’s not as bad as you fear. You can do it. Good luck and God Bless.

Jump to this post

Glad you got through this very well. I can only hope to do as well. Here in Canada, I am limited with my options of who and where to get this done. My last encounter in the ICU here, was not a memorable one. I am in good health, well other than this time bomb they found. I am trying to find out cost to have this done in the US. And I need to sell myself on either to do this or leave it to the powers that be. Cheers and stay strong, Godspeed.

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@lynetteirizarry

I feel your pain! I have AAA that has been measured from 3.7 to 4.9.....just got a scan this Am will get report around 3 pm. Up and down depressed and afraid to pick up anything, someone here told me not to pickup more than a jug of milk, been being careful. I wish they could just do damn surgery and get it over with!!!

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hi @lynetteirizarry So did you get your results?

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After I experienced a heart attack 12 years ago(at the age of 59) the cardiac catheterization revealed a 4.5 cm aneurysm on my ascending aorta. I opted to have a graft repair and that was performed less than six months later (my heart attack was considered to be as a result of ‘broken heart syndrome’ so my recovery was fairly quick). After a few months of recovery from the surgery I was beginning to feel pretty much like my old self again. And after that other than being thankful every day I don’t need to think about this experience except to get an ECHO and/or an MRA once every couple of years.

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@mlemieux

Hey All

I'm so sorry to hear about your experiences with your aneurysm. Never a fun DX to have, very scary. But there are some time-test techniques you can do to prevent them, and/or prevent your aneurysm from rupturing:

1) DO NOT SMOKE:
Smoking is probably the #1 reason why people get reoccurring problems with blood conditions. It hinders the ability to pump blood to health parts of your body, causing all sorts of complications. It restricts blood flow: throughout your body, to your heart and to your wonderful brain.

2) Eat a regular diet:
I can't stress this enough. Stay away from fatty foods, drive-thru windows (you know what that means), eat a lot of protein (nuts, and non-meat protein diet), vegetables (watch out for Vitamin K if you take specific blood thinners), and try to eat smaller portions throughout the day to keep your energy flowing all day.

3) Do NOT drink in excess:
Drinking alcohol thins out your blood and makes it more dangerous for those who suffer with aneurysm's, DVT's, etc. Not to mention alcohol weakens the walls of your arteries and of course kills brain cells 😉 .

4) Do NOT overuse medications and/or street drugs:
Medications can save you life, absolutely! But, overuse and abuse of medications can do the exact opposite affect within your body. I had a friend a long time ago who suffered from a cocaine addiction and got an aneurysm which almost killed him. The doctor told him that street drugs, especially cocaine was the cause.

Now that being said, ask your doctor if 1 baby aspirin a day is ok for you to take? Baby aspirin, while not taking other blood thinners can help to increase proper blood flow. I've recommended baby aspirin for over 20 years now and will continue to do so. Please consult your doctor.

5) Exercise in small doses:
In order to keep your heath at peak performance, and your arteries strong, it's important to exercise in small doses. Nothing too strenuous, especially nothing that forces you to lift way too much weight and over stress your veins and arteries too quickly. Small walks with a friend, taking the dog out to a park, playing with children, etc can go a long way to living healthier.

6) Try to keep a happy and un-stressful life:
Preventing more stress in your life is very important for your body to rebuild and give you energy, this can be accomplished from relaxation techniques, including, but not limited to: Thai-chi, yoga, and especially meditation. When you meditate, see your blood flowing like the Nile River, see it being a source of life, see yourself happy and healthy. Do this 10min a day and I promise your life will change in a great way.

7) Long car rides and plane trips:
Be very careful while travelling. Now don't get me wrong because going on a trip is excellent for your health, BUT sitting for long periods is extremely bad for blood flow and can cause all sorts of mishaps within your arterial system sending too much blood flow all at once when you get up to stretch. Make sure to get up and stretch or something similar every 20-30 minutes MAX.

I hope this helps, again i'm sorry you have to go through this.

Take care all!

Martin R. Lemieux
@Martin_Lemieux - Twitter

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What is it with folks regarding exercise and a person who had a heart issue??I've exercised for over 50 years so naturally i look nothing like my peer group at 67 years of age.I had stents put in on feb.09.2023. My cardiologist of UCLA after reviewing my test results had a very difficult time finding anything detrimental to my progress except stating I had a mildly dilated proximal ascending aorta. Okay. I get it a man at 67 ISNT supposed to have BMI of 16.1 upon arrival for chest pains along with a standing heart rate of 59. Because hey, I DID have a buildup of plaque which resulted in an Emergency Visit.That stated my doctors first go to was stop lifting weights essentially.My blood pressure hovers around 128/60 ,heart rate 69 ( yes ,I did capitulate ) reduced the amount of weight used not duration of exercise, increased cardio daily. Mother still alive ,fully functioning at 93,drives ,takes no medication (no family history of heart issues) Went back to working out after 3rd week from stent placements enrolled in a cardio rehab (offered by UCLA) naturally made adjustments with diet .The key is one has to know their body and yes if ones history of exercise is moving the groceries from the car to the kitchen then by all means strenuous exercise for them would in fact be a brisk walk if they NEVER lifted more than their fork and coffee cup..

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