Aortic root ecstasia/aneurysm

Posted by ryan8410 @ryan8410, Jul 4, 2023

Hello everyone. I’ve been doctoring for about 9-10 years when an incidental cta revealed ectactic aortic root measuring 3.8cm. This was an incidental finding and never brought to my attention for discussion from my cardiologist. I had to mention it. I was about 28-29 then. I’m now 39. I’m 6’3 with a smoking history of about 25 years. Controlled hypertension with metoprolol and losartan (per my request). I follow with cardiology annually with either an echo or cta. Most recent cta revealed stable aortic root ectasia of 43mm. In 2021 it was 4.2cm. No valvular issues. 34mm ascending and 22mm descending at aorta diaphragmatic hiatus. None of my reports have ever mentioned aneurysm, only ever dilation or ectasia and my cardiologist, when asked, doesn’t seemed concerned and has only recommended I don’t do any really heavy isometrics when it reaches about 5cm. Despite my height, Im told I don’t have typical features of marfans and I have no known familial history of tissue disorders. Obviously the smoking doesn’t help and I am working at quitting. Is it normal to have growth , my case 0.5cm in the last 10 years without any underlining connective tissue diseases? What differentiates between an aneurysm and ectasia/dilation ? These are questions that I don’t get answers to from several cardiologists I’ve seen and one thoracic surgeon over the last 10 years. Thanks for any responses!

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bitsygirl | @bitsygirl | Jul 6, 2023

I was recently diagnosed with an "aneurysmal dilation" of the ascending aorta. Here's what I learned on the chance it will help.

I learned that the term "aneurysm" versus "dilation" is determined by size. IIRC, when it's 1.5x normal, it's classified as an "aneurysm" -- smaller and it's a dilation. There is probably a minimum for it to be considered a dilation, but I don't know what it is. I found a paper that gave an average growth rate (around .1cm per year?). However, there is a lot of variation. I only looked at the ascending aorta; it may also depend on which section of the aorta the growth is within. I don't have a family history of connective tissue disorders either. There are a significant number of aneurysms that are not tied to connective tissue disorders. My cardiologist indicated that it's believed that smoking is a possible factor. I smoked for a few years in my mid-20s but haven't smoked in the 30 years since. I don't think they really know what the cause is in all cases.

Here's a link that describes aortic disease in some detail. A warning though, I don't think it's meant for laymen. So it may be confusing or misleading. Link: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001106. Yet, I found it useful for learning more about the terminology and standard treatments.

For the ascending aorta, the treatment threshold also is 5.0cm. That's when I guess you have a greater chance of a bad outcome from leaving it untreated than having a bad outcome from the treatment (surgery).

I would be surprised if a cardiologist couldn't/wouldn't answer these questions. It should be pretty routine for them. Maybe they didn't offer the information and you didn't ask specifically?

I was really panicked at first, but the treatment seems to be pretty standard: monitoring and treatment beyond a specific size or if the growth rate is high.

Hope this helps. You'll find lots of discussions about aortic aneurysms if you look through the discussions here.

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