Ascending Aorta 3.5 cm

I’m not a doctor, but I am a fellow patient who survived a catastrophic Type A aortic dissection in 2015, and I’ve been living with a surgically repaired ascending aorta ever since.

So here’s the deal: a 3.5 cm ascending aorta is technically still in the “normal” range for most people. The average is around 2.5–3.0 cm, and you don’t usually get truly worried until you’re talking 4.0 cm and up. That said, the key word in your report is “ectasia,” which means there’s mild dilation—not an aneurysm yet, but something to watch.

What bothers me isn’t the number—it’s the nonchalance. When the CT report says the aorta is "somewhat prominent compared to the descending aorta and body habitus,” that’s not something to shrug off for two years. At a minimum, you deserve a baseline echocardiogram now, so there's a clear reference point for the future. Two years without that is too long, especially at 62 and with controlled hypertension.

It also never hurts to get eyes on this from someone who does evaluate aortas for a living—namely, a cardiologist who specializes in dissections or BETTER YET a thoracic surgeon with aorta expertise. You’re not being dramatic or anxious. You’re being smart. A referral now means you’ll be seen if the aorta grows or changes. If nothing happens? Great. But if it does, you’ll be ready. I get CT scans every single year with contrast to monitor for changes.

Bottom line: trust your gut. You’re not overreacting. Ask for that echo and a cardiology referral. It’s your body, and this is too important to treat like a background issue. Peace.

Hello, I am a 65 year old female. I have the same issue that was found 6 months ago. Mine was measured at a 4.0-4.2. I just had another echo and it seems as if it hasn't changed but I am waiting to hear from my Cardiologist. I do not take any medication but I do take a lot of supplements. I am a little worried about this. trying to keep my BP down and cholesterol down. It is a bit scary. I am glad yours is lower. Don't worry

I am not a doctor but if it makes you feel you can have peace of mind then request your doctor refer you to a cardiologist. Sometimes having the conversation with a specialist can give you peace especially since you are taking meds for high blood pressure and high cholesterol. Share with your doctor how you would rather be proactive in your future health plan by speaking to a cardiologist.

Yes I agree Either go back to your PCP and ask for a cardiologist or just do your own research and find one. If you’re close to a university hospital you will likely find a good cardiologist and if need be a surgeon . Best

Hi, I was diagnosed with ascending aortic arch aneurysm. Have forgotten measurements. I was also very worried. Then I went to a Thoracic vascular surgeon. I also was 62. Female 5’ overweight but no problems with blood pressure or meds for anything but anxiety and adhd. The surgeon was great. He told me that were I two inches taller, it would be a normal sized aorta. And I could just get it checked annually. Perhaps you look into this type of doctor. Best wishes!

I concur with moonboy 100%👍

Curious - is it necessary to have annual CT’s after surgery?

To answer you as plainly as possible: YES, in most cases, annual imaging—usually a CT angiogram or MRI—is considered necessary after aortic graft surgery, especially in the first few years post-op. The goal is to monitor for complications such as aneurysm formation downstream from the graft, progression of a dissection flap if you had one, or changes in the native aorta that might require further intervention. Over time, and depending on how stable things look, your care team may stretch out the intervals. But surveillance is for life. I get mine annual and every three years with contrast dye. The contrast helps visualize things but its hard on your kidneys. The where it was explained to me is that your kidneys are a little bit like a donor cartridge. They don't last forever and every time you inject contrast, it reduces their functionality. All of that contrast overtime can add up and cause more problems than it solves. My thoracic surgeon was very adamant with me about getting annual CT scans.

It's not about paranoia—it's about prevention. These scans catch changes before they become emergencies. I get mine regularly, and while I don’t love the radiation, I love knowing that I’m still ahead of the curve. It gives me peace of mind and lets me focus on living. I had emergency open-heart surgery almost 10 years ago for a Type A aortic dissection. They put in a Dacron graft to replace the ascending aorta and part of the arch. Since then, I've lived with that graft in my chest, and like you, I’ve asked a lot of the same questions. Peace.

@tommot: Hi, Ectasia is the key word which I am sure you have found means a mild or early stage of enlargement, At that stage (3.5cm), its not considered an aneurysm until (4.0cm). It is generally accepted that aneurysms will grow at 1/3cm per year. Normally, surgery is not indicated until the aneurysm reaches 5.5cm. From 3.5 to 5.5 means at least 6 years prior to surgery. That's why your doctors have recommended two years before you need to scan again, unless you have very unusual growth. You are already taking the meds recommended for aneurysm, so if you add a gym or exercise regimen you may not even get the average growth rate.
I worried too with dual ascending aneurysms: 4.2 and root 4.5 until I learned that the surgery is 98% effective. So, I am going to enjoy the next 3 years and then worry about the surgery and if I am in the 2% bracket. So, like the song says: ""Be Happy....Don't Worry"" until you need to.

@gjms I am surprised that your doctor has not prescribed a statin for cholesterol and an ace inhibitor for blood pressure which are the two meds usually given to seniors as a precaution. But you are passed the precaution stage. The other thing you might consider is an exercise regimen which along with the two types of meds is what I am on. I was just diagnosed with a dual aneurysm 4.2 & 4.5cm root & ascending. But at 88 I have been going to the gym 3 days a week and still doing what i have done since I was your age. It is scary but we can be pro-active and hope for the best outcomes. Good Luck with yours.