Ascending Aortic Aneurysm Size Discrepancies and Update

Hello....with the results you've shown, your aneurysm, if it has grown, has done so at the expected rate....about 1mm per year. It could also be a measurement "error" resulting from who measured it and how it was done. As you describe yourself as active, in a healthy bmi/weight range, and having a healthy lifestyle, you're doing all that you can to help your health. Depending on your age, you may consider more BP medication, but the way you've described things, it's more "anxiety" related than physiological. The size of your aneurysm may be "normal" for your age, and is on the low "manageable" end. Some may even consider it an aortic "dilation". If you can stay off more meds, you are probably better off. You like your doctor and he's "highly rated". Sounds like he's doing a good job for you. Try not to stress over this too much, and you'll be doing yourself a great favor. Enjoy your health and lifestyle. As it's said....STAY CALM AND CARRY ON.

I was diagnosed in 2024 at 4.2 . Frightening when you first get the diagnosis. I see my cardiologist every 6 months. I think it's very important to stay with a doctor who you have confidence in and you seem to. He is monitoring you. You're getting your ECHOs and CTAs. You're doing other things to stay healthy.
It's hard to tell someone not to stress, but it's important. There can be discrepancies in imaging . The angle that the tech holds the probe. I get an ECHO every 6 months and once it read smaller than previous and my CTAs. Aneurysms don't shrink.
I feel more comfortable with my diagnosis now. I'm 72. I lived 70 years not knowing it was there. I have to make a few changes to my life, such as how much weight I can lift, certain medications I can't take, see a cardiologist every 6 months.
I wasn't worried when I didn't know it was there. I've come to a point that I don't worry about it now that I know. Mine is still 4.2 by recent CTA. I'm not going to let it control my life.
I hope you can relax and not stress about it so much. You're being monitored. You're working at staying healthy. Please relax and enjoy your life!!!!

Hello hercules,

1–2 mm falls within the normal range that is acceptable for measurement variations.

Starting in March 2026, I have had the following measurement results:

1) MRA whole-body non gated protocol: 47 mm in March; first detection of a dilation.
2) Echocardiogram: Acsendens 40 mm; the dilation was completely missed by the cardiologist.
3) Echocardiogram: Acsendens 41 mm; the dilation was completely missed by the cardiologist.
4) Echocardiogram: Acsendens 40 mm; the dilation was completely missed by the cardiologist,this one was specifically for the entire ascending aorta , from proximal to distal...
5) Non gated CT scan: 48 mm; report of severe pulsation artifacts. The root and proximal segment were unmeasurable; the mid-ascending segment was reasonably measurable at 48mm.
6) Echocardiogram 49 mm; instead of lying on the left side, now lying on the right side.And my arms pulled back behind my back.So it seems that the mid-ascendant can indeed be measured accurately
7) CTA 49.3. July

The CTA in July is the baseline; a new CTA will follow in November.

Why, then, are there such large differences compared to the 40 mm echocardiograms?
The root and proximal ascending aorta are perfectly measurable with an echocardiogram because an echocardiogram can freeze its images at end-diastole.
My dilation is in the mid- to distal ascending aorta, which is notorious for poor visibility.
On top of that, an ultrasound measures “leading edge to leading edge,” while a CTA measures “inner to inner,” and that makes a difference as well.

It might sound strange, but I’m just glad it’s now heading toward 50 mm; in my case, elective surgery at 50 mm is an option, and my aortic center (in Germany) specializes in minimally invasive techniques. So I’d rather spend a few months recovering from a major procedure than spend many more years living in anxiety and having to make major lifestyle adjustments.

As for my stress , it wasn't until I switched to a highly reputable aortic center that my fears subsided significantly.The “ordinary” cardiologist simply lacks the necessary knowledge and experience

Based on your information I would say you’re doing the right thing. Keeping your bp under control is very important as well as cholesterol level.. you’re walking and working out which is the best thing to do but what i may suggest is please calm yourself down! May be early morning meditations help you to stay away from stress.. other than that you will be fine.. sometimes dilations stop at one point.. and you may not be even in need of a surgery at all..
If I may suggest besides all these please keep a positive attitude.🙏❤️

Wanneram, Hi, I was going to put a note for Hercules but then read your response and thought I would share with you since you seem to think that surgery (minimally invasive in Germany) is going to put you back to "normal". A good friend of mine looked at the surgery like you and went ahead and had it done. He did not even know what his dilation numbers were. Now, about a year later, he is beginning to wonder if he should have had it done at all. He is far from "normal". But what I was most interested in is what German surgeons define as minimally invasive. Descending aorta (both thoracic and abdominal) in the U.S. can be considered minimally invasive since reaching an aneurysm can be no more invasive than an angiogram. But, an aortic ascending aneurysm is still considered "open heart surgery" and is VERY invasive to reach the aneurysm. Have German surgeons perfected some method of reaching an ascending aneurysm with a minimally invasive procedure? I and dozens of others will be on the next plane to Germany if that is the situation now.

@ctflyr thank you for your reply.

@wanneram I agree. Being at a center of excellence would help alleviate some fears

@dew88

I think I should have been a little clearer—my mistake.

By “minimally invasive techniques,” I meant a mini-sternotomy, not endovascular procedures like TEVAR—which, incidentally, isn’t possible for an ascending aorta. And even if it were possible, I’d still opt for a traditional Dacron replacement. This procedure is much riskier and the recovery is much more difficult, but in the long run, it’s still much better and safer.

Yes, I’m well aware that this is a very invasive and dangerous procedure, but for relatively young people (I’m 53 years old) who are otherwise in very good health, such an operation—performed by a highly experienced surgical team at a high-volume center—nowadays carries a very low mortality risk.

It’s not for nothing that the threshold has been lowered from 55 mm to 50 mm if performed in high volume centers .
To be honest, I do have my doubts about the story that your friend doesn’t know what his aortic diameters were. Every fellow patient I know on forums could recite his exact diameter in their sleep.

And of course, you won’t be 100% again after surgery, but it will still be much better than it is now because the fear of a dissection is gone and the lifestyle recommendations are a lot more flexible. In my case, it involves replacing a segment of the mid-ascending aorta—no bicuspid valves, so no valve replacement. So it’s a fairly straightforward procedure where the risks are quite minimal. And yes, I’m more than willing to take that 0.5–1% risk of death.

I was 78 and in very good health. The 5cm ascending aortic repair with Dacron and hemiarch repair went well, but my heart would not restart immediately after surgery. The surgeon explained to my family that my heart needed to rest. My chest was left open for 5 days. Carcinogenic shock, ECMO, pneumonia, intubation all followed in cardiac intensive care for 10 days. I believe I would not have survived unless I was at Mayo. After 22 days I could go home where it felt essential that I be. I used a walker for a week, a cane for a week, then slowly regained strength with much rest, quiet, and a superhero husband.
Now I am 18 months out. I gave up pickle and tennis, but walk daily. Still enjoy an afternoon nap time. I regained memory completely. Lucky there.

Wow, that’s incredible. I’m glad you came out on the other side. Is all well now 18 months out? Do you have any restrictions or follow ups? Do you mind sharing which Mayo location you were at? Wishing you well in your post op recovery and life ahead.