Ascending thoracic aneurysm: What should I do and not do?

Mine was 4.2 2 years ago, and I found out the other day it is 5.0 now. They are saying I need to have surgery or it might rupture. I don’t know the day of the surgery yet, I’m really scared

Hello @tdan4

I can chime in on what I learned after an unexpected diagnosis of a 4.3cm ascending aortic dilation. It showed up as 4.5 cm on a calcium CT and the measurement was refined during a ct coronary angiogram. (Other problems showed up on the calcium CT.)

The routine standard seems to be an operation at 5cm. Body size and growth rate appear to be factors that can change the size for surgery. There are probably other factors as well. I am not a doctor.

When it's less than 5cm, it's monitored according to a prescribed schedule. The first check is in 6 months and yearly afterward if the growth rate is below some threshold. The growth rate seems to vary substantially.

I learned a lot at this link: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001106 and from this group.

Hope this helps.

New to forum. 71 y o male, 6'4' rated obese. Two weeks ago, my regular doc sent me for echogram which showed aortic root at 4.1 and ascending aorta at 4.7. Sent then to CT which showed ascending at 4.8. Have received a message from my reg. doc that at my next visit (next week) we are going to discuss my results. Have a feeling I'll be seeing a heart doc in the near future. lol. I have a few other health issues and this news of a heart situation was completely unexpected. Have not shown any symptoms of what I would probably imagine. I had been diagnosed with degenerative joint disease for a couple of decades now, and have had both knees totally replaced about 14 years ago. Been under care of a rheumatologist for about 7 years, and currently going for chemo infusions of Rituxan to slow the deterioration timeframe down. Rituxan is notorious for hurting the autoimmune system. I don't smoke or drink. Because of my arthritis situation, my exercise regimen is minimal. With all that info on me, can anyone offer me some advice? I'm a bit concerned about where this is all going to lead me. Thanks. tdan4

I am also 81 and my "mildly dilated" ascending aorta was noted in '04 as result of seeing a Cardiologist for PVC's observed during my treadmill stress test. An Echocardiogram showed my AoD to be 4.4 cm. In 2007 a CT w c measured 4.8 cm. Since then, I have had 10 CT's showing the aorta to be anywhere between 4.4 to 5.0 cm. The latest was 4.8 cm. The Echo AoD's have ranged between 4.4 and 3.7 cm with the latest being 3.8 cm. Point being a dilated aorta does not necessarily mean the end is near. One thing I find fascinating is that the CT Program can extract an image of the aorta. Earl the Pearl

i also am 81. Just back from the Cleveland Clinic. Aneurysm measure 4.7 but did not get larger in the past year. Play golf, garden and bike. No heavy lifting. Dr said reaching 90 is possible. What ever, keep going and live life to its fullest.

I'm 74 and was diagnosed with an ascending aortic aneurysm 12 years ago after a CT scan after a car accident. Mine has been holding steady at 4.6, I originally had a CT scan done every year, seeing as there has been no changes I get a scan done every 2 years. I don't dwell on the fact that I have an aneurysm, I try and not lift anything too heavy and that's about it. Live life, there's lots of other things that'll kill you too, can't worry about them all.

This is wonderful news, upartist! So happy for you. It' s amazing how this kind of health news can make such a big difference. Glad you enjoyed the excerpt, too! I hope you and all of us can continue to find more and more ways to enhance our happiness and quality of life 🙂
suz1950

Thank you Suz1950! I enjoyed reading your excerpt from the Journal of Thoracic and Cardiovascular Surgery! Very very informative, as I heavily consider stats on outcomes in weighing my medical decisions. Quality of LIFE is the biggest element! My recent cardiac visit revealed that my ascending aneurysm is holding steady at 4.2 and my stats have actually improved. So it will be a wait and monitor scenario. Pretty cool! So I plan to approach living today in mindfulness, and appreciation! My other issues are being dissected out and addressed. That to is really nice! As a result of this reassurance, I feel more in control of myself/my body/ my mind. My happiness levels have just been increased ten-fold! I hope the readers of this blog, with the excellent info it provides, can also achieve a higher level of "Happiness".
UPArtist 😊

It's great you are seeing your Dr. on Monday. Coincidentally, I am having a 2 month follow-up after the initial consult. At that time, my cardiologist ordered the CT Cardiac Scan that revealed the 4.8 cm aneurysm. After seeing the results, he doubled the dose of my statin and ordered some lab tests (C-reactive protein, Lipid protein (d), and a lipid panel). This seems to have worked from what I can see about the results, so I am excited to find out if the results are as positive as I think they are. I'm also curious to see if he wants to follow up on doing an echocardiogram as he had mentioned at the first visit.

I'm so glad you found this group, I've found it very helpful and I hope you do too! I've received a lot of great advice and heard people's experiences which help me feel that I am not alone. All the best to you--will be thinking of you on Monday 🙂
suz1950

Wonderful! I am so glad to hear that you are doing well and have not needed intervention to this point! Initially, it was hard for accept (or even grasp) the guideline of "watchful waiting," but I understand it now. I firmly believe that my acceptance of this approach also resulted from fully incorporating your guidance.
Something else that helped me understand watchful waiting was the article, Commentary: "Surgical threshold for ascending aortic aneurysm: A moving target begging for randomized controlled data," published in Journal of Thoracic and Cardiovascular Surgery, Feb. 2021 . [Especially the last 3 sentences.]

"Over the years, results have improved, and elective ascending aorta replacement has
become a safer and more reproducible operation. In a recent analysis from the Society of Thoracic Surgeons database, including >22,000 patients who underwent isolated ascending aorta replacement, in-hospital mortality was 3.4%.1 Conversely, surgery in the context of acute aortic dissection is a more complex operation, with mortality ranging between 10%and 25%in large series. In the latest International Registry of Acute Aortic Dissections report,
in-hospital mortality after type A dissection surgery was 22%.2,3
This stark difference in outcomes highlights the need to operate on patients with aortic aneurysm before dissection, or even worse, rupture. Presented with such data, most
patients would choose prophylactic surgery instead of an emergency operation associated with a higher risk of mortality. However, aortic aneurysm being an indolent and silent disease, surgery aims to alter the course of the disease rather than to alleviate symptoms. Consequently,
because surgery does not help patients “feel better,” it is crucial to ensure that the procedure does not portend a higher risk of death than watchful waiting. In the short
term, this is almost impossible to achieve. In fact, for a given patient, the risk of death on the day of an elective ascending aorta replacement almost certainly outweighs that of watchful waiting during that same day. However, over time, the hope is that this early risk will translate
into long-term benefits and survival. Thus, following a concept known as “time until treatment equipoise,” there comes a point after surgery where the risk of the intervention is outweighed by the cumulative risk of conservative management (Figure 1).4"

Suz1950