Dilated Ascending Thoractic Aorta- Growth from 4.0 to 4.3

Mine has gone from 42 to 45 in 3 years. I have had other results in the past of 50 and 48mm , but then they remeasured and realised the measure was the lower numbers. They say its quite awkward to measure .

I am told 12 monthly measures (on the nhs here in UK ) but i am going to get mine measured 6 monthly privately.

How do these cardiologists know they are not going to explode at 45 mm ( i am Sure some have) why wait for 50 mm

I was wondering why a stent ((TAVR) couldnt be fitted to take the pressure off the wall of the Aorta before it got any bigger , preventative and less invasive ?

Hopefully someone can tell me the answer on here.

I am not a doctor, but my understanding is: (1) the rate of aortic dissections for aneurysms of less than 50 mm is very low (I believe around 1% or less) provided there are no other risk factors, like Marfans or a genetic issue; and (2) the physics involved with stenting the ascending aorta are simply very challenging (short distance, blood vessels branching off, etc.) compared to the abdominal aorta - when I asked my doctor (in the US) about it, his view was that stenting the ascending arch was likely at least five years away from being a viable and reliable option.

Thanks for your insights. All of the responses and input are very helpful.

Thanks for that information.
Paul

It sounds like you might have two different conditions. Statins are typically prescribed for atherosclerosis. Was it prescribed to control the aneurysm growth? I’d not heard of that but a quick google turned up an article that indicated it might help. Hmmm ….

I have coronary atherosclerosis (but no blockages greater than 50%) and an ascending aneurysm somewhere in the 4.3-4.7 range. I don’t have atherosclerosis in my aorta. I’ve talked to a couple of vascular surgeons and a couple of cardiologists and tried to educate myself about both conditions. I had run for decades and strength trained pretty consistently for a few years before my diagnosis about a year ago. I continue to run and strength train. Here’s my take on **my** situation FWIW. There appears to be no concern about endurance training if you keep the effort below “hard”. These were the exact words said to me on several occasions. One of the cardiologists I spoke with (monitoring the coronary atherosclerosis) asked me why I’d want to run for an hour or two when I asked if it was OK. That gave me a good chuckle.

WRT strength training, the advice seems to be more muddled. I imagine because it is so hard to measure BP spikes during exercise. The rule of thumb I have landed on is to also avoid “hard” or “straining” (valsalva manuever) for the aneurysm. I never hold my breath. I try to keep the weight low by raising the reps and slowing the eccentric portion of the exercise. FWIW, my cardiovascular surgeon said at the size of my aneurysm, he doesn’t recommend any restriction of activity, but he wouldn’t recommend power lifting. (There are lots of videos online of people passing out after a hard deadlift or getting nose bleeds on a record attempt. I don’t deadlift yet.) I am more conservative than he is I think. I also have the impression that cross body movements are problematic — so chopping wood for example. Also contact sports are obviously out.

It’s hard to find guidance on exercising for an aneurysm. I’ve seen a few Q&A sessions here: https://www.aortichope.org/ with doctors that study the question of exercise with aortic aneurysms. I don’t remember the doctor names, but you should be able to find videos if you poke around on that site.

WRT growth, I don’t have any experience. I didn’t think that exercise was a real contributor, but I may be wrong. Mine has been measured twice, one year apart, and it appears to have grown .2 cm, which is a lot. Yet, the measurements in general are relatively inaccurate, so I think you need to build up a history to have a guess at its real size. I try to keep my systolic less that 120 and my diastolic less that 80. But that’s for the atherosclerosis, rather than the aneurysm. I think the high BP can damage the veins of some people. If you have any sign of atherosclerosis and are otherwise healthy, I think there’ s no reason to not get your BP down a little.

WRT surgery now, I also had that question. I gather it’s hard (and possibly unwise) to get a surgeon who would do the surgery if the risk from the surgery is not greater than the risk from the aneurysm. I asked my cardiovascular surgeon if I could get too old for the repair and he said “80 years old” is generally when they stop.

This is just how I’m handling my own situation. I may be dead tomorrow. 🙂 Hope this helps. Good luck!

I recently had an echocardiogram that showed that my thoracic aorta at 4.9 and an enlarged left atrium. I am a lifelong exerciser, including resistance training and cycling. I also have a high coronary plaque burden. My cardiologist said that we will follow-up in a year on the echocardiogram. I also have a couple of other heart tests in the works, a 14-day heart monitor for arrythmia and a CT heart angiogram in September. I don't know what to make of all this and have not considered reducing high intensity workouts, but maybe I should based on previous comments. At age 75, I don't want to unnecessarily push any envelopes.

I primarily cycle in Zone 2 (moderate level heart rate), but have been doing some high-intensity intervals a couple days a week. I do strength training 3 days a week with low weight/high volume and no straining except at the end of a set.

I'm 73 and 4.0 .weighs and walk/run. Age 80 seem pessimistic for me.🥺

With an aneurysm measuring at 4.9, you need to see a cardiologist at a major academic center that specializes in aortic aneurysms. Following up in a year with another echocardiogram sounds pretty "dicey" to me. I think that you are on dangerous ground if you follow this advice - just my opinion from our experience over the last three years and lots of reading of the medical literature. You definitely seem to be pushing the envelope particularly with your resistance training and the high plaque burden.
My husband is 80; his 4.8 thoracic aneurysm was diagnosed in 2021. He has been followed yearly (now) at Mayo with a CT angiogram with contrast. The echo is not as accurate as other modalities. My husband's aneurysm has been stable but the first year we came back every three months just to make sure it was stable.
Some surgeons would consider doing surgery with an aneurysm at 4.9 -- if other factors made it appropriate.
Best wishes and good luck. You need a second opinion from an expert in thoracic aneurysms.

I was also told by my cardiac surgeon that an echocardiogram is not as accutate as a CT Scan with contrast. My first reading back in December 23 was at 4.9 with an echo. The last CT scan in March was read at 4.6. I'm repeating another CT scan with contrast in September. I would definitely request a CT Scan with contrast.

I was 67 when had been diagnosed with a 4cc aortic aneurysm by accident. They were doing X-rays for a kidney condition when it was found. I was told they don't do anything until it reaches a 5. We did do blood tests, looked at family history, heart health, and an TEE. All was good. Let's get you scans once a year. A year later while waiting for the appointment card for scans I had an emergency aortic dissection and was life flighted to Mayo. I went to my ER because I was sweating quickly, lightheaded, and my eyes felt funny. Eventually I began to vomit. My Mayo surgeon said my aorta measured 4.5. I had three repairs done. My point is you never know. An aorta problem does not mean a heart problem. I have no heart problems. From what I understand is they want the blood pressure down so blood flow does not beat against the wall of the aorta. Sudden lifting raises the blood pressure. But when you walk, bike, swim, etc. and gradually increase your heart rate that is a different issue and it is good for you to keep active. I recommend you visit with your doctor and ask questions until you understand what he thinks would be to your benefit. I am now 70.5. I feel good. I walk, bike or swim daily. My weight wasn't terrible but I have kept 10 pounds off. I will live daily with it could happen again. But every day is a gift anyhow. This is an unpredictable condition. Trust your medical staff.