What do I ask ?

I can give you my perspective as someone with a 4.5-ish cm ascending aortic aneursym diagnosed a couple of years ago. First, sorry you are going through this. I know it's a shock, or at least it was for me. Importantly, 4.6cm is not near the typical dimension at which surgery is discussed. That is generally 5.0/5.5cm or greater unless you have a genetic condition. If you have family members that died suddenly of an aneurysm or unexplainably that would be an indicator of a potential genetic condition. There may be others. Your doctor should ask about this. If not, you should ask whether genetic testing is appropriate for you.

You should also ask about if/how she recommends that your activity be modified. My doctor only said "Don't become a power lifter", but that seemed a little cavalier. You'll hear widely varying recommendations on this. If you poke around on these boards, you'll find lots of discussions as well. As you can imagine, doctors vary in their degree of conservatism and knowledge about exercise. There's no definitive recommendation so far as I know except to avoid holding your breath while straining (the valsalva maneuver). It causes your BP to rise and high BP puts strain on the aneurysm and can cause it to continue to grow or, in a severe case, dissect or rupture.

Your doctor should ask about your BP. If you aren't taking it yet yourself, you should find a good BP machine and start. I use an Omron and like it. This would be useful information for your doctor at your appointment I'd guess.

Ascending aneurysms are treated with open heart surgery, so far as I know. There is work on using stents, but I don't think it's mainstream yet. Others may have more knowledge about it.

Try not to panic, though many do when they get the diagnosis before they meet with their doctor. I did. Remember she's the expert. You should be able to count on her to tell you what you need to know. Regardless, at the size of your aneurysm, there's time to become more knowledgeable yourself and to gauge her expertise.

If you want to read about it from a doctor's perspective, here's a useful link: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106. It's written for physicians, though, so it may be a slog.

@bitsygirl has pretty much covered everything I would have said. Vascular surgeons are often in the same team as cardiothoracic surgeons, as bitsygirl mentioned as far as we know the only effective treatment to repair an ascending aortic aneurysm is through OH surgery and that’s normally performed by a cardiothoracic surgeon. I may be wrong but endovascular surgeons normally do catheter type surgeries, stents, angiograms, etc which would be useful if your aneurysm was abdominal. But listen to her and ask that question, how many OH ascending aortic repairs she has done.

You are far from the surgery range, so in my mind you should find a good aortic disease specialist (cardiologist) that establishes the follow up protocol and is familiar with the type of care you need to have.

Lastly don’t be worried about feeling you are asking dumb questions, there are no dumb questions especially as they relate to your health, if you have doubts just ask whatever question comes to your mind.

Take care of your body, you want to be in the best shape possible if you ever need surgery

All the best

The good news is that your measurements are not at the point to require surgical repair right now. There are many people who have no idea that they have an aneurysm. I hope that you will consider yourself BLESSED to have found out now so that you can take every means avaialble to you to keep the aneurysm from reaching the surgical intervention need. It is possible that at some point in time, you may need to have open heart surgery as TEVAR ( minimally invasive-not open heart surgery) is NOT FDA approved for correcting a thoracic ascending aortic aneurysm. You should ask your surgeon what actions she recommends to PREVENT the aseurysm from enlarging. I have been told to keep my B/P below 120/70. Avoid very heavy lifting, regular exercise but NO holding your breath or bearing down requiring you to hold your breath. Get sufficient exercise, low sodium diet. She may want to put you on a medication to help lower your B/P as a precautionary measure. Look at your current health history and Family hsitory as she will be asking you about Family history of aneurysm, certain connective tissue disorders, chest trauma history, etc. This diagnosis is very challenging to deal with and the initial shock is an eye opener. I cannot emphasize enough that finding out about your aneurysm is truly a blessing. Best wishes and may you find peace in wisdom.

Interventional cardiologists usually do catheter procedures related to the heart and cardiovascular surgeons do open heart surgery. Interventional radiologists do catheter procedures on bronchial arteries etc. I have had all three.