Ascending Aortic Aneurysm

Thanks for your input. I had my scan Sept. 24. My aneurysm has not grown appreciably since my April 20 scan. It's somewhere around 5.2 or 5.3 cm. I have been advised to have another scan in a year.

Frankly, I'm relieved. I was so convinced I would be booked for surgery after my last scan that I organized my whole life around the pending surgery. I know it won't go away, but I have a reprieve for another year, and I guess I'll just have to learn not to obsess about it until same time next year.

Few restrictions, few answers. The bottom line is, there's a lot "they" don't know. Number 1 is keeping blood pressure down. I now own a machine and am keeping a log as advised, but I've had lower than normal blood pressure my whole life.

I was fit, healthy, active. When the aneurysm was discovered, I stopped weight training. My jazz dance classes ended for other reasons. I continued yoga, pilates and walking. Nevertheless, the aneurysm grew .5 cm in the 10 months ending April 20, 2012. I couldn't help wondering why and stopped all activity except walking. The aneurysm did not grow from April 20 to Sept. 24. My surgeon told me not to do anything that strains the glottis. I believe some of the yoga and pilates moves were doing that.

I also wonder if my fairly frequent air travel was a factor in the growth. Two specialists have told me I can fly because airplane cabins are pressurized. A retired family doctor who used to practice aviation medicine said definitely I cannot fly. Cabins are only pressurized to 7,500 ft. and those long haul flights are flying at 30,000 to 40,000 ft. I'm going to play it safe and stay on the ground. Now I'm wondering if I should move back east where family and old friends are, since I'm kind of stranded here with no plane travel.

Does anyone have more information about flying and other restrictions?

Hi Kristina;

Welcome to the forum. Try not to freak out. (Easier said than done, I know.) It's a big shock to learn you have something that sounds so drastic when you didn't have a clue anything was wrong.

The first thing is to realize you have lots of time. At 4 cm, your aneurysm is just beginning and you won't know how quickly it's growing (if at all) until you have been monitored a few times - usually annually.

You are absolutely right to take a list of well thought out questions to your specialist appointment, and I think they appreciate it too. It results in the best use of their time and helps you focus and feel a little more in control. Research as much as you can before you go, and ask the questions that are important to you. Everyone is different.

Wishing you the best,
Ann

Thanks for writing, Frank. My aneurysm was only discovered because of a dry cough I had for 6 months. After a multitude of tests and examinations, I finally had a chest ct scan and there it was ..... a 4.7 cm ascending aortic aneurysm (now 5.3 cm). I was shocked! The cough mysteriously disappeared the very day of the scan and has not come back.

I've always had low bp and was very fit and active, but stopped most activities out of fear. I also stopped flying after the aneurysm grew so fast. I'm glad to hear you have been encouraged to keep active.

Ann

Hi DocRuckus;

Sorry to hear of your aneurysm, but glad to hear from someone in the medical profession. I was frustrated at first by the vague responses from my family doctor and others, then I finally realized they just didn't have definitive answers to my questions.

What is your opinion about flying with an AA? Most doctors I ask say they "think" it's ok to fly because airplane cabins are pressurized. One retired doctor I met by chance said I absolutely cannot fly. Those cabins are only pressurized to 7,500 feet, and long haul flights fly at 30 to 40,000 feet. He used to practice aviation medicine years ago in England. I'm listening to him because my AA grew much faster than anticipated within the first year after discovery. I flew 3 return trips during that year. I was monitored again 5 months later, during which period I did not fly, and it did not grow further.

I was also born with bicuspid aortic valve (I was however diagnosed at birth). I also have a dilated Aorta which is pretty common with BAV. I had my valve replaced this year (due to endocarditis) I'm 38. The plan was always to wait to replace the valve until the AA gets to 4.5 cm, then replace and repair. I couldn't have my aorta repaired during my valve replacement though, because of the infection. So the hope is that the new valve will help the AA not get bigger (less regurg) and will be able to hold off on repair until my current valve is ready to be replaced again in 10-15 years. (fingers crossed)

I run and bike. I'm crap at long distance, but have done several half marathons and for me that means a lot of walking. The rule of thumb for me has always been no isometric exercise, high rep low weight. Everything else is as I tolerate it. You are looking for shortness of breath, chest pain, dizziness with excursion. Cardio is good for everyone, and even more so for us! You want to be in tip top shape if you do have to go into a surgery!

Good luck.

I had a valve replacement in May of 2012. I went tissue and have a bovine valve. A mechanical valve wasn't really an option for me as I also have Crohn's disease and blood thinners for the rest of my life wouldn't work.

Good luck. Talk to your surgeon and make the right choice for you!

New to the site and learned about a month ago I had an aortic aneurysm, diagnosed by PET scan as 4.5cm. Follow up with Cardio Thoracic surgeon indicated it may be as large as 4.8 and follow-up testing later confirmed it is 5.1cm. Also found I have a bicuspid aortic valve so will be having surgery within a month. Given I am so close to surgery I will be limiting my exercising to walking and leisurely biking, but for most of the past month I didn't think I was so close to surgery and so I did quite a bit of reading about recommendations on exercise limitations. Some key points I'll share below:

From the Q&A at the end of this article:
http://www.uthsc.edu/cardiology/articles/thoracic%20aneurysm.pdf
"We recommend continuing any and all aerobic activities, including running, swimming, and bicycling. Regarding weight lifting, we recommend one half the body weight as a limit. We recommend against contact sports or those that might produce an abrupt physical impact, such as tackle football, snow skiiing, water skiing, and horseback riding"

My observations based on a study described in the book Acute Aortic Disease:
http://www.amazon.com/Aortic-Disease-Fundamental-Clinical-Cardiology/dp/084937023X
(You can see some of this from the look inside feature. I bought the book and consider it well worth the money for those with this condition)
The team documented 31 cases of extreme exertion related aortic dissesction or rupture. Aortic size ranged from 3 to 7.8cm, mean 4.63cm. What was surprising to me was that the cases involved people not only involved in heavy weight lifting, but: push-ups (2), intense swimming (3), Intense Tennis or Racquetball (2), shoveling snow (1), changing storm windows (1), moving heavy boxes (1), pulling hard against large dog (1).

From a Q&A with Lars Svensson, MD, PhD, Director, Center for Aortic Surgery, Cleveland Clinic:
http://my.clevelandclinic.org/heart/webchat/1145_thoracic-aortic-aneurysm.aspx
"wmurray8: Would you say that playing golf could be detrimental to someone with a 5.0 CM aortic aneurysm (ascending aorta)?

Dr__Svensson: While some people consider golf safe with aortic aneurysms at your size I would not recommend golf since I have seen patients develop aortic dissection"

(Golf?! There is other good info in this webchat as well.)

From this article (and in the book above), towards the end:
http://content.onlinejacc.org/article.aspx?articleid=1140497
From a follow-up study done with patients and surviving family members of people that suffered an aortic dissection or rupture: "Specifically, we found that a majority of patients could recall a specific episode of severe emotional upset" ... " or extreme exertion at the time of their dissection." (in fact the accompanying chart shows 27% of dissections were preceded by physical exertion and 40% WERE PRECEDED BY EMOTIONAL EVENTS! )

Also in this paper, probably the best brief description of this condition:
"The suscptibility to aortic aneurysm and dissection is set from birth by genetics. The aorta is destroyed over time, at least in part by excess proteolysis by the MMPs. The aorta enlarges as its wall is damaged. As the aorta enlarges, the mechanical properties deteriorate, with loss of distensibility and imposition of excess wall tension. An acute hypertensive event supervenes, usually emotional or exertional, and exceeds the tensile limit of the aortic wall, producing an acute aortic dissection."

It seems that intense exercise of any kind, even aerobic may carry some risks for those with aneurysms, though low level aerobic exercise is recommended. Emotional upset may carry similar or even greater risks. Everyone has to decide for themselves based on their specific condition, lifestyle, etc, but I think it is fair to say that those with this condition need to carefully consider their lifestyle and possible changes. It is my understanding that changes post-surgery may be required as well, though perhaps not as severe. That doesn't seem to be slowing down Jeff Green. After having aortic aneurysm surgery a year or so ago he is tearing up the court in the NBA:
http://espn.go.com/blog/boston/celtics/post/_/id/4703667/green-shows-heart-in-cleveland.


Don

I have bicuspid aortic valve disease and an aortic dilation as well (I'm only at 4cm). Had my aortic valve replaced last year, went bioprosthetic, bovine. The surgery and recovery wasn't to bad at all. I was running 7 weeks post-op. (I couldn't repair the aorta at that time as I had endocarditis)

I stay clear of isometric exercise. I run and bike. I listen to my body, if I'm tired I stop. I've found compression socks help me greatly for recovery and keeping me from becoming dizzy during exercise (stupid beta-blockers).

The last thing you want is to be in bad shape, particularly cardiovascular shape going into surgery.

I wasn't in great shape going into surgery, but I wasn't in horrible shape either. I was not a runner prior to surgery. I'm only 37.

I would say 4 months and I was fully healed, no longer in any pain (could sneeze with no fear) and most importantly, no longer afraid I was going to do something weird to my breast bone.

I came off the vent at around 12 hours post-op, moved out of ICU at 22 hours, was home 4 days after surgery. I could climb stairs after about 3 weeks, walking alone for several blocks after 4 weeks. Started driving and back to work (part time) at 5 weeks. Ran/walked my first mile at 7 weeks. Could ride my bike at 4 months.

I'm about to hit my 1 year surgery anniversary and I've run four 5K's. I was never a runner before. That's how much better I felt after replacing my valve. I didn't know how bad I felt until I felt great!

Don,
Based upon info from my cardio doctor, I have decided to go with a bio valve, if needed, despite the fact that with afib I have been told "Coumadin for life" which made me tend to previously lean towards a mechanical valve. My sister had surgery last year and they were able to repair the aneurysm and did not have to replace the valve. They are doing a genetic study, referencing a type of loeys-dietz. Obviously a genetic defect, because our respective ascending aortic aneurysms are in the same place, but her pre surgery symptoms were much more severe than mine at the same size. I can still bike and do some distance, while she would get winded simply walking. My prior leaning for a mechanical valve was because I have every intention of continuing to bike which might cause accelerated wear of a bio, and was not looking forward to another surgery for replacement. As far as connective tissue disorder, I have recently sprained my thumb and ankle neither of which were associated with trauma or related causes. Constant back pain as well. Thought others may have noticed similar symptoms. Still able to bike however.

Good Morning All,

This is Kitt , one of the moderators for this forum. 

I've missed welcoming several new members as I've been dealing with health problems  so I thought I would do a big shout out welcome to all new comers. Glad you found us but sorry you are suffering with cardiovascular problems and treatment concerns.

It is good to see each of you sharing your own personal info with one another.  You have my support and please know that you'll find much support, encouragement and advice from others who understand.

Again a warm welcome to all,

Kitt