Ascending Aortic Aneurysm

Thoracic aortic aneurysms may be diagnosed by echocardiogram, and this technique is often used to screen family members of those with thoracic aortic aneurysm. An echocardiogram is often used to check for aneurysms in someone with Marfan syndrome. An echocardiogram uses sound waves to capture real-time images of your heart in motion. Echocardiograms show how well your heart chambers and valves are working. Occasionally, to better see your aorta, your doctor may recommend a transesophageal echocardiogram — in which the sound waves are generated from within your body by a device threaded down your esophagus.

Computerized tomography (CT) scan. This painless test can provide your doctor with clear images of your aorta. During a CT scan, you lie on a table inside a doughnut-shaped machine. Detectors inside the gantry measure the radiation that has passed through your body and converts it into electrical signals. One downside of the use of CT in detecting and following aortic aneurysms is the exposure to radiation, particularly for patients who require frequent monitoring, such as those with Marfan syndrome.

Marfan syndrome is an inherited disorder that affects connective tissue — the fibers that support and anchor your organs and other structures in your body. AS you never mentioned Marfans I am guessing that is not one of your problems........Hurrah !

In your case it would make sense for your Dr. to look at all the test results as well as your over all health and put all the pieces together before doing any surgery.

Be well,

Kitt

nightingale57,

Your latest advice from the Dr. is alarming for you I am sure and is a contradiction from what you have been led to believe.  You have the right to vent and this is a great place to do it.  Also this topic gets lots of reads even thow everyone does not post. 

Seeing the right Cardiologist is 100% correct and sadly it is hard, sometimes, to know if you have the right physician.   The definition of an aneurysm may be based on comparison with the normal blood vessel size for an individual. When the permanent enlargement of some part of a blood vessel is at least 1.5 times greater than normal size, it may be termed an aneurysm. Applying this to the aorta, if an individual's normal aorta is 2.5 cm, then dilation of 3.75 cm or greater represents an aneurysm in that person. A variation of this defines an aneurysm when the enlarged aorta is at least twice its normal size.  

 

The above is the criteria for identifying an aneurysm not indicative of when you need surgery, however, if you feel your new Dr. has the most experience  and is top notch in his field than I would be leaning towards taking his advice.

 

I am happy to know you are advocating for your self and remember vent away here.  We have your back.

 

Kindly,

Kitt

Wow, Nightingale. I can sure see how this would really knock you for a loop. Thank you so much for sharing the information, even while you’re reeling. I remember that you have been through this once before and I’m sure that makes it even more unnerving when it is ‘different’.
I am pretty new to this process, and I find that one of my coping mechanisms is to find out as much information as I can, and inevitably from my layperson education, I am anticipating what the professional advice will be. It is unnerving when a doctor seems to have a different take, but if he is the one working and studying this specific problem, I can see leaning toward his assessment, even if it is the toughest. It also seems to be a lot of clinical information and changes in treatment and monitoring of ascending aortic aneurysm, I think because the surgery is becoming more and more successful. I have seen articles discussing taking into account height of a patient in determining the ‘magic’ number, so it makes sense that the actual size of your aorta would be a factor. I’m glad that you are getting advice from someone very knowledgeable in the field because it has changed a lot in the last 10 years and will be continuing to advance.
AZDon referred me to this good article about changes in assessing the size of an aneurysm and evaluating ‘when’ to operate. I found to be current, nuanced and not to technical to read.
http://content.onlinejacc.org/article.aspx?articleid=1140497
I’m glad you have family around to take your mind off this tough news. While the anxiety is always simmering, I’m amazed at how often I really do forget about it all—especially when I’m with people I love, doing things I love to do. Have a good weekend and vent away when it boils over.

Ralele,

Thank-you for your excellent referral of the article from the jacc. I've spent the afternoon looking for current information and found another article that you and anyone else reading this might find helpful.

http://www.update.com/contents/management-and-outcome-of-thoracic-aortic-aneurysm

You're right, information is empowering.

LastBanana,
I am sorry to hear your news, and I certainly understand the exhausting part! My surgery to repair my ascending aortic aneurysm is scheduled for 09/12/13. I did get a second opinion. I looked at large medical centers in my area and then researched the cardiothoracic surgeons on staff for those specializing in ascending aortas. Good luck to you, and please let us know how you are doing.

I know what you mean. I haven't told my 89 year old mother yet, I'm waiting until a week before my surgery. She'll tie herself in a knot if she has too long to worry about it. I'm not looking forward to that conversation. Still, I am ready to be on the other side of this.

nightingale57,
Please keep us updated. Can I ask, how old are you and what is your general health?
All my research shows at 4.5 one should wait unless there are other factors. Rate of increase in size, symptoms, age, health, other conditions of the heart such as valves.
One doctor I spoke with told me to wait under 5cm as long as possible since medicine is improving every year.
I know every situation is different, but there must be another reason other than 4.5cm that they have decided to operate.
What was it?

Ralele,
Exactly. When to have surgery is the hardest decision. Unless you fit into the higher percentage for rupture,
see my line on my last post, keep your bp down, lipids good and stress free. Easier said than done, I know.
The longer you can wait, the more medicine will improve. Thats what my cardiologist told me.
Was thinking of you as well Nightingale57. Fingers all crossed here.

I just noticed the article I cited in one of my previous posts, I gave the wrong address. It should be www.uptodate.com/contents/management-and-outcone-of-thoracic-aortic-aneursym. Very good information.

nightingale57,
Perfectly explained. Should go text book. We will let you rest for a while but look forward to hearing from you.
Im at 4.5, was 4.3 last year. My insurance company turned my gated MRI down and said a echo should be sufficient. Hopefully I will win on the appeal, even the Cardiologist says they need to be accurate.

Post Edited (ZDAD) : 9/16/2013 7:06:57 PM (GMT-6)

Hello everyone! Well, I'm almost 2 weeks post-op.  I've been home since
Sunday. Would have been home sooner, but they had trouble with my blood work for my Coumadin dosage which most of you won't have to worry about.  I can tell you all, hang in there, you will be okay. Pretty freaky stuff, I had 15 minutes of hypothermic circulatory arrest time! I am taking 3, 20 - 30 minute walks a day.  Pain control is not an issue, it isn't terribly painful once they take out the chest tubes. LatBanana, you are exactly right, nothing like being on the other side of this.  Please keep us updated on your surgery.  ZDAD, hope you win your appeal, gated MRI or CT scan definitely needed for accurate diagnosis.

nightingale57,
I just re-read your post and saw that you're walking three times daily. How tiring is that at this point? A friend of mine had aortic valve replacement last December. He and I had a long talk last week and the impression I came away with was he was surprised by how weak the surgery left him for several weeks.
Again, I'm very happy you came through the surgery and are on the road to recovery.