When is the right time for surgery for ascending aorta aneurysm repair?

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Hi everyone,

I was diagnosed with an aneurysm of my ascending aorta almost three months ago now and I feel like nothing is happening very quickly with regards to my treatment.

It was an incidental finding on a CT-PA after I had been having some chest pains and episodes of shortness of breath and was measured at 51mm on that scan. I was referred to the cardiothoracic dept of a local hospital who (after losing the first referral) referred me back to a cardiologist at the hospital where I work. Since then he has done a 24 hour BP monitor, a trans-thoracic echo cardiogram, and two weeks ago a CT angiogram. This last CT measured the aneurysm at 52mm, and confirmed a functionally bicuspid aortic valve.

While I was having that scan the cardiologist told me that "if your valve is working ok even though it is bicuspid we like to string you along for as long as we can before doing surgery to replace it" which has left me rather confused and disheartened. When I was first diagnosed I was given the impression that I would have surgery to repair the aneurysm quite soon but now I don't know what to think.

After googling around the internet somewhat it appears that the "normal" rate of growth for a thoracic aneurysm is 1mm per year but it looks like mine has grown that much in just over two months! I'm worried that if the cardiologist decides on a "watch and wait" approach my aneurysm will burst before my next scan. I'm only 45 years old and was planning to start a family with my fiancé this year (we're getting married next June) but now I don't know where I am at all. I daren't even think about trying for a baby in case the increased heart rate causes my aneurysm to rupture or grow faster!

When I was first diagnosed, although I was shocked I at least thought that by the time of our wedding the repair would be done and I'd be fully (as much as possible) recovered. Now I don't even know if the surgery will have been done never mind any recovery. What's making it worse is that the consultant hasn't returned my calls or replied to an email I sent asking if surgery will be done this year, and I work for the same Trust / Hospital!

I've seriously thought about telling my fiancé to find someone else. She's 15 years younger than me and wants a family, the last thing she needs or deserves is to be married to someone with my health problems. I know she'd refuse of course but I just feel so awful for putting her through all of this, she deserves so much better.

Sorry, I've ranted on far too much. I only wanted to ask whether anyone knows if surgery is appropriate at 52mm or not.

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4 Replies

  • Posted

    Are you in shape or overweight, do you eat healthy, do you get headaches or migraines?
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    • Posted

      I'm overweight but not obese. I can't say I'm fit, I don't run anymore, but I can manage walking 2-4 miles with some chest pain and shortness of breath. I eat fairly healthily and I don't get headaches or migraines. I don't smoke or drink.

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  • Posted

    Hi thr,

    I had my aortic root repaired 12 week's ago at age 32. I also had my bicuspid aortic valve replaced with a tissue valve. When I found out about my aneurysm over 2 year's ago it measured 4.1 my surgeon said if it got to 4.5 he would consider fixing it as I was very active and fit and this aneurysm was holding me back. Last year it went from 4.1 to 4.5 and after looking at my ct scan results he left the decision up to me. He was willing to operate but would wait until it reached 5 if I so wished but it would mean restrictions on everything exercise etc. So i went ahead with the surgery and am glad I did. My surgeon told us after that my aneurysm was over 5 when measured during the op and they always allow for that when reading scans. If I were you I would sit down with your surgeon and ask plenty of questions if your still not happy get a second opinion. I met one consultant who would not consider surgery til 5.5 and gave me green light to go ahead with a pregnancy!! Im doing really well now and it hasn't bn half as bad as I thougt it would be. I will need surgery down the road again for my tissue valve at some point but will cross that bridge when it comes! You'll need surgery at some point anyways so why wait it's not going get smaller. Good luck with it all.

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  • Posted

    I read on WebMD "epair might be recommended if an aneurysm is 5.5 to 6.0 cm in diameter". My mom had an ascending aortic aneurysm and they waited until here's was over 6cm before they surgery. Her's was not fast-growing and she was in her mid-70s. I.has a 5 3cm aortic aneurysm and I had no idea I had it until it dissected.

    Your cardiologist should explain why thinks watching a fast-growing aneurysm instead of recommending surgery. If he can't or won't then you should get another cardiologist. I don't know where you live but your writing sounds like American English. You should be able to get a recommendation to another cardiologist from your primary care physician. You can always make an appt with a cardiologist without a referral nut insurance probably won't pay for the visit.

    Doctors are usually very good at what they do but are not known for being great communicators. The first step is to go to your current cardiologist with a list of questions and discuss then with him, not by one and take notes. I've taken a list of questions to my cardiovascular surgeon and my vascular surgeon more than once.

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