Newbie question: dilatation ascending aorta and aortic root

[whatsnext]

Hi, I'm new to the forum and would like any info possible before meeting with a cardiologist. To introduce myself, I'm a 57-year-old female. On one-year follow-up from breast cancer diagnosis and treatment, I had a chest and pelvic CT scan. The chest CT indicated "a mild dilatation of the ascending aorta and aortic root, with the ascending aorta measuring 4.0 x 4.1 cm." However, a chest CT from April 2013 did not indicate any such enlargement. My onc said this could be that the person reading the scan did not think it necessary to mention and advised me to follow up with my PCP or a cardiogist. I've done a little research on this issue, but I have few questions. Are the terms "dilatation" and "aneurym" synonomous? Is this indeed mild? Could it have been there last year? And if not, should I be worried? And probably most importantly, what questions should I ask the cardiologist when I meet with him? Thanks so much. It's a little disheartening to be relieved on the oncological end only to be thrown into the cardiological arena.

 

[Superbob]

Hi, I'm new to the forum and would like any info possible before meeting with a cardiologist. To introduce myself, I'm a 57-year-old female. On one-year follow-up from breast cancer diagnosis and treatment, I had a chest and pelvic CT scan. The chest CT indicated "a mild dilatation of the ascending aorta and aortic root, with the ascending aorta measuring 4.0 x 4.1 cm." However, a chest CT from April 2013 did not indicate any such enlargement. My onc said this could be that the person reading the scan did not think it necessary to mention and advised me to follow up with my PCP or a cardiogist. I've done a little research on this issue, but I have few questions. Are the terms "dilatation" and "aneurym" synonomous? Is this indeed mild? Could it have been there last year? And if not, should I be worried? And probably most importantly, what questions should I ask the cardiologist when I meet with him? Thanks so much. It's a little disheartening to be relieved on the oncological end only to be thrown into the cardiological arena.

Yes "dilation" is basically medspeak for enlargement, and an abnormal enlargement is an aneurysm.

For years, I was told I had an "enlarged heart," which some docs even attributed to my being involved in a lot of sports.

But at age 63, a cardiologist found that my congenitally leaky valve had contributed to serious dilation of my aortic root, and I needed to have both replaced -- root and valve.

My understanding was that a dimension of 5.0 cm was usually the trigger point for having surgery to prevent dissection. Mine was done when it had reached 5.3 cm. The critical sizes vary according to the overall size of the person. It may be that 4.0 is enough to be regularly monitored, but not necessarily at the size yet for surgery (and maybe that day might never come). But obviously, don't take my word -- the doctors can evaluate this according to your own physical proportions -- somewhere between 4.0 and 5.0 might be time for replacement surgery for you (again, if that time ever comes).

Meanwhile, I know it must be stressful to deal with this on the heels of the cancer challenge, but I hope you will be reassured to know that the valve and root replacements are done with a very high rate of success. Best wishes to you.

 

[workmonkey]

Hello - My suspicion would be the same as your oncologist's, which is that 4.0 x 4.1 is at the lowest limits considered a "dilation" so whoever analyzed the scan didn't think it was worth noting (especially as the exam wasn't for that in particular). The newest guidelines from the AHA have raised the trigger point for aortic aneurysm surgery to 5.5 cm in many cases, so you really don't have anything to worry about at this point. At the typical rate of growth for an aortic aneurysm, it could be years and years - if ever - before you'd have to be concerned (especially if you are managing blood pressure properly). The word "aneurysm" is scary but often misunderstood (which is why "dilation" might be better), but is common and easy to monitor once diagnosed. As your oncologist said, you should follow up with a cardiologist to keep this on the radar (i.e. make sure your valves are in solid shape) and just generally put your mind at ease. But don't stress in the meantime. You'll find plenty of people on this forum in a similar situation.

Best wishes for continued health!

 

[mbeard]

SuperBob and workmonkey's advice and description of the enlarged aorta is great information. This forum is a blessing to us who may be diagnosed with these heart valve issues.

 

[Ryan CA]

Hi Whatsnext...welcome. I have gotten a ton of enlightenment and piece of mind from this forum, so I hope to be able to pass some of that on....Of course, I am not a doctor, but my ascending aorta is measured at 5.0 to 5.1 and I have been riding a mountain bike for years with no ill effects. Typically 4.0-4.1 is nothing alarming to a cardiologist and even though its only a 1 centimeter difference from 4.0 to 5.0, that 1 centimeter takes a lonnng time to develop in most cases.

I guess what I am trying to say is don't let it freak you out just yet!

 

[AZ Don]

Hi, Welcome to the forum. You will find a wealth of information here from people that have been (or are in) similar situations. Like you it was follow-up testing for cancer that found my aortic aneurysm just a little over a year ago. I was already at the surgical criteria which was 5.0cm at the time but as mentioned above is now 5.5cm in most cases. The way I look at it, I'm one of the few people whose life was saved by having cancer as larger aneurysms are much more likely to progress. The good news for you is that now that you know about it you can have it monitored. It could be a long time, or never, before anything needs to be done about it. I understand very well the frustration to get the news that there are no signs of cancer only to find you have another medical condition, but the cure rate for diagnosed aneurysms is much higher than that for cancer.

I believe that 4.0 to 4.5cm is considered dilated and 4.5+ is considered an aneurysm. The difference is just a matter of severity and I would say that yours would definitely be considered mild.

Questions for your Dr:
- What testing is required and how often? (typically echocardiogram every year)
- Do you have any co-morbid conditions, such as Bicuspid Aortic Valve (BAV), Marfan's syndrome, etc? (Something like 20% of those with BAV develop aortic aneurysms. Not sure what percent of those with aneurysm also have BAV. Marfan's is rare but would likely influence the follow-up schedule and surgical criteria).
- Should you modify your lifestyle in any way? (at 4.1cm I think most Dr's would simply say no. For larger aneurysms some Dr's would say to avoid heavy lifting, and possibly other intense exercise or stress)
- Is there anything that you can do to reduce the chances of progression? (If your blood pressure is high your Dr. may want to do something to control it. There is some speculation and anecdotal reports that the blood pressure medicine Losartan may slow or stop aneurysm progression. This is currently being examined in a couple studies but is as of now unproven).

 

[whatsnext]

Thanks all for your quick, informative and caring replies. I'm actually not freaking out but just didn't want to have to deal with something else. I certainly didn't have that sinking-in-the-stomach, end-of-the-world feeling like I had last year at this time. LOL!! It was definitely fortuitous to have this show up on a CT taken for a different purpose.

A couple other questions. I've made an appt with a cardiologist for May 2. As far as knowing whether I have a BAV, wouldn't it have shown up on the CT scan? I had an echo in my late 20s which showed a MVP without regurgitation (it's been pretty much asymptomatic). Wouldn't a BAV have shown up then? Also, I'm an identical twin. What ramifications are there for her? I hear this can run in families and other family members need to be checked. Have any of you found that to be true? Also, I've had my onc's office send both the April 2013 and April 2014 scans for comparison because I've read if there is a change of .5cm in any given year, then surgery might be also be indicated despite aneurysm size. Also, about proportions: I'm 5'2, 135 lbs. What would my "normal" be? I've read 2.5-2.86 for women.

And, lastly, thank you again for allowing me to be a member and bombard you with questions. After I submitted my registration request, I realize this is about VALVES and I'm not sure I meet that criteria, but am glad you have allowed me to participate. You've eased my mind.

 

[AZ Don]

BAV is the most common congenital heart condition, so many here have BAV. Since something like 20% of people with BAV have aortic aneurysms then I think there are many here that have (or had) aneurysms so I certainly think it is a fair topic for discussion and it is often discussed. I think something like 20% of the people with aortic aneurysms have family members that are also affected. Your immediate family: parents, siblings, kids should all be checked. None of my relatives had aneurysms or BAV but I have heard of families with multiple people affected. I'm not sure if a CT scan can diagnose a bicuspid valve and the echo is somewhat imprecise so mistakes can be made. Re. normal, my surgeon showed me the cross section of my aorta on a CT scan. He was able to move along the aorta and show the dimensions where there was no aneurysm, and the dimensions where there was. So your Cardio should be able to show you or tell you what your normal is. Some Dr's have created guidelines for surgical intervention that accounts for body size, but the most recent Guidelines for Valvular Heart Disease (which talks about aneurysm criteria associated with BAV) states:

The writing committee also does not recommend the application of formulas to adjust the aortic diameter for body size

I expect some Dr's may disagree. You can find the guidelines here: http://content.onlinejacc.org/article.aspx?articleid=1838843

 

[chaconne]

whatsnext,

I can sympathize with your situation, since 2 years after being diagnosed with stage 3a Melanoma, I found out my long standing heart-murmur was calling for valve replacement surgery. It's nice to have one thing taken care of before you go on to the next. In my case I didn't know if my cancer was clear, so having to balance that against the need for heart surgery was very stressful.

It sounds like you've beaten the cancer and and aorta of 4.0mm sounds mild to me (mine was a 4.7cm aneurism, and growing). The valve -related heart surgery stuff is definitely way less risky and stressful than the cancer.