Doctor Q&A: The Progression and Surgery of Dilated Aortic Root Aneurysms with Dr. Luis Castro

[@taryn330]

i’m cooked. i have a dilated aortic root at 16. i also have bicuspid aortic valve

[@Katesac]

Dr. Trento at Cedars in LA saved a family member’s heart/and life. Multiple valve replacements, over 75 years old.

[@chrispowers4704]

At 16 years old , that's pretty young for that. Talk to the dr , or have parents bring it up if you need , in front of you and the dr. Have them address all your concerns. I am 51, and I was just told that I have one also at the ascending aorta 4.3 . The good news for both of us . Is that they don't grow that fast typically. So it could just mean getting tests to look at it every year to make sure it isn't getting too big. From what I researched so far most of them barely grow .1 of the number they are quoted as per year .

[@paullanfear5762]

I've had a bi-cuspid since birth. I was a keen road cyclist and have also lifted weights since my late 20's (fairly heavy - eg squat 140kg for 8 reps... benched over 100 for reps) - i am now 54 and mine is now 42mm. I have been monitored every 5 years since age 42, but recenlty i now have to be monitored every 3 years. Don't despair! The medical bods tell me to lift "light weights"... as long as you are monitored.... and dont do heavy weights - eg no single lifts where you're lifting your maximum and straining... I think Jan Pall Sigmarsson died doing VERY heavy deadlifts. I was advised low intensity cardio is good for bi-cuspids. A good diet too! And definately consume vitamin K2 which allegedly helps to deposit calcium in the right places (ie not in your arteries and bi-cuspid). This isnt medical advice, but gives you something to look into - do your own research! Hope this helps. Good luck from the UK.

[@HeartValveSurgery]

Why do you think you're cooked? We know of many patients who had aortic valve and aneurysm surgery and live great, wonderful, long lives.

[@phucyutoob6477]

Is it possible to have a mild dilated aorta without having an aneurysm?

[@HeartValveSurgery]

Hi Phucytoo, Great question. Unfortunately, I do not have a great answer for you. That said, I will put this question into our educational queue. The next time we meet with an expert in this space, I will ask your question and do my best to get an answer (hopefully on video). Sound good?

[@teru797]

@@HeartValveSurgery Any updates or answers?

[@kchilz32]

I was informed last night I need my aortic root replace but sparing my valve in a few months. I’m in Massachusetts what hospital/surgeon would you recommend for valve sparing aortic root replacement? I have Marfan syndrome

[@HeartValveSurgery]

Hi KChilz, Nice to meet you. Yes, it is very important to find a doctor with a lot of experience when it comes to valve-sparing root replacement and Marfan's syndrome. You can learn about this procedure and surgeons that specialize in that procedure at HeartValveSugery.com. Here is a link you with resources specific to valve-sparing aortic root replacement - www.heart-valve-surgery.com/search.php?q=valve-sparing.

[@TheHardCorePunkHead]

My aortic root aneurysm is 5cm. Currently in "Watchful Waiting" until it gets to 5.5cm. I love cycling, but exercise has been curtailed 🥲

[@donttalkwet1]

Mines 4.5. I've been told not to lift any weight. Only in very early 40s. Bit scared

[@donttalkwet1]

@TheHardCorePunkHead hey how come you can't cycle or exercise anymore?

[@EliForPr3z]

​@@donttalkwet1mine is 4.8 cm last I check. I have a follow up next month. Soon I'll know if mine has grown or stayed where it's at. I cycle, jog and do light weights.

[@donttalkwet1]

@ElijahForPrez I'm gonna do similar to you but lift very light weights

[@MYLGAMING12]

​@donttalkwet1 same just hit 40yr and at 4.6

[@valhovanesian9747]

I have a 4.6cm im womdering how Desmond is doing now and what treatment he went through.

[@darroz3146]

How old and how tall are you?

[@HeartValveSurgery]

Last we heard... Desmond is doing great!

[@amatt4776]

Hello Dr Castro, I too am a physician, but in surg onc, not CV surgery like yourself. I am 37 years old, 6 feet tall, 230 lbs, with low body fat and a former power lifter. I have thoracic aortic ectasia, measuring 4.0 cm on cardiac CT, and an echo from 3 years prior, measuring 3.9 cm. I am aware that larger, power athletes tend to have larger thoracic aortas, partly due to their larger frames but also, potentially, the result of vascular remodelling from years of lifting and valsalva meaneuvers. My question to you is, should I avoid these power focused exercises? Or should I simply monitor and make any changes of my exercise routine based upon signs of progression?

[@HeartValveSurgery]

Hi Amatt4776, Great question. Unfortunately, Dr. Castro does not actively monitor or respond to patient questions at KZbin. That said, we would encourage you to discuss your question with your medical team. If, however, you would like to contact Dr. Castro, you can obtain his information at this link - www.heart-valve-surgery.com/surgeons/dr-Luis-Castro-Redwood+City-California.php.

[@teru797]

yes def avoid weight lifting.

[@ryan041984]

I’m 39 with a dilated aortic root of 4.2cm at the maximal transverse diameter via cta, with a overall growth of about 2mm over the past 7-8 years. Each diagnostic conclusion mentions no aneurysm, only dilation. I thought the two were interchangeable? My cardio still does biannual surveillance and have never been told aneurysm, only dilation. I’m 6’3” and am scheduled for cta in a few weeks

[@MRAIDANGWALSH]

Do you have any connective tissue illnesses like EDS or Marfan's?

[@ryan041984]

@@MRAIDANGWALSHnot that I’m aware of. I’ve mentioned this to cardiologist and he doesn’t seem to think. I did do an ancestry DNA heritage testing a few years back which was negative for fb1 genes and ehlers danlos. Who knows. It’s very frustrating never getting even a hint as to why or what I can expect in the years to come

[@cliffg4437]

Aneurysm is technical 150% of normal diameter, and they are often not mentioned (even at 4.6 cm mine was still 'dilated'), possibly for fear of frightening the patient. But basically anything above 4 cm is an aneurysm.

[@cliffg4437]

By the way, get seen by a proper aortic centre. A straightforward Cardiologist will follow the Guidelines but these are always behind the latest understanding that real aortic specialists have.

[@ryan041984]

@@cliffg4437 I saw your other post that yours dissected at 4.6. Were you already aware of its size and were you being treated with meds? BB, ARBs prior to its dissection?

[@pezzermra]

My Aorta diolation is currently 5.3 I am having more scans soon. Here in UK. I know I am facing surgery

[@sherrid5315]

Is it at your root? And did it take a while to grow mine is 3.5 I see the heart doctor again March 8 🥹

[@captainplanet1260]

Mines 5.6cm. Found out very recently. Whats your experience like in the UK?

[@captainplanet1260]

@Russia Bro Z (You know, like Dragonball Z lol) I'm 38. I will refuse surgery. Its my belief that the heart adapts to stresses like any muscle in the body. I used to be 126kgs bw... very muscular with LVH and diastolic dysfunction, A recent mri says that has drastically reversed but the Aorta is now dialated, Potential causes for it were (Stress+ covid + lifting too heavy natural). With just a few lifestyle and perception changes I already feel far better and can Skate, Jog and much more without any issues. My current bw is 96kgs. In my opinion and don't adopt it as your own, surgery if you don't have Marfan is pointless and dangerous. Modern medicine seems to be completely convinced that the body cannot heal or adapt at all in any way without being cut up or dosed up. Maybe I'm a dumb ass and will drop dead suddenly some day soon. But strangely my instincts tell me nope. Just don't let this stress you out, negative thinking is of 0 use to you... and anxiety can go fk itself. Remove the causes and the problem will be resolved. If your an athlete like myself/I was, your aorta will be larger than sedentary peoples anyway. More powerful engines require larger injectors and exhaust systems. Harvard have some great papers on this, that most cardiologists wont even be aware of for 10+ years.

[@whatsthatnow7466]

Diagnosed with mine last year, I think the covid spike protein has everything to do with it. I also think building collagen, atp by adding copper, boron, silica, and getting rid of the dang spike protein will help.

[@captainplanet1260]

@@whatsthatnow7466 interesting that you said this. How did you feel after getting covid?. Any vertigo or lethargy

[@rogerbrandon629]

Hi Dr Castro my name is Roger Brandon. My height is 58 I weigh 197. I’ve had a enlarged aortic route for many years. It’s been at 4.2 to 4.6 now the day I found out that it is 5.1 at the aorta group coming from the aorta how serious is that and when do I consider surgery?

[@rogerbrandon629]

5/8 my rate is 197 I am 66 years old

[@HeartValveSurgery]

Hi Roger, Dr. Castro does not actively monitor the HeartValveSurgery.com KZbin Channel. That said, we would strongly encourage to discuss this issue with your cardiologist at your earliest convenience. You can learn more about guidelines for aorta treatment at www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/11/01/12/21/2022-guideline-on-aortic-disease-2-gl-ad. We hope that helps!

[@randyvann677]

Randy in WI. I have the exact situation. except 6 months ago I was at 4.7. I expect I'm headed to the table soon.

[@teru797]

@@rogerbrandon629 Hey man how is it going? How fast did it grow? Any updates?

[@iandarlpow8830]

I am not sure if this is the correct forum to ask this question. I have had an aortic valve replacement. A 20mm Edwards valve. I'm not sure what model. I am due for a replacement and want to know whether a valve in valve is possible would the valve opening of the new valve be reduced radical

[@AndreaHillcreator]

My husband had the Onyx valve for aortic valve replacement- he must maintain a weekly INR score between 1.5-2.0 . So far he is doing great- however we will always have to monitor his aortic root for swelling- he had one side already repaired and the doctor told us that the other side would swell and we would have to repair that side as well.

[@HeartValveSurgery]

Yes, there are some patients that can have valve-in-valve therapies but it would be best that you contact your medical team to discuss this.

[@TABREZKHAN-jx8su]

Hi dear MY Accendung arota size is 5.2cm, my age is 40b, now the question is what I should do, should I go fir surgery or it can cure with Medicine, kindly reply.

[@EliForPr3z]

Mine is 4.8 at the root. It's crazy because I don't smoke or drink and it's very healthy and active at 5'7 age 38. Well to answer your question the doctor will monitor you every 6 months to a year to see if it grows or stays the same. Also put you in beta blockers and restrict you from smoking, drinking heavily and lifting heavy weights. If the size gets to 5.5cm- 6.5cm then it is considered critical size and surgery will need to be done.

[@chrispowers4704]

In 2023

[@chrispowers4704]

There was revised guidelines in 2022. Aneurysms of 5 to 5.5 are big enough to consider surgery now.. There are other factors that come into play for reasons to do surgery before it hits 5.5. Please talk to your Dr about this and see what is best for you. If your dr isn't helpful. Get another one.

[@HeartValveSurgery]

Hi, We would encourage you to see your medical team about your aneurysm.

[@GSSVideos]

I have had open heart surgery in the middle of lockdown at the Royal Papworth Hospital in Cambridge in the uk 🇬🇧 I had to have my aortic root cutaway and replaced i’m really like to exercise, but don’t know what I can do that won’t affect my heart condition?

[@nicholashernandez1375]

Walking cycling and swimming

[@judyfoster5802]

contact your local Cardiac Rehab department :)

[@HeartValveSurgery]

We would encourage you to speak with your cardiologist and surgeon to determine the best next steps in your treatment and your exercise.

[@irmaalvarado2360]

I have diabetes type 2. Just had open heart surgery in May 2024 (two blocked arteries). While I was recovering, they did scans and advised that my aorta is enlarged 4.5. They will monitor. Will I be a candidate for surgery given that I’ve had open heart surgery already?

[@HeartValveSurgery]

Hi Irma, Great question. Yes, reoperations for cardiac conditions are possible. That said, we would encourage you to discuss this with your medical team to determine the best next step in the treatment process.

[@captainplanet1260]

Mines 56mm/5.6cm at the root. Feeling fine but anxious since the news. Acquired via a random MRI. Age 37 5.11" height 205lbs muscular. Living in Ireland so Surgery or similar can just that get kicked down the road.

[@EliForPr3z]

Mine is 4.8cm at the root. I'm 36 and very active myself and in good shape. Not sure how I got it since I don't smoke, rarely ever drink and never taken drugs in my life, but just as you are I am also very anxious and anxiety is off the roof. Hope your surgery comes successful my friend. My name is Elliot and im from the US

[@captainplanet1260]

@@EliForPr3z I'm not getting surgery. Huge risk for potentially no gain. I'm fine with the 5.6cm if its even still at that size. Ireland is so slow and backwards that its DIY or die here, I had a flu during my MRI which may have contributed to the readings, it was very hard to hold my breath over and over during the MRI. perhaps I'm an idiot but I believe the heart responds and heals just like any other part if the body. I never smoked, don't drink, never used drugs and I eat healthy. Athletes have larger Aortas recent studies are starting to discover. years ago when I had LVH I was told the same hypochondriac crap from specialists my LV wall was 19.7mm at the time... 3years later my hearth had responded to my lifestyle and was 14.3mm. I had lost 70lbs of muscle+fat. My research suggests Don't lift to heavy, keep stress minimal by focussing on achieving goals and pursuing knowledge, keep diet clean and nutritious, have a positive perception and your heart will adapt. I'm training light, easy l.i.s.s cardio, but I'm stressed out of my mind due to the dicks incharge of this country ruining the place but otherwise no pain no limitations... nothing. When I had LVH it was much worse, edema in the legs brain fog, chest pains etc, this is going to sound insane but men we have a certain organ that swells up in response to certain external factors yet said organ also contracts/shrinks right back down afterwards the Aorta made up of similar elastic tissues , if you have Marfan syndrome its a very different story but my belief is what can be done can be undone.

[@captainplanet1260]

I was advised to get surgery on my back age 25 when I got a compressed vertebrae... I didn't listen and just began training... good mornings, light deadlifts to build the supporting muscles of the spine etc I'm 38 now and I skateboard and rollerblade, weight train and much more and I don't mean just rolling around I mean flips down steps, grinding ledges etc, serendipitously for my perspective I met a lady in a wheelchair at a market about a year ago...we got chatting and the subject of how she had a sky diving accident resulting in a compressed vertabre arose, she said she could walk and function with it at the time but her nerves would hurt from time to time, then she took the advice and got the surgery, the compressed vertabre was removed and the above and below vertabre fused together via pins/plates, 3 follow up surgeries later due to complications and she has been in a wheel chair since. Bottom line is... Learn from the lessons of others. Anxiety is a bitch, I've had girly moments/anxiety since my childhood... gratitude and creativity seem to decrease anxiety to the greatest extent. Pick 3 things each day that your grateful for and write or say them out loud. + Being creative alters brain chemistry and lowers cortisol. Painting, writing, creating businesses, planting forests, designing products etc create a purpose, outlet and a sense of accomplishment and at no time can your mind wander to negatives because its too busy achieving. Take the advice of your doctors but also listen to your body and intuition. Medicine/medical care is a business just like auto mechanic's or animal agriculture but instead of cars and cattle we are the valuable commodity. Its easy for a personal trainer to sell you a program if he convinces you that your a fat fk as it is for a specialist.... if you get my drift. Relax though I'm a good few months into this and its honestly sweet fk all. I bet you've no occlusion in your aortic root? (Should say on your mri results)

[@valhovanesian9747]

Did you follow up since?

[@cliffg4437]

Well, best of luck! I was all the things you describe, and not Marfans etc. I dissected at 4.6 cm. I wish I had even had the offer of preventive surgery. The dissection was completely life changing. I wouldn't wish my experiemce on anyone. The 5.5 or 5.0 cm diameter is entirely statistical, there is no proper science behind it, and there are plenty of outliers. A friend of mine dissected young and his life was saved at the Mater hospital i Ireland, so it's not true that everywhere there is behind the curve. Find someone who knows what they are talking about, at a major aortic centre. Elective surgery is ALWAYS better than emergency surgery.

[@rogerbrandon629]

If I have an aortic root at the base coming from the aorta is 5.1 when do I consider surgery?

[@thebests3153]

They normally say at 5.5mm or if it grows more than 3mm in a year.

[@HeartValveSurgery]

We would encourage you to speak with your medical team about the size of your aortic aneurysm.

[@MRAIDANGWALSH]

What happens when an ascending Aorta has dilation & the person has also AFib recently diagnosed? Can the ascending Aorta be causing one's AFib? thanks for the info & video, Aidan xx

[@edwardenglish1519]

That describes myself.

[@MRAIDANGWALSH]

@@edwardenglish1519 They now found something else thinking it may not be Afib, they mentioned (PND) Paroxysmal Nocturia Dyspnea/Orthopenia/Dyspnea issues with oxygen/mucus, some say it indicates heart failure

[@HeartValveSurgery]

Great question. We do not know the answer but we will do our best to find out. Thanks!

[@Mb44069]

I am a 17 year old with a dilated ascending aorta, and wanted to know if I'm able to go to the gym, because I am desperate to build muscle and get big.

[@sherrid5315]

What size ? My doctor never gave me any restrictions. Just on two cholesterol meds and watch my diet. Your awful young. Good Luck 🍀

[@sherrid5315]

And aspirin

[@Mb44069]

@@sherrid5315 3.1 cm

[@sherrid5315]

@@Mb44069 Mine is aorta root . Is it your root? If so that’s fairly small. My mothers was her stomach and she did not want surgery to complicated because she had many health issues. And they didn’t find my brothers until it was getting ready to rupture at 10.1 and had to take him to a different clinic and have emergency surgery. He never knew he had it.

[@captainplanet1260]

@@sherrid5315 I was a bodybuilder for over 10years. Its a tough and unhealthy lifestyle esp when your trying to get big/over 125kgs. Im now 37 had Left ventricular hypertrophy 4 years ago and some other heart issues, I reversed those as it seems from my recent MRI but I now have an An Aorta of 5.6cm No mention of surgery as I havn't been to the Dr(no appointments available until next month) about it yet. You mentioned your brothers was 10.1cm?. Wow thats big. What size is he?. I'm now 96kgs 5.11". When I had LVH I was 125kg very muscular

[@EmperorFrosttGaming]

My aortic dilation is 4.3cm the hospital said im okay that everything is stable but i recently started getting upper back pain , should i go get tbag checked out by the way im 5,8 slim guy . I also had a vsd repair when I was child if that counts for anything

[@4umy]

yes absolutely. how are you doing now? Did you get it checked?

[@HeartValveSurgery]

Yes, smart idea to see a cardiologist about your dilated aorta.

[@GrayChaptah]

Hey , im a 34 year old male with a ascending aorta of 43mm , last been diagnosed in January, i stopped weighttraining bc im scared it would rupture.. is there a chance it will stay this way? Some people say its unlikely bc im so young.. im kinda scared to do any sports at all.. ty everyone

[@EliForPr3z]

Hey man, I checked mine and I'm still at 4.8 in the last 3 years. I still lift and do cardio but I don't lift too heavy. My next check up is next March.

[@HeartValveSurgery]

Hi Gray, It's really important that you discuss this with your medical team. Every patient is unique and we want to ensure that you get the best information and recommendations for your specific body.

[@onlywenilaugh6589]

IS the radiation risks of a CT scan worth rechecking a 2yr old 4.1 aortic root? Or is it safe to wait a few more years before exposing myself to another CT scan due to the ionizing radiation they emit that damages DNA?

[@MRAIDANGWALSH]

Ask for other safer method scans instead

[@cliffg4437]

CT scans are getting safer all the time. The question is, is the risk of not having the scan greater. I dissected at 4.6 cm and am now monitored annually by CT after my surgery. I never give the radiation a thought. YMMV.

[@Lisachelle]

@@cliffg4437hit ripped at 4.6? Gee what surgery you got

[@HeartValveSurgery]

Great question. We would encourage you to discuss this with your medical team.

[@sbubb9155]

Ill never get ct scan. I do mri instead.

[@DB-hf7di]

Are there any studies regarding statistical values of growth per year for an aortic root?

[@cliffg4437]

General statistics don't count, what matters is what *your* aorta is doing.

[@HeartValveSurgery]

Yes, here is a new video you may want to check out about annual growth rates of aneurysms - kzbin.info/www/bejne/mqjWdp6YgNOVmM0.

[@HobbyOrganist]

Three years ago I had mitral valve repair and they put in a pacemaker and annular ring, the echo results had this; "Aortic root dimensions appeared to be at the upper limits of normal (diameter 3.6 cm). Ascending aortic dimensions appeared to be at the upper limits of normal (diameter 3.5 cm). Aortic arch dimensions appeared normal (diameter 3.0 cm)."

[@HeartValveSurgery]

Hey there, It would be best that you discuss this with your medical team.