Management of the Borderline Ascending Aorta

In this lecture, Dr. Zlatko Pozeg (www.aorta.ca), thoracic aortic specialist from the New Brunswick Heart Centre, shares his insights on the management of borderline dilatation of the ascending aorta.
Session given on February 24, 2021

[@cathyloibl1037]

My brother’s (73 )new doctor sent him to cardio because he thought he had a fib. Turned out to be ascending aortic aneurysm (4.8cm). They’re watching it. Family history , both mother and father) father had an abdominal AA , had surgery at 66 years and lived to 87. Cousin on dads side dropped with no warning, mothers side: her sister had abdominal AA; her brother had one that “blew out” in 1965 and died in 2002 at 82; another of her brothers refused surgery and he died from burst aneurysm. My brother and I are 11 1/2 mos apart and because of our family history my cardiologist is recommending complete testing and I concur.

[@patcunningham747]

Thank you, 62yo male here recently discovered a 4.2cm Ascending aortic aneurysm via CT scan. I am educating myself ASAP.

[@SavedBySweetGrace]

My husband is only 37 years old, and we just found out he has an enlarged aorta at 4.2 cm as well. I feel like our world is upside down right now. We knew nothing about this. We have 4 little children, and as you can imagine, we are panicking!

[@patcunningham747]

@@SavedBySweetGrace after doing an electro cardiogram, and a stress test I've learned that 4.2 cm is not that large, based on my "Body mass" they are saying it is "enlarged" not an immediate threat. definitely follow the doctors orders and hell likely be fine!

[@SavedBySweetGrace]

@@patcunningham747 Yes! Thank you for your reply. That’s what we were told today by the dr. as well!

[@Davidh741]

@@patcunningham747 same here I have 2 3.8 and 4 mm 2 cardiologist told me that’s not aneurism then I seen relly good cardiologist at major hospital he also published medical papers on cardiologist he said it’s not anurisam I asked about exercise they all said no restriction he said your high and body max that’s not anurisam

[@pwrfl2357]

62 year old male diagnosed with 4.3 cm ascending aortic aneurysm. Educating myself as well.

[@cliffg4437]

Thank you for your talk and video. It is refreshing to hear someone recognise that the data on this problem are not robust. I was monitored for 20 years up to 2017 for an enlarged aorta but dissected at an ascending diameter of 4.6 (@CT 1 year before dissection), and was almost certainly assessed against 5.5 cm. I really want no-one else to have to go through what I have. I certainly hope the TITAN:SvS trial produces some clearer figures. Please don't forget that diameter is only one of four variables in the Laplace equation, and variability in the other three (BP, wall thickness and allowable stress value) will be the resaon for the different diameters at dissection. CTDs considerably affect the allowable stress, body size and type affect the wall thickness, BP is modifiable. Agree on getting BP down immediately and effectively.

[@Faith-ko5eg]

That was great! Thank you!

[@tspot816]

I am a 53yo male, 5'7", 175 pounds, and I walk about 28 miles a week. My blood pressure is good. However, I do have a bicuspid valve, a maternal grandfather that died at 62 of a heart attack, a father who had heart problems. I was also injured when I was younger in an auto accident and I have portal vein thrombosis and espophageal varices due to a loss of my spleen, and I almost bled to death this year due to the varices bleeding. As a result of various tests, I was diagnosed with a 4.8 cm ascending aortic aneurysm. My doctor is willing to do surgery now. My thinking is I don't want this hanging over me, a growth rate of 14mm/year means I'll be at the 5.0 threshold in a couple of years, and I am very fit and healthy otherwise now and never going to be healthier or younger. I really don't want open heart surgery. But I also think it is time to have the surgery. Anyone have any thoughts?

[@kiya4fun]

Did you have the surgery? I am 55 and in great shape but have a 4.7mm ascending aneurism with oderate to severe aortic stenosis from bicuspid valve. Doctor want to operate in 4 weeks. I am scared, but I feel like you, the best shape of my life, so now is the time.

[@gordongamble3244]

62 year old male at 5.1 AAA and have good bp and descent cholesterol. Surgeon wants to wait till next summer and monitor it. Also have a leaking valve .This has been monitored for 20 years and has just increased this year.

[@dolores373]

thankyou I have a bicuspid valve lasted 74yrs and and I have had a Edward sapien valve put in on 27th

[@prowelsh56]

Absoultely outstanding. Thank you very much indeed for posting this disucssion. Help a great deal with the worry about such a finding on Echo. 4.2 dialtion of aortic root. BP well controlled as is weight. Question about profession - semi-professional athelets. I did find a couple of studies mostly focused on cardiac hypertrophy and LV diastolic dysfucntion..grade 1. Low normal EJ 50 -55%. So looking at the mechanics. This dysfucntionand dilation seems a little more complicated with a low EJ? Best wishes to all on this. Once again thank to Dr. Pozeg.

[@michaelh1889]

63 y.o. w.m... just clocked in at 4.3 aorta read... chol. 157... Bp 137 / 83 ... Follow up in june ... 🙏🤞🧐😎

[@davidsicard2651]

Thank you, this was very informative.

[@Junker_Dustoff]

Are endovascular stents an option for

[@lesbrown8099]

Thank you…:)

[@earlking4299]

I have a 4.3 aortic aneurysm in my aortic root learning how to cope

[@Tomcaatt]

Yea it’s definitely a detail if family has had the same previously , it was discovered a 7.7 in my aorta ( wich burst on my father at same age of 62 , followed by death 3 days later ) in wich they immediately operated on 5 weeks ago, my brother also has had the same one

[@sharonfisher6491]

Are you going to have surgery?

[@sharonfisher6491]

Did you already have a successful surgery? My thoracic aorta is 5.0. I do not want to want surgery. 😢

[@lashabasiladze5867]

What do you think about aortic wrapping?

[@debraschneider8746]

I have a question about a dilated aortic root and exercise. What kind of exercise is okay to do? What types of exercise should one avoid?

[@Davidh741]

You cardiologist should address that depends on size and if you have any connective tissue disorders

[@marybeth2791]

♥️♥️Great information, all explained so one can understand ♥️♥️……sorta♥️♥️

[@MrGODINTHEMAKING]

Im 42 and need a aortic aneurysm repair my number is 6.2 cm. And i need a valve replacement. Severe aortic stenosis with regurgitation. I literally getting a review now and find out what the gameplan is. Im was born with aortic valve disease. But im optimistic and just want to getbit done and over with fairly healthy besides this issue. Thanks for video nice to know whats gonna happen. Nov 14th my surgery 🎉🎉🎉

[@arunchauhan9071]

Hey.. wish you speedy recovery from surgery !

[@streb6]

Wish you complete recovery

[@monarchheartsolutions]

How did your surgery go? Hope you are doing well. My aortic was 4.8 cm a few months ago.

[@yanirhadan8004]

Hello, when is the discussed study supposed to have some results ?

[@redc52]

Thanks , 71 yr old male just discovered 3.7 cm ascending aortic aneurysm by CT scan w/contrast.

[@jayyarnell4710]

71 y.o. Male with 4.3 aorta. Being monitored biannually bp normally 120/70 low cholesterol and good blood chemistry. Are there lifestyle changes I should consider to minimize risk? Very active physically, good diet, medium alcohol consumption

[@aleksbakman7562]

jayyarnell4710, I am 70, 4.3 cm. High cholesterol in my instance but otherwise I am just like you. Did you have to take medicine or you have gotten away with just adjustment of the lifestyle?

[@allenreihman6283]

seems like age should be a significant factor in decisions. Putting off surgery for a 60 year old places potential surgery into later years when surgery is higher risk. And there is a compounding effect, with a certain percent mortality that compounds each year, vs surgery which is a discrete event, once and done.

[@sherrid5315]

I just found out last year during being very I’ll from being septic! They did a electrocardiogram mine was 3.3 ! I just had another one March 9 now it is 3.5 I don’t know whether to be scared ? If it’s growing at a fast rate! My mother had the same but her abdominal was very large! They found my brothers last year abdominal as well ready to rupture and his was 10.1 had emergency surgery! Waiting to see the heart doc now and it not until March 23! And of course anyone with these worry ! I lost my mother she was 81 choose not to have the surgery! Good Luck to you all!

[@Davidh741]

Look like it’s genetics for you do a genetic testing for it and if it is genetics then they operate at 5.0mm

[@sherrid5315]

@@Davidh741 I seen heart doc she said it is not an aneurysm! Studied all my test very well! Kind of odd to me!

[@DB-hf7di]

My aortic root measured 4.4cm on a CT calcium test, but a CTA 1 week later measured 3.7cm. How should I interpret this?

[@mstainasbabies7063]

Hi! What is CTA?

[@aleksbakman7562]

Computed Tomography Angiography (CTA)

[@aleksbakman7562]

@DB-hf7di, maybe CTA is a more precise instrument

[@christophersharron6967]

Hi. You should not interpret this. You should ask your cardiologist directly. I had a major discrepancy between my first CTA (5.2) and second (4.5) - but these things do not shrink. The cardiologist should follow up with whoever did the readings and get clarity for you.

[@bahiagoumez4282]

My mom is 56 years old just diagnosed with dilated ascending aorta of 4.95 mm she is 5.3 inches tall and 122 lbs, my world is collapsing I don’t know what to think or do, leaving in another country didn’t see her since 5 years 😢

[@phillipdavies9233]

My wife is 75 years old, weighs 45 kgm and is 5'2" (158cm) tall. She had a CT scan and she was found to have an Upper Ascending Aortic Aneurysm of 5.2 cm and I have calculated her Index Ratio based on the formula given at 13.4, which is significantly beyond the index of 10 - 12 stated. She is nimble, agile and her general health is very good other than this asymptomatic aneurysm. The question is should she have the surgery to prolong her life with all the associated risks taken into account (potential strokes, depression, etc) or should she just carry on with medication to reduce her blood pressure?

[@matthewstokes1608]

Wish I knew... I trust my doctor... My aaa is still just under 5... I know that my hypertension is the biggest concern - so beta-blockers seem to keep me well. She needs to eat very well - no smoking - no booze... good diet... and keep blood pressure in the healthy range. I have to say, Christianity is the greatest medicine.

[@phillipdavies9233]

@@matthewstokes1608 thanks for the advice. I totally agree with you that faith in God and clean living with a healthy diet are best medicines for a happy and healthy life, supported by medical intervention as and when necessary. She had the Upper Ascending Aorta Aneurysm open surgery and Aortic valve repair last month and it's still relatively early days as to the ultimate success of the surgery. She has some complications following the surgery however; low sodium, Atrial Fibrillation, rapid heart rate and fluid build up in the lungs. These are being addressed and we realise it's a long slow road to as full a recovery as possible. With prayer and God's guiding hand we hopefully will achieve it.

[@matthewstokes1608]

@@phillipdavies9233 my prayers for you both - keep the faith and all will be well 👍🙏

[@michaelh1889]

Huge info / data at 10:30

[@Davidh741]

Please explain

[@DanielleA2023]

I'm 56 and 4.3mm😢

[@Oldspartan65]

62 year old here I have three of them yikes one of them is 4.5 my Dr. Told me not to worry to come back in a year but I do a whole lot it’s the only thing on my mind all the time dont sleep very well Should I worry or am I over reacting? Someone help !!!

[@mariewhitman8758]

Hi Curtis, my husband was told the same, not to worry, since his is also 4.5. All we can do is follow the guidelines to manage this, and be aware of symptoms in case of a dissection. Since you have 3, maybe you should also see another doctor. Knowing that you are taking actions to manage this condition should help alleviate stress. Sleep is vital to cardiovascular health. Best wishes to you.

[@jessiegearns3678]

Dr apparently isn’t concerned or you would be checked every 6 months. Treatment options are getting better by the day. It won’t be long until they take care of aneurysm’s through the groin. Hopefully mine holds off that long.

[@markbilsborough4150]

Ascending Aorta normally grows .07cm a year. I was at 4.3 in Dec 2020. In june of 2023, it was

[@lauriemorey8289]

Hi I’m 65 have ascending aneurism at 4.8 not taking blood pressure meds I was told every 6 months get tested it’s a watch and wait we need to trust GOD!

[@lauriemorey8289]

I am taking blood pressure meds! Metroprlol

[@TK-ec5bv]

This doctor isn't a good communicator. I sent his office a question about this video, and he can't bother to respond, or recommend that I schedule a visit for a consult. Very poor communication style.

[@robertreidmd]

OMG

[@michaelh1889]

This doctor is NOT a flake .. imo. Extremely helpful !!

[@TK-ec5bv]

@@michaelh1889 Opposite experience for me. Very poor communication style on his part, as I mentioned.

[@marshhen]

Rounds are for other doctors, not for potential patient questions on youtube. Go through your own doctor. He is busy doing heart surgeries, you know, those things that nobody wants to wait very long for. I do not cardiac experts spending time responding to youtube audience questions. That is ridiculous.

[@TK-ec5bv]

@marshhen Excessively negative and dogmatic on your part. Getting opinions and going in for consults with more than one doctor prior to major heart surgery is perfectly reasonable. A doctor could certainly say to come in for a consult - a reasonable response which most doctors would do - and this doctor could not bother to do that.