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Forum Name: Cardiology Diagnostics

Question: 28 y/o Male - Aortic Root Dilation / Aortic Aneurysm


 Mariners68 - Thu May 07, 2009 8:33 am

I am a 28 y/o, white, male, 6'4" 240lbs and starting last October (2008), I began having chest pain. My doctor said it might be heartburn or something more serious so I should take antacid and go have a stress test done. I was scheduled for my stress test in December but cancelled it because I wanted to give the anacids a little more time (and I was worried what they might find).

In March (2009), my symptoms increased. Instead of "just" chest pain, I now began feeling my heart beating in my chest and in my neck. I also began getting really dizzy and lightheaded (even from walking up one flight of stairs). I rescheduled my stress test and finished it last week. My doctor called me the next day and told me that I have an Aortic Root Dilation and an Aortic Aneurysm. She stated that she was not very familar with the norms and my results but did know I was close to when they would start talking about doing sometype of surgery. I got a copy of the stress test results but I have no idea what it means. I have looked all over on the internet but I am hoping that someone can help me understand what would be considered normal with these measurements. If I have a better understanding as to what is wrong, I believe I can be better prepared for my appointment with the cardiologist next week.

I do not know a lot about my father or grandfather but I do know that they both suffered from heart issues. I have two kids and both of them have pulmonary stenosis (my son has a moderate version and my daughter has a mild version). It only seems logical that I would have something, seeing my family history.

I am trying to keep this short so here are the measurements from the stress test & echo. If you need more information, please let me know.

IVSd - 0.90cm
LVPWd - 1.0cm
LVIDd - 5.1cm
LVIDs - 3.3cm
Ao root diam - 4.3cm
LA dimension - 4.1cm

MMode / 2D Measurement / Calculations

RVDd - 3.2cm
FS - 35%
asc Aorta - 3.0cm
Aortic arch (trans.) - 2.3cm
LA/Ao - 0.95
LVOT diam - 2.5cm
LVOT area - 4.9cm2

Aortic HR - 65 BPM

Doppler Measurements / Calculations

MV E max vel - 61 cm/sec
MV A max vel - 51 cm/sec
MV E/A - 1.2
MV dec time - 0.18 sec
Ao V2 max - 98cm/sec
Ao max PG - 4.0mmHg
Ao V2 mean - 3.0mmHg
Ao V2 VTI - 23cm
AVA(I,D) - 4.4cm2
AVA(V,D) - 4.7cm2
LV max PG - 3.0mmHg
LV mean PG - 2.0mmHg
LV V1 max - 93cm/sec
LV V1 mean - 68cm/sec
LV V1VTI - 20cm

CO(LVOT) - 6.5 1/min
CI(LVOT) - 2.7 1/min/m2
SV(LVOT - 100ml

Thank you so much for your help!
 John Kenyon, CNA - Sun May 10, 2009 11:00 pm

User avatar Hi there --

Based upon measurements alone, you would be classified as having an ascending aortic aneurysm, as well as abnormal aortic room dimensions. All other measurements are reasonable for your height and weight, but height and weight, in this case, also figure in, along with the valvular abnormalities in your children, strongly suggest you either have a familial genetic structural heart issue, or perhaps you have (based on height alone) Marfan syndrome. One of the very common complications of Marfan's is dilation of aortic root and any portion of the aorta, as well as specifically the proximal ascending aorta, which is where you do appear to have a statistically verifiable, though not remarkably large, aneurysm.

Now then: there are two criteria for surgical intervention in these situations. One is size (and growth rate) of aneurysm. You probably wouldn't qualify under that criteria as yet. However, there is the second criteria, which is symptoms, and your symptoms probably do qualify you for surgical intervention. What you describe may well herald a dissection of proximal aortic aneuryms and root, and you need to stay close to a first class surgical intervention facility until this is clarified and a treatment plan initiated. You will be seeing a cardiogist who very likey will refer you to a cardiothoracic or vascular surgeon to decide if urgent or emergent repair of the aneurysm is appropriate now (and it seems likely it will be necessary eventually if not now). If, at any time in the meanwhile your symptoms should increase or you should experience any significant chest pain and espcially a tearing sensation in your chest or throat, you must dial 9-1-1 and get yourself to an emergency medical facility at once, as this would indicate dissection and imminent rupture, which, to put not too fine a point on it, is not something you want.

Since this has evolved slowly over a period of months I'm expecting you'll be able to see your cardiologist as scheduled, and this will be very helpful in sorting out what needs to be done next. In the meantime please fololow up with us here as needed, and keep us updated as well. Good luck to you.
 Mariners68 - Thu May 14, 2009 6:01 pm

Mr. Kenyon-

Thank you for your response. I would like to ask you a few further questions though.

You (along with the doctor (who is a cardiologist) who read my stress echo) stated that I have an Aortic Root Dilation and an ascending aortic aneurysm, however the cardiologist I seen yesterday (a partner of the one who read the stress echo) said I have a very minimal aortic root dilation and no aneurysm. I realize that, like all areas of medicine, things are subjective. Could you tell me why you believe I have an aortic root dilation and an ascending aortic aneurysm? What measurements (in my results above) makes you believe this and what would be considered the “norm” for those measurements?

At my request, the cardiologist yesterday ordered a CT of the Aorta for tomorrow. I believe that should give me a better understanding as to what is going on.

Thank you for your time and your response!

Troy
 John Kenyon, CNA - Fri May 15, 2009 4:37 pm

User avatar Hi Troy, I'll do my best to explain my view of this. Unfortunately much of it can be subjective, and some doctors do use the patient's size and weight to create a relative standard for judging these things (you're a good sized guy, and this theory of relative organ dimensions is not unreasonable). Based on the measurements alone, your aortic root diameter is substantially larger than normal, and, since it is above 4 cm is considered, by the numbers, to be dilated. Same thing hold true for the ascending aorta, although the rule for intervention here is more subjective yet, depending on possible underlying causes such as Marfan syndrome and whether or not the patient is symptomatic. As I am only able to go by the numbers -- can't make a subjective evaluation of your build vs. structural heart dimensions in a setting like this, at a distance, I'd read the report as positive for root dilatation and an early ascending aneurism. It is a doctor's job to determine if symptoms warrant anything beyond just following this and observing, but based on the numerical values you technically would be diagnosed by the numbers. Again, there are those doctors (and as I said, this is not unreasonable) who will take into consideration total body type and size in judging this, as well as the aortic valve and artery itself compared with overall heart size (which appears to be normal).

Normal aortic root diameter is 2-3 cm, but of course may be greater in a much larger than average person. Still, 4.3 is significantly broader. Your ascending aorta was measured using the formula of ascending aortic diameter divided by body surface area, it appears, and that is correct the numbers place you in the highest of the three risk groups for aneurysm. However, this same formula can be used to mitigate severity of aneurysm subjectively. Again, this comes down to absolute numbers. Also I note the M-mode measurement is much smaller than the doppler measurment computed as above. This means there could easily be a disparity in findings between two doctors. Since the two who've read your results are in the same practice one would expect them to compare notes and come to some sort of agreement in what to tell you. I'd definitely call them on this, since you're getting two answers. Finally, the CT should clarify things a great deal and may possibly help bring the two differing opinions together. I certainly hope so. Please let us know how this turns out.
 Mariners68 - Tue May 19, 2009 9:59 am

Mr. Kenyon-

Thank you for your response. I appreciate your wiliness to communicate your views and the rational for your views with me. I believe the more information you have on the front end, the better decisions you can make down the road.

I do have good news however. The CTA of the aorta shows no aneurysm! I was very pleased to learn this however; the cardiologist I am seeing seems a little too laid back for me. He said that although my Ao Root diameter is 4.5cm (on my echo it was 4.3cm (2+ weeks ago) so I do not know if the CTA provided a new measurement or what) he is not concerned about it. He said he does not worry about them until they reach 6-7cm.

My concern is that the symptoms I am having might be related to my Ao Root being 4.5cm. If he says that he does not do anything until it gets to be 6-7cm then how bad will my symptoms be at that point? I am not sure if he is saying this to calm me down or what, but he would like to monitor it with an echo.

While this course of action seems somewhat reasonable to me, because I am symptomatic, I worry that the symptoms will only get worse. I know you stated that an average Ao Root is 2-3cm but could you tell me what is the range when they typically only want to monitor the Ao Root (i.e. 3-4.5cm), when they talk about treatment / repair (i.e. 4-5.5cm) and/or when they say urgent / emergency repair is needed (i.e. > 7cm)?

If you could provide any insight or things I should discuss with my doctor, I would greatly appreciate it!

As always, thank you for your time and your response!

Troy

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