Aortic Aneurysms

[geebee]

I have seen a lot of discussions about aortic aneurysms. If you have or had one, how did you find out about it? Are there symptoms or is it something that was found because of some other condition?

Just curious. Thanks, in advance, for your responses.

[fyrfytr]

Hey Gina,
I had chest pain and they did a cath, that is when they found the aortic aneurysm and that my aortic valve needed replaced.
Take Care

[Central Jersey Steve]

Mine was just the natural progression of my congenital condition.

I have it monitored every 6 months via echos, cats, mri's, etc.

[Ross]

I had bouts of chest pain with my lung disease. Well one day getting ready for work in November of 94, I had a sudden pain that about knocked my socks off. Went to the ER and they could find nothing wrong even though I had another spell while waiting eternally on someone to see me. I knew it felt different then lung pains. We now believe this is when my dissection actually started. Cardio did an echo and saw it. It was only 4.3 or abouts at the time, so he said intervention if or when it became necessary. I made it until March 9th and the darn thing blew without any notice whatsoever!

[Les]

I have one that shows up on my annual echoes but I have no symptoms. They're monitoring growth, I'm waiting for the other shoe to drop...

[lucky400]

Why do they wait to fix these until they get too large? Why don't they just fix them when they are discovered so you don't have to worry about having them blow? Is it because the surgery for the repair is high risk?

[Ross]

Why do they wait to fix these until they get too large? Why don't they just fix them when they are discovered so you don't have to worry about having them blow? Is it because the surgery for the repair is high risk?
Yes! It is high risk, so they want to wait until the risk of disaster outweighs the risk of surgery.

[Tom F.]

I had an ascending aortic aneurysm, found by accident by a very good young doc. I had surgery 6 mos. later. The risks of such surgery are the same as for valve replacement.

[Baldrick]

I have an ascending aortic aneurysm currently around 4.5cm. I am asymptomatic. I had AVR in 2000 and thought I was finished with surgery, but my cardiologist recently told me that current research indicates a link between BAVs and aortic problems. She sent me for an MRA and a TEE and found it that way. Apparently a regular echo cannot see far enough to inspect the entire aorta. If you problem is a BAV, I would definitely ask your cardio about an MRA (I found it less traumatic than the TEE, but everyone's different).
Regarding risk, my research seems to indicate that the aortic surgery requires a greater degree of specialization on the surgeon's part than standard valve replacement. And, of course, the more re-ops you the have, the greater your risk becomes as well.
Hope this helps.

[Central Jersey Steve]

As I am new to some of the acronyms, what is a MRA and a CAV?

Thanks

[Central Jersey Steve]

Meant to type BAV.

[PapaHappyStar]

MRA: Magnetic Resonance Angiography -- MRI with injected dye to highlight blood flow along with tissue

BAV: Bicuspid Aortic Valve

[hayden]

Found my husband's during an angio after a bout with what they think was a gallstone - 6.5cm - surgery four days later.


found mine during an echo following gall bladder surgery, (prior to the gall bladder surgery, the gas passer told my wife that I had an abnormal heart, but it would not effect the gall bladder surgery and I should have it checked out, I did and here I am 7 months after repair and valve replacement)......the anuyresm was 5.2, I was a walking time bomb and did not know it.....

[Creed3]

I found out that I had an ascending aortic anuerysm right before I had surgery. The only symptoms I had were when I had pain months before and it turned out I had an aortic dissection. My anuerysm then occured because of the dissection. I was never diagnosed with any of this until right before my surgery. I think everyone is different, but for the most part I believe when it comes to anuerysms, a lot of the time there are no symptoms until something catastrophic happens.

Take Care!
Gail

[geebee]

Thanks for all the reponses. It certainly confirms my thoughts that these are discovered mostly by "accident" meaning during examination of some other problem or when they are so bad one is lucky to survive.

Kind of scary.

[inlaguna]

Gina,

I had an anuerysm which was monitored and I think about 4.5cm or a little under at the time of my valve replacement. I know that my surgeon and cardiologist debated about repairing the night before my surgery. My cardio convinced the surgeon to do the graft given my lifestyle and he did not want to risk another surgery for me within five years. There were no complications during surgery. Now I have two dacron grafts in my aorta.....one for over 30 years.



Here is a link to an article from the Wall Street Journal (November 2003)

http://www.pulitzer.org/year/2004/explanatory-reporting/works/story7.html

Dan

[hayden]

Both my aneurysms were discovered by the use of imaging procedures in the course of investigating a heart murmer and other problems. Sometimes an aortic aneurysm can be seen on a regular chest Xray, although I think they are often overlooked or underestimated if this the only way they manifest themselves.


I think there is a "power to be" greater than me that allowed mine to be discovered. I had a brother younger than me drop dead 4 years ago, now we all know what happened to him......

[RobThatsMe]

Hi,

I looked back in my files and found some information regarding this topic that you may find informative.

Happy Easter! ;)

Rob


Aortic Detection.

How are AORTIC ANEURYSMS detected?
Patients sometimes detect an aneurysm by feeling a pulsating mass in the abdomen, or it may be found by their physician during a routine physical examination. The best way to detect unsuspected aortic aneurysms is by an ultrasound or CAT scan of the abdomen. Ultrasound is quick, inexpensive, non-invasive, and accurate; if the aorta can be seen, the presence of an aneurysm can be identified or excluded. CAT scans of the abdomen remain the most accurate tests for aortic aneurysm, both for initial detection and for determining aneurysm size. They provide information equal to MRI scans.



Delay Suggested For Aneurysm Surgery

May 9, 2002

The Associated Press (AP)

Two new studies on aortic aneurysms, weak spots in the body's largest blood
vessel that can burst and cause a person to drop dead, suggest that many
doctors can safely wait a little longer to operate than they used to.

Surgeons have long known that small aneurysms are unlikely to break, and
they typically wait until the weak spot gets big enough to worry about.

However, they disagreed over whether that should be 4, 5 or 6 centimeters,
or anywhere from 1.6 to 2.4 inches.

The new studies set a higher threshold for what is "big enough," at least in
men.

If the aorta balloons out less than 5.5 centimeters, just under 2.2 inches,
it makes more sense to check it every six months rather than sew it back
together immediately, surgeons with the U.S. Department of Veterans Affairs
and the United Kingdom Small Aneurysm Trial concluded.

"A test like ultrasound typically costs $150 or $200. The operation is more
on the order of $25,000 or more. You'd have to do a lot of surveillance
before the cost was comparable," said Dr. Frank A. Lederle, director of the
VA Medical Center in Minneapolis and lead author of the U.S. study.

Most aneurysms eventually will get big enough to need surgery. The question
is whether the danger of death from the untreated aneurysm is greater than
that from the operation itself.

Both studies found that the chances of death in those who underwent early
surgery and those who waited were about equal among men for the first five
years.

Four centimeters, about 1.6 inches, had been considered the threshold for
operating on an aneurysm, but two studies in the early 1990s suggested that
5 or 6 centimeters, as much as 2.4 inches, would make more sense. Many
surgeons already had moved to the higher threshold.

The new study "is hard data for something I personally believed in, patients
with 4- or 5-centimeter aneurysms don't need surgery immediately," said Dr.
John Kern, head of vascular surgery at the University of Virginia Hospital.

He added: "These are two studies a lot of us were waiting to see in press.
We were all quite excited by the data being generated."

The U.S. study looked at 1,135 patients at VA hospitals around the country.

The British research involved 188 women and 902 men in England, Scotland and
Wales.

The British study found that women's aneurysms are FOUR TIMES MORE LIKELY TO
RUPTURE than men's.

It said 5.5 centimeters may be too high a threshold for women, but it did
not have enough information to suggest what the threshold should be.

[geebee]

Hayden - Sorry to hear about your brother but glad you are OK.

Rob - thanks for taking the time to look up the detailed info. It does give me a bit more to go on.

Thanks all.

[BionicRedneck]

I guess you can say a Guardian Angel found mine. I damaged my ear and went to the Dr. to see if I had punctured my ear drum. Nelda the PA was very worried and persistent about my BP and Pulse Rate (High and irregular). She did very little on the subject of my ear but spent the rest of the visit hounding me about going to a Cardiologist. I dont think she would have let me leave until I promised her I would have it checked out. I had a 7cm aneurysm on my ascending aorta. She i the whole reason I am here to day. I owe her my life.

[geebee]

I hope you gave Nelda lots of flowers and candy :D.

Seriously tho, glad she was so intent on finding out what was wrong. Also happy to have you aboard.

[Arlyss]

Aneurysms may occur in any part of the aorta; however, they are divided into two main categories: those in the chest, and those in the abdomen. Abdominal aneurysms are treated by vascular surgeons. Aneurysms in the chest are treated by cardiothoracic surgeons. The approach and recommendations are different for the abdominal aorta than for the chest.

The AP article quoted in this thread does not clearly mention which type of aortic aneurysm is being discussed, but it appears to be abdominal aneurysms. There is reference to a vascular surgeon, John Kern, and Dr. Lederle is also mentioned. In searching the literature, I found this paper from May 2002, which lists Dr. Lederle as the first author. This paper is referring to abdominal aneurysms, not aneurysms in the chest. Here is the link http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12000813

For aortic aneurysms in the chest, the trend is toward doing the surgery sooner, at smaller sizes, in experienced aortic centers. In the past, when the surgery for aortic aneurysms in the chest carried higher risk, many people either dissected or ruptured while waiting, before they had surgery. Today the risk of surgery is low enough that people can have surgery sooner and avoid dissection or rupture.

It is important to know that the approach and surgical treatment for the aorta in the chest is different than that in the abdomen, and the surgeons who handle them have different expertise. I hope this helps clarify this.

Best Wishes,
Arlyss