Questions about Aortic Disease

 

After having a CT scan I was told that I have an ascending aortic aneurysm that is 4.2 cm in size. I am on a beta blocker and other blood pressure medication. My aortic valve is normal. If I continue on the blood pressure medicine, will it shrink the aneurysm?

An aneurysm results from weakness in the tissue of the aortic wall. There is no way to restore or strengthen this weakened tissue. The purpose of the blood pressure medication is to slow or prevent further enlargement of the aneurysm and protect against dissection or rupture of the aortic wall.

 

I have an ascending aortic aneurysm. My blood pressure is normal at 120/80. Why am I being given a beta blocker and other high blood pressure medicine if my blood pressure is normal?

Aneurysmal aortic tissue is thin, weak and fragile. Beta blockers and blood pressure medications are important in reducing the pressure on the fragile aortic tissue and lowering the risk of aneurysm rupture or dissection. With normal activity, the desired range for the systolic reading (top number) for those with an aneurysm is between 105 and 110. It should also be noted that according to a recent research study, systolic blood pressure greater than 120 at rest is considered hypertension.

 

My friend died on the way to the hospital at the age of 54 from an acute ascending aortic dissection. How can I make sure that this will not happen to me?

Almost all patients with aortic dissection have labile, under-treated hypertension as well as varying degrees of a connective tissue disorder affecting their aorta. This can be made worse by active or passive smoking. Other added risk factors are the presence of a bicuspid aortic valve, a sedentary life style or being overweight. Patients with any signs of the above should be considered high risk and be carefully evaluated and treated by aortic specialists.

 

Can I still exercise if I have an aortic aneurysm or chronic dissection?

Exercise is very helpful for those with aortic disease. Brisk walking is excellent for the heart and lungs, as well as general health. It also helps reduce severe changes in blood pressure on a daily basis. When blood pressure does not dramatically fluctuate between times of activity and rest, it is possible for medical treatment to maintain an optimal blood pressure range more effectively. Therefore, exercise along with medical treatment is very important in maintaining blood pressure within a desirable range. However, heavy lifting is not allowed because it increases the pressure on the aorta and may put you at risk of rupture or dissection. An aortic disease specialist should advise you on a specific exercise program that is best for you individually.

 

I was first told that my aorta is slightly dilated at 4.0 cm. I was later told that this is an aneurysm. What is the difference between "slightly dilated" and having an aneurysm?

There is some variation in the way the term aneurysm is used. For the thoracic aorta, most agree that at a diameter of 4.0 cm it has reached a size that is considered an aneurysm. The word dilated refers to the enlargement of the aorta. To characterize an aorta as slightly dilated, it would need to be compared to the normal size of the aorta in that individual. Typically when the size is considered aneurysmal, the term slightly dilated would not apply. However, the most important thing to understand is that regardless of the term used, an enlarged aorta requires medical treatment and possibly elective surgery.

 

On the report from my CT scan, it says that I have a fusiform aneurysm. What kind of aneurysm is this?

This word refers to the shape of the aneurysm. When the enlargement is uniform - that is, the blood vessel bulges equally in all directions - it is called fusiform. Aneurysms that bulge out in only one place or on one side of the blood vessel are called saccular, since they have the appearance of a sack on one side of the vessel. 

 

I have an aneurysm that extends from my chest into my abdomen. I have been told I should have surgery. Is this type of surgery done at Cedars-Sinai?

Yes. This type of aneurysm is called thoracoabdominal, and a considerable number of these surgeries are performed at Cedars-Sinai. In our most recent surgical series, dating from 1994, excellent outcomes were achieved. 

 

I am a 56-year-old male and have a 4.6 cm ascending aortic aneurysm. My aortic valve is normal, and I do not seem to have any connective tissue disease. I have never smoked, and always exercised regularly. My blood pressure has averaged around 130/70. What could have caused my aneurysm?

Even when there are no obvious signs of a connective tissue disorder, when the aorta develops an aneurysm at a relatively young age it is highly probable that a degenerative condition of some kind is affecting the aortic tissue. In some families where there are bicuspid aortic valves, other family members develop aortic aneurysms even though their aortic valve appears normal. It is important that your blood pressure be lowered to between 105 and 110 systolic with normal activity. This can be accomplished with blood pressure medication.

 

I am 76 years old and have recently been told that I have a large aneurysm at the top of my aorta. I am healthy except for having high blood pressure. Would surgery be too dangerous at my age?

Aortic surgery certainly may be done at your age. However, age is not the only factor that must be considered when assessing suitability for surgery. A complete medical assessment is needed in order to determine the risk associated with surgery for each individual. Immediate medical treatment of your high blood pressure is very important to reduce the pressure on your aneurysm and increase your margin of safety.

 

I was hospitalized with severe chest and back pain and have been told that my descending aorta is dissected. I did not have surgery. Will I need it some day?

There is no way to predict if or when surgery for a dissected descending aorta may be needed. Proper medical treatment and life style changes should be in place in order to minimize factors that may cause the dissected aorta to enlarge. The size of the aorta should be monitored, and if it enlarges to a size that represents increased risk to your life compared to the risk of surgery, then surgery will become necessary. For further detail about descending aortic surgery please see Surgical Procedures (Descending and Thoracoabdominal Aorta).

 

My aneurysm was found first on an echocardiogram, and then a CT Scan was done. Later I had an MRI to check the size of the aneurysm. Why did I have three different kinds of tests?

These tests are generally used to evaluate the heart and the aorta. The echocardiogram is used to evaluate the heart valves and the thickness of the heart wall. Either CT scans or MRIs may be used to provide an accurate view of the aorta and a precise measurement of the aneurysm size. MRIs cannot be used for those who have metal in their body, including such things as pacemakers. CT scans and MRIs to evaluate the aorta are interchangeable, and doing both tests in most cases is not necessary. However, certain complicated dissected aortas might benefit from using them both to confirm the diagnosis. The advantage of the CT scan is that it is a quicker, cheaper test that is more widely available. The advantage of the MRI is that there is no exposure to X-rays, and the contrast used has no adverse affects on the kidneys.

 

I have a chronic descending aortic dissection. I have been scheduled to have an exercise stress test. I am worried about the effect that a stress test may have on my aorta. Is it safe?

Generally an exercise stress test is not recommended for patients with aortic dissection or aortic aneurysm because of the potential of inducing hypertension, which can be harmful to the aorta. More appropriately, a drug-induced stress test can be used (adenosine thallium) which generally will not induce any hypertension.

 

I have heard that stents are now being used to repair the aorta in the chest. I have an enlarged descending aorta (4.8 cm) with a chronic dissection. Could a stent be considered to repair this?

The most proven method for the descending aorta is still surgery. However, stents have been introduced for use on a limited basis in those patients who are too sick to have surgery. Technological advances in the aortic stent industry are rapidly evolving and require close monitoring of both the short and long term results. You should discuss your individual situation with an aortic disease specialist to determine what the best treatment is for you.