I have not personally experienced an aneurysm, for which I am entirely grateful.
I'm not a medical professional, but from watching the site for a long time, seeing how things turn out for people, and from what reading I have done, I would like to chime in with some observations and thoughts...
-There is no "safe zone" for aneurysms. Anything over 4.5 in a person with a bicuspid AV must be treated as suspect. Call it what you will, it should be viewed as an aneurysm.
-Women's symptoms are usually different from men's (women often experience angina as jaw pain), which doctors still allow to interfere with diagnoses.
-Women's symptoms are not recognized or are routinely brushed aside by doctors, as they don't match the list of symptoms (generated by studies done on men), or are attributed to some vague form of hysteria that is mystically and unscientifically ascribed to the nature of femininity.
- Men are equal to or worse than women as hypochondria goes. Probably worse. They're just less public about it. Practitioners of medicine should get over that.
-Cardiologists recognize that women generally have a smaller frame and skin surface area than men, and some will encourage women to wait until their aortic annulus is a frightening .6cm or less before surgery, sometimes at the cost of permanent heart damage or extended, arrhythmia-laden recoveries, whereas men become surgery-ready at .9cm. Yet those same cardiologists judge aortic enlargement danger in women by using the same scale they use for men (usually 5.0cm or 5.5cm). They also judge ventricular hypertrophy (enlargement) using the same standards for women as men, even though they realize that most women's hearts start out smaller than most men's.
-Under no circumstances would it make sense for you undergo surgery for your valve and not have your ascending aorta repaired/replaced at that time. It would likely enlarge swifty or even dissect within a year after the surgery disturbed it. That is a highly recurrent theme in similar surgeries.
- I don't know what the best test is for layer separation in the aorta, but I believe you should have it.
- Under no circumstances should you agree to an exercise stress test.
- At this point, if you have to grunt to pick it up, don't pick it up. Avoid doing things that cause you to bend over a lot, such as picking things up off the floor, lacing boots, etc. Don't hold your breath when you do pick things up or try to do something that takes a physical effort - breathe through it instead.
-The excessive motion and stroke force caused by ventricular hypertrophy tend to accelerate aneurysm growth (dilation, enlargement, whatever term you choose) and aggravate any layer separation that might be present. You don't mention VH, but it's likely to be there or in development with moderate-to-severe aortic regurgitation (insufficiency).
- You are tall, slender, bicuspid, and have aortic expansion. That is a combination of physical happenstance that bears placing greater emphasis on and credence in any symptoms you display.
I believe your doctors are responding appropriately to the sizes and symptoms as they see them. But I'm not convinced those parameters are correct for you personally, based on your descriptions.
As I mentioned above, I believe your ascending aorta should be specifically tested for layer separations. I just don't know the best test for it. A second opinion makes great sense at this time.
This is going to sound ridiculous after the rest of this post, but really don't go crazy over the possibilities at this time. The odds are in your favor that your aorta is going to last until your valve surgery becomes necessary. This is just intended to address my personal opinions about what you've written, and my desire to be sure you take the proper precautions to ensure that the aortic enlargement is not dangerous at this time. (Which we all realize you are trying to do.)
Being bicuspid and young, you are unlikely to be having angina from blocked arteries (large or small). You may have some secondary pulmonary hypertension, which is commeon before valve surgery. It may well be, however, from your aortic regurgitation, which can certainly cause angina pain, which varies highly by individual. Leave yourself open to that possibility, but please get another opinion and a more definitive test if possible.
Very best wishes,
