Ascding Aorta Aneursym - mixed results

[Terri]

I'm sooooooo confused!
I was diagnosed with a BAV 4 years ago and put on a yearly watch.

2005 revealed a 4.3 Aneursym.
Early 2006...CT showed it at 4.4.
Oct. 2006...MRA showed it at 4.9 c.m.
Feb. 2007..64 Slice CT Scan shows it at 4.4 c.m.

OK, I decided it's time to prepare for surgery. I had previously met with, and selected a surgeon, so I called him with the news, he scheduled a 64 slice CT Scan which was done last week prior to our meeting. That test showed results of 4.4 c.m. with a phone message saying we'd run it again in a year.

Today, I visited with my cardiologist (different health plan than my surgeon) and he seemed somewhat upset that I had a 64 slice. He quizzed me about why I would do such a test with so much radiation. I reminded him that the test was ordered in preparation for surgery stemming from a test score that he gave me in November of my aneursym showing rapid growth to 4.9.

I told him that I'm not sure what to believe. Is it 4.4 or 4.9??? How could the two tests differ so much. Honestly, he had no answer other than saying different machines, and perhaps the heart was reacting differently during the different tests. I honestly don't buy any of it, but most important.....I DO NOT KNOW WHAT TO DO. Did I fail to mention that my family and friends are worried sick over me, and that because of doctors orders in November, I've stopped exercising and gained more weight. (Not too much a problem, 15 lbs overweight.) I don't know what to do.

I'd be interested in your thoughts and suggestions.
Thanks,
Terri

 

[Karlynn]

Terri, I don't know much of anything about which is the more accurate test. I'm sure others will be along soon that do know. I just wanted to say how sorry I am that this has become so confusing for you, not to mention scary. Hang in there.

 

[MrP]

Terri,
A 64 slice CT scan is more accurate than a 32 slice or 16 slice CT scan, as the 64 slices represent finer resolution and more precision. The 64 slice may indeed be more accurate than the MRA which may have a greater margin of error. I'd trust the 64 slice CT scan measurement, and especially given the earlier CT scan results and knowing that aneurysms grow slowly (about 0.1 cm per year, although the growth rate increases as the aneurysmal dilatation increases).

And the radiation exposure is minimal and represents significantly less risk than a growing aneurysm above your heart, so I wouldn't worry about radiation exposure (although many folks on this forum tend to worry about this and prefer more costly MRI measurements).

A CT scan (with contrast) each year may be warranted, although you may want to consider MRI or CT scans every two years until such time your ascending aorta diameter reaches 4.5cm or larger (depends upon your size and the size of the rest of your aorta). Very important is how the diameter of the ascending aorta compares with the diameter of the proximal descending aorta. In other words, your ascending aorta may be significantly larger or comparable in size with the rest of your aorta. The risks of surgery versus the risk of rupture or dissection is a difficult tradeoff after the ascending aorta diameter is greater than 4.5 to 5.0cm (depending upon your normal size), and many surgeons will recommend reducing risks and performing surgery when the ascending aorta reaches 4.5 to 5.0 cm for BAV patients. Surgery may not be necessary for many years.

Pay attention to any symptoms which may develop such as sharp, knife-like chest pain. This may represent stretching of the aortic medial layer and indicates pending rupture or dissection. If you develop symptoms, surgery is recommended right away regardless of the size of your aneurysmal dilatation. It is best to have elective surgery versus emergency surgery, as the long term results will be more favorable.

You may want to consider a different cardilogist or second opinion. And I seriously doubt that your heart is reacting to the different measurements. In other words, your environment does not affect the size of your aorta.
Hope this helps.

 

[Arlyss]

If you request the actual images of each of your tests, you can have them evaluated/measured by an aortic expert. Aortic surgery is really a specialty unto itself, and there are still relatively few medical centers in the US with that expertise.

If it were my own body, I would have my tests reviewed by an aortic surgeon. I would also be sure that I have good blood pressure control to minimize stress on my aorta.

Best wishes,
Arlyss

 

[PJmomrunner]

Hi Terri:

I have been where you are...oh, wait a minute...I'm still there! (Well, I moved from southern California five years ago , but here I sit with an an aneurysm just like yours! )

Arlyss is, of course, right on track. Get copies of your imaging studies and have them looked at by someone who specializes in aortas. The following presentation does an excellent job of explaining the nuances of aortic measurement:

Decision Making in Thoracic Aortic Surgery, Eric Isselbacher, MD, presentation to the American Association of Thoracic Surgeons Annual Meeting, Philadelphia, April 29 ? May 3, 2006.

http://www.conferencearchives.com/aats2006/sessions/1500.PGAC.10/session.html

 

[Mike C]

I wanted to second what MR. P stated.

The only thing I will add is you may want to discuss with your cardiologist going on a beta blocker or such drug, as it MAY be possible to slow the growth.

 

[Ross]

64 slice CAT is HIGHLY believeable. It doesn't get any better or clearer then that. While I know these guys like to wait for the magic number 5 to show up before considering surgery, I'd like to remind you that mine ruptured right around 4.7. It never got to 5. You certainly don't want that to happen. 4.4, I'd want another in 6 months. You should be on a 6 month watch, not 1 year. Aneurysms have minds of their own. When they decide to go South, they do it quickly.

 

[Terri]

Thanks everyone for the great advise and suggestions.

I have just requested a CD copy of the 64 slice and will have it reviewed against the others.

I do take a beta blocker twice a day, and blood pressure meds twice a day.

I agree, twelve months is a long time to recheck, especially since the measurements seem to be all over the map. I believe I will contact Cedars Sinai for a second opinion and more important....peace of mind.

Thanks again for the feedback!
Twerri

 

[Kate]

Hi Terri!
I had my aortic aneurysm corrected about 18 months ago and agree with those posting above. Even more than most surgeries, aortic aneurysm repair is one that you want handled by an expert - both to help determine when the surgery should be performed but also to ensure that the procedure is done with minimal risk and that you receive the best possible guidance regarding how to manage your related valve issues throughout the process. Luckily, you live in California where there is at least one highly-rated program - at Cedars-Sinai in Los Angelas - and perhaps more.

The second point I'd like to stress is the importance of the relationship between your size and that of your aneurysm. This was mentioned previously, but it really is important. If on the short side (under 5' 5"), I'd recommend you make sure your height and weight are included along with the materials to be sent for review by the aortic specialist. Because the majority of people with aortic aneurysms are men, the recommended surgery point skews to their larger body size which may not be good for those of us who aren't six feet tall. Take care, Kate

 

[aussigal]

Just for your own peace of mind I would go with what Arlyss mentions...I am sure Cedars offer to evaluate scans (I reckon I read it on their web-site).

I sent mine to them via the internet. I live in Australia. They emailed me back an anser within about 2 days...I was very gateful and impressed.

It is possible that the tech. who did the MRI was slightly off-centre when measuring, this would account for the difference. It can be tricky to measure across a bendy aorta.

I also agree that at 4.4 you can probably afford to wait a little while under close monitoring but if it were 4.9 I would be heading to the surgeon. I had several 64 slice CT's and they all measured the same, it helped that they were done by the same person.

 

[Terri]

I will contact Cedars Sinai to see if I am able to forward the results of three different CT Scans and MRA. I received a CD yesterday of the 64 Slice from the imaging center with a written report.
One section of the report mentions some calcium in the Aorta and coronary arteries.

Recommendation: defiintive coronary angiogram to delineate the findings.
How do they do an angiogram, and, how does one get calcium buildup?

I see my cardio next month, I'll ask him these questions to, but I'm interested in hearing what field of experts think????

Terri