Normal Ascending Aorta Size??

[savysmommy]

Hello All,
Every once in a while, something spikes my curiosity, and I cant stop searching for the "answer" until I find it. Of course one of the first places I look, is here!

I am trying to research normal ascending aortic size, and I cant seem to find any definitive values. I have found a lot about when to do surgery, ect, but nothing on normal values, or how to calculate normal values. I know that the patients size does also play a role. If your a larger person you may have a larger aorta, and a smaller person might have a smaller. But what is the size of the ascending aorta suppose to be?

The only good info I have found related to size, is more related to risk of dissection, and rupture. Its actually really interesting.

Scroll down to the yellow chart, which shows the risk based on size.
http://www.slrctsurgery.com/Thoracic aortic aneurysms.htm

Anyhow, does anybody know what the normal value should be in a younger (20 something) 5'8", healthy weight person?

One more question. Does anyone know, or have studies on how the aorta responds to expansion, after its been cut?

Thanks for all your input!

 

[67walkon]

Cool chart! The surgeon at Shands sent me the same chart, but without the other info.

I think normal is around 3 cm, but I'm not sure. And I don't know how body size affects that.

Someone here will know!

 

[briansmom]

Interesting article. My son dissected before we ever knew about an aneurysm.

 

[Ross]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1728670&dopt=Abstract

 

[savysmommy]

Ok, this article says "Aortic Aneurysm". Is that the same as an ascending aortic aneurysm? That might be a stupid question. But the article doesn't indicate where in the aorta they are referencing, and I believe different parts have different values. isn't that correct?

Thanks for posting this though, this is the first thing I have seen that has normal values.

 

[beth]

The aorta is divided into sections - after the aortic valve is the root, then the ascending aorta, then the arch, then the descending thoracic aorta. I can tell you my 21 year old son's (6 feet, 185 lbs) ascending aorta was at 3cm and was normal. I believe when a section of the aorta is 1.5 times the size of the rest of the aorta, it is considered an aneurym. My kids now have a baseline to see if they have any changes down the road. Hope this helped a bit.

Beth, husband of Alan (46) with a BAV and valve replacement with a Carpentier Edwards on May 30th ath Boston Medical Center.

 

[savysmommy]

Tanks Beth. I understand the general anatomy of the aorta, I just don't understand if the Aortic Aneurysm term is meant as a general term for any part of the aorta, or a specific part, like the ascending or something. The article wasn't too specific.

Btw, best wishes for your husbands surgery. Glad you found this site!

 

[Bionic Man]

Don't know what normal is but I can tell you what's not

Don't know what normal is but I can tell you what's not

My aorta measured 4.5 in the ultrasound when the doc told me it was time to get surgery but when they got inside they realized it was really 5.3 and had partially dissected.

Hope all is well.

 

[Arlyss]

Normal Size of Aorta versus Enlargement/Aneurysm

Normal Size of Aorta versus Enlargement/Aneurysm

This is a very important topic, and one that is still not broadly understood in medicine.

The normal size of the aorta depends on body size, age, and gender. So how does anyone know what is normal for them? Generally, one area is enlarged or aneurysmal, not the entire aorta. As Beth has mentioned, the best comparison is to one's own aorta, and an aneurysm is defined as 1.5 times the normal diameter. For the ascending aorta, to determine how much it may be enlarged, it can be compared to the size of the descending aorta. The descending is very slightly smaller but a good reference point for the ascending.

As an example, if the descending aorta was 2 cm, the ascending should be about that same size. If it is enlarged, but not 3.5 cm (1.5 times 2), it would be considered dilated (somtimes the word ectasia is used) but not an aneurysm. At 3.5 cm or greater, in that person it would be considered an aneurysm.

There is also a rule of thumb that an ascending aorta of 4 cm or more is an aneurysm - but this does not consider individual characteristics, so it is not as precise - just a general indication.

Dr. Eric Isselbacher gave a presentation that compares the aortas of two different people side by side. One person's actual measurement was much smaller than the others, but relative to their body size, the enlargement was equally significant, and it was decided in this person to perform aortic surgery. Relative to what was normal for the smaller person, their aorta had enlarged just as much, even though the actual measurement was smaller.

The bottom line is that the entire aorta should be looked at (CT or MRI) and measured by someone with expertise. "Normal" ranges listed on reports for the size of the aorta are actually meaningless - just a range that covers the possible sizes across the population. It can be dangerous, because an enlarged aorta in a small person may fit in this so called normal range - when it is not normal at all for that person. Ignore the normal ranges given on any report about the aorta, and insist on knowing what is normal for you as an individual.

The paper that is listed in this thread applies to the abdominal aorta, not the aorta in the chest. They are two different disciplines.

There was a question about the expansion of the aorta after it has been cut - this needs to be quite a specific question really - how and where was the aorta cut?

I hope this helps. The difference between a properly measured aorta can really be the difference between life and death. It is a great concern when I read things like the posting by Queen Victoria re. her son Scott. Initially thought to have a 6 cm aneurysm, she later posted that it was actually 8.9 cm. This should not happen.

Best wishes,
Arlyss

 

[Ross]

It is a great concern when I read things like the posting by Queen Victoria re. her son Scott. Initially thought to have a 6 cm aneurysm, she later posted that it was actually 8.9 cm. This should not happen.

Best wishes,
Arlyss

No it shouldn't, but it happens all the time and is the reason I cringe everytime someone posts that theirs is over 5.0.

 

[Lynlw]

No it shouldn't, but it happens all the time and is the reason I cringe everytime someone posts that theirs is over 5.0.

I doesn't really surprise me they can be so far off in the size measurements. When you hear weekly about babies that have several severe CHDs, 3 chambers not 4, and even their hearts on the wrong side of the body, that are missed during multiple prenatal echos, you kind of lose faith in the people performing and reading echos.

 

[Arlyss]

Ross,

There may be someone who might try to explain medically how your life was saved..... but I will offer a very important reason for it - you are the voice of many who didn't make it. Someone needs to speak for them and warn others. They are dying today, and it should not happen.

You came back from the brink of death to warn us all about what can happen to those with disease of the aorta.

There is no way to thank you and others like you who share your experience in hopes of warning someone else.... You are a hero in the fight with aortic disease.....

You always have my very best wishes,
Arlyss

 

[Ross]

Ross,

There may be someone who might try to explain medically how your life was saved..... but I will offer a very important reason for it - you are the voice of many who didn't make it. Someone needs to speak for them and warn others. They are dying today, and it should not happen.

You came back from the brink of death to warn us all about what can happen to those with disease of the aorta.

There is no way to thank you and others like you who share your experience in hopes of warning someone else.... You are a hero in the fight with aortic disease.....

You always have my very best wishes,
Arlyss

Thank you! I've had people write me and say that at first, they thought I was just being a butthole about how it is, then they found out differently and were so glad that I did speak my mind, because it made them stop and think even if it wasn't pleasant. Maybe I saved a life or two, maybe not, but I'd like to think I did.

 

[savysmommy]

Arlyss, this is great information. So, really what somebody needs to do is keep a file of their records, and you can probably make the comparison pretty easy, if the values are given. Also having a CT scan of the entire aorta would be a good idea, so you can see the comparison as well. I don't know if its routine to look or measure the abdominal region of the aorta during routine echo's, is it?

If there is no hard and fast rule as to normal values, then there definitely shouldn't be any hard and fast rules for determining what an aneurysm is.

In regards to the cut aorta. During AVR, they cut through the aorta to get to the valve. Also, a procedure called Plication was done. The aorta was cut like a football shape, and sewn shut. This was suppose to get rid of the small aneurysm that I had. So, my question is how does cutting the aorta effect the tissue within the walls of the aorta, and its ability to stretch and expand. Has it lost some elasticity because of this?

There is a reason behind all my questions. I will start another post in a few days regarding that.

Thanks again for everyones wonderful insights about this.

 

[Arlyss]

Comparing echo reports before and after my husband's first AVR, his ascending aorta had grown. However, the increased size was still within the "normal range". I assume that is why nothing was said. It makes no sense to tell someone that his aorta is in the size range across the general population (all body sizes, genders, ages) and not even notice it is increasing! What does make sense is to know what his own aorta size should be, and notice that it is getting bigger!

Here is the link to Dr. Isselbacher's presentation. The slide is very interesting where he shows the aortas of two different people side by side. Relative to their own body, they both were ready for surgery, even though the diameters of their aortas were different.

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

Regarding the aorta and cutting it, perhaps this paper gives some idea of what ascending aortic aneurysm tissue is like in those with BAVD.

http://circ.ahajournals.org/cgi/content/full/106/8/900

If you look at Figure 4, you see the normal aorta tissue compared to the abnornal, aneurysmal tissue associated with BAVD - a great difference that sets up for life-threatening tearing or rupture.

There is some work being done on discovering what happens to make this tissue lose its elasticity and strength - but no one knows today. There is no medicine to fix those tattered fibers/tissue. The solution is to remove it. In my husband's aorta, that meant taking all of his ascending aorta and some area underneath his arch and replacing it with Dacron.

If abnormal aortic tissue was cut and some of it left behind in my own chest, I would keep my blood pressure low and have my aorta carefully watched for problems by an expert.

Best wishes,
Arlyss

 

[Arlyss]

I will just follow up what Rachel has mentioned for Savysmommy and anyone else who may read this.

If problems develop at the stitching line where the aorta was cut, it is usually called a pseudoaneurysm - not all of the aortic wall is even there, and it is very dangerous.

Rachel, like Ross, is another survivor who went to the brink of death to come back and help others. They are both "expert witnesses" because of what they have heard, what they have seen, and what has happened to them.

Arlyss

 

[Ross]

If there is no hard and fast rule as to normal values, then there definitely shouldn't be any hard and fast rules for determining what an aneurysm is.

It's very safe to say that if they see ballooning in any part of the aorta, it's an aneurysm. Anything that does not equal the rest of what they see. I know I just found out in August that I have an abdominal aneurysm growing and I'm not the least bit happy about it. Terrified as a matter of fact.

 

[Susan BAV]

Ross, one of my distant cousins had, I think three, abdominal aneurysms repaired through his groin with some kind of stents a couple or more years ago. He's apparently still doing really well. Is that an option for you?

 

[Ross]

Ross, one of my distant cousins had, I think three, abdominal aneurysms repaired through his groin with some kind of stents a couple or more years ago. He's apparently still doing really well. Is that an option for you?

God I hope so, I won't make it through another major surgery.

 

[savysmommy]

Ross, I would be scared as well. I hope that it stays as is, and doesn't grow any larger. Have they talked about surgery yet?

Well, I don't think I have an aneurysm, at least I hope not. I cant seem to locate my medical records to compare reports. I have a new copy in the mail on its way to me now. All I know is that my ascending aorta is larger today than it was when it was "fixed". This is why I wanted to find out if its size was normal. I guess it doesn't matter, because if its bigger, than thats a problem. Surgery wasn't even two years ago.

The reason I was so interested in finding out all of this is because ( I was gonna put this in a different thread, but oh well) I am pregnant. This was all ok, and I expected everything to be fine. I am sure it still is, but just a few comments stuck out at my last doc apt, that now have me concerned. I am concerned about the additional 50% blood volume that will be going through my heart by the 20th week, and I am concerned what this effect will have on my aorta. After learning that it is bigger than it was after surgery, is what has me concerned. However, I don't know how significant the change was yet.

As soon as I get the copies from my docs office, I can figure out exactly what has changed. BTW, I am only 8 weeks.

Thanks everyone for the very informative post!