Questions re: progression of ascending aortic aneurysm

[afraidofsurgery]

Losartan has been studied in a trial of Marfan patients to slow down dilation of ascending aneurism, academic.oup.com/eurheartj/article/34/45/3491/436122
I am now on it since my ascending aortic aneurism was recently discovered, I'm at 5.1 cm stable over the past 3 months. Was also evaluated for connective tissue disorders since I may have had a bicuspid aortic valve (replaced with mech valve 2009).

 

[Gordo60]

Even though I’m very tall testing by a Marfan clinic suggests I’m negative for same.

However a few years ago I asked if I could try Losartan. Because my blood pressure is normal the maximum dose they could put me on is 25 mg. Some suggest this is not high enough to be effective. At the last two echos my aortic root aneurysm appears to have been stable around 4.8 cm after having previously grown the usual 1 mm per year. However given the inaccuracy of echo it’s hard to know. I go for my annual echo / consult this Friday so it will be interesting to see if the stability is valid or not being the third echo since starting losartan. I tend to not think much about the aneurysm most of the year but get a bit miserable in the few weeks leading up to the annual echo as it brings it back into focus.

Curious what dosage of Losartan others are on?

 

[Keithl]

I was on 25mg Losartan for years(over a dozen) can’t tell you if it kept me stable or not, but it took from 2007 to 2017 to go from about 4.4 to 4.7, but then from 2017 to 2019, 24 months it went from 4.7 to 5.1 triggering the surgery. While my valve was listed as moderate all those years the surgeon reported that when he replaced it the valve was worse than the images showed and that the valve was actually severe. In the end it all worked out.

 

[Gordo60]

I’ve seen it mentioned that once an aneurysm reaches 4.7 cm it’s far more likely that it’ll continue to grow rather than stay stable. So at 4.8 cm I’m not all that confident mine will stay stable but time will tell. A few more years would be good as it would make the decision of tissue vs mechanical valve if needed easier.

 

[Superbob]

One surgeon measures mine at 5.5 cm, and the other surgeon measures it at 5.7 -- so virtually the same, and both indicate enlargement and brisk increase. So no doubt of the danger level being high. Surgeon did mention my having a catheterization prior -- and said it would okay to have it done locally instead of at his hospital 200 miles north. I had one prior to my OHS in 2005 and it didn't bother me. However, watching videos of the procedure tonight, I wondered: Is it possible the movement of the cath could rupture the aortic aneurysm? Is this test necessary to have prior to OHS?

 

[AZ Don]

I've been on Losartan, 25mg since my valve sparing aortic aneurysm repair 6 years ago. My valve started leaking after the surgery and my ejection fraction dropped to a low of 40-45. I was told it would not improve. It was 55 last year and 56 this year. My Cardio thinks the improvement may be due to Losartan. I was initially Rx'd 25mg twice per day but stopped the 2nd pill due to dizziness.

 

[AZ Don]

The Dr. that performed my cardiac catheterization prior to my OHS told me that it was to check my coronary arteries to see if I needed a bypass while they were doing OHS. This was both surprising and upsetting to me as there was no reason to suspect an issue with these arteries - and they were clear.

My surgeon told me the cardiac catheterization was needed to get a better view of what he was going to be working on during the surgery.

 

[Keithl]

The Dr. that performed my cardiac catheterization prior to my OHS told me that it was to check my coronary arteries to see if I needed a bypass while they were doing OHS. This was both surprising and upsetting to me as there was no reason to suspect an issue with these arteries - and they were clear.

My surgeon told me the cardiac catheterization was needed to get a better view of what he was going to be working on during the surgery.

I was catherterized as well, told to make sure I don’t need a bypass as the bypass would then be done at same time since bypass require Coumadin for a period of time.

 

[Dan Zulu]

My surgeon said that my imaged 4.8cm root would continue to expand, and surgery was inevitable to repair it. Instead of delaying it with no benefit, I went ahead. In surgery it measured 5.0.

 

[Keithl]

My surgeon said that my imaged 4.8cm root would continue to expand, and surgery was inevitable to repair it. Instead of delaying it with no benefit, I went ahead. In surgery it measured 5.0.

I have heard some will recommend going in earlier than 5cm. There is supposedly new studies that say the absolute size is not as accurate a prediction as the size compared to a persons height. The taller you are the sooner they should go in. I held out u til 5 as I was around 4.8 for a few years then it went 4.9 and then 5.1 so after years of very slow growth it was on the move.

 

[Gordo60]

There is supposedly new studies that say the absolute size is not as accurate a prediction as the size compared to a persons height. The taller you are the sooner they should go in.

I think it’s the other way round. That is, the shorter one is there may be need for surgery sooner.

New evidence has shown that the size of the aneurysm in addition to a patient’s height plays an important role in the decision for surgery. While 5 centimeters is the size most aneurysms are considered for surgery, Cleveland Clinic surgeons have compiled years of experience and published studies to find that a patient’s height and their aneurysm’s size strongly correlates with the need for surgery. For instance, a patient who is over 6 feet tall with a 5 centimeter aneurysm would be recommended for surgery. Yet, a patient who is 5 feet 7 inches with a thoracic aneurysm of 4.7 centimeters is a candidate for surgery due to their individual risk of rupture.

https://my.clevelandclinic.org/health/treatments/17527-thoracic-aortic-aneurysm-surgery

 

[Thunderheart]

Hi there, I'm 49 y/o and coming up on 3 years post AVR (ON-X mechanical) this July. All is well but I'm a little concerned about the progression of an ascending aortic aneurysm. Prior to and during surgery in 2016 my surgeon measured the aneurysm at 40mm which is below the threshold for repair or replacement. This is about the same diameter it had been since about 2007 (fluctuating between 38mm and 41mm over that time) as measured by echocardiogram. Since then I have been going in annually for echos and the number was 41mm in 2017 and has been at 43mm for the past two years. We confirmed this with a CT scan last year as I'm aware that echocardiogram isn't always precise.

My main questions are:

1. how quickly do these kinds of aneurysms typically progress after AVR?
2. anyone have any experience with a second OHS for aorta replacement years after AVR?
3. I know I shouldn't be weightlifting or lifting anything heavy in general but is it ok to do push-ups and planks?

Post-surgery my surgeon said there was a 10% chance I would need the aorta replaced at some future point so I'm still hopeful but unsure.

P.S. Thanks in advance, this forum is such a great resource!

Hi
I have an OnX. It was put into years ago after my third AVR/aortic root/A sending arch replacement. I had endocarditis in between my two tissue replacement so I didn’t get as long as I should’ve out of them because I had an extraordinary amount of calcification and scarring they decided to go mechanical this time because I can’t have another surgery without drastically changing things.
I don’t lift heavy weights but I am able to do yoga and planks and push-ups however the pounding becomes very intense I have an incredibly loud valve due to all the calcification and scarring and subsequent surgeries were more had to be replaced.
It’s a good sign that your aneurysm has not traveled up your attending arch or into your root. My advice would be not to worry about it and just keep doing what you’ve been doing I think thoughts become things inside and outside of my body so stay positive my friend.

 

[LonMel]

I have heard some will recommend going in earlier than 5cm. There is supposedly new studies that say the absolute size is not as accurate a prediction as the size compared to a persons height. The taller you are the sooner they should go in. I held out u til 5 as I was around 4.8 for a few years then it went 4.9 and then 5.1 so after years of very slow growth it was on the move.

I had my ascending Aorta done @4.7. My surgeon has been studying the shearing of the walls of the Aorta and he said there are no hard and fast rules regarding size and dissections.
That and some symptoms I was starting to develop convinced me to get it sooner rather than later.
My valve was to fenestrated to be repaired and I received a bovine bio-synthetic valve.

 

[Keithl]

I had my ascending Aorta done @4.7. My surgeon has been studying the shearing of the walls of the Aorta and he said there are no hard and fast rules regarding size and dissections.
That and some symptoms I was starting to develop convinced me to get it sooner rather than later.
My valve was to fenestrated to be repaired and I received a bovine bio-synthetic valve.

I know my cardiologist was pushing me at 4.8 as he also was mentioning some newer studies indicating possible intervention at smaller sizes. I know when I hit 4.5 they started discussing it since my valve was degrading. The surgeons kept saying the valve did not warrant going in before 5cm, but then they did mention near the end that they felt that Cleveland would have recommended going in sooner. Since there was no signs of wall dissecting they felt good with 5cm.

 

[Hairballusmaximus]

My ascending Aorta was done @6.7
They were monitoring it for a few years, but had me throttled back with meds so bad I forced the issue of med reduction. I dont know if that's what allowed it to expand or not. I pushed for a med reduction regardless of risk because getting winded and needing a nap after walking to the mailbox wasnt LIVING, it was EXISTING. I was supposed to be getting Echo's every 6 months, but due to changes in insurance companies and policies.....I went around 2.5 years between, and it was during this time that it expanded. Now, to your question....my Dr's didn't want me doing pretty much anything. No planking, no running, no sports, literally nothing except walking, slightly moderate walking was his description. I dont do laying around, so.....I did whatever I wanted, Wakeboarding, rode quads at the sand dunes, yard work, mowing, weed whacking, hiking, etc.
I don't know what part caused it to expand, I don't know if ANY of it did, don't know if it was med reduction, it may have expanded no matter what I did. I won't/can't tell you what's safe for you to do....all I'm saying is I couldn't just "exist"......I needed to "live" ......but everyone is different and you sound like you're not as throttled back as I was. Dr's said not to do anything that involved strain, or any strenuous activities, nothing that would raise my BP.
My AVR was 12/12/2012, my ascending Aorta replacement was 4/16/2018
My ascending Aorta replacement was not OHS, they went in through my left side. The Aorta runs just in front of spine and there is a ton of stuff in the way that has to be moved to gain access to it. I also had damaged arteries to both kidneys, so they replaced those at same time as well.

 

[tom in MO]

One surgeon measures mine at 5.5 cm, and the other surgeon measures it at 5.7 -- so virtually the same, and both indicate enlargement and brisk increase. So no doubt of the danger level being high. Surgeon did mention my having a catheterization prior -- and said it would okay to have it done locally instead of at his hospital 200 miles north. I had one prior to my OHS in 2005 and it didn't bother me. However, watching videos of the procedure tonight, I wondered: Is it possible the movement of the cath could rupture the aortic aneurysm? Is this test necessary to have prior to OHS?

Good question Superbob. Tell us what you find out.

I only had an AVR and but asked if the cathaterization was needed. I was told by the cardio it was needed to see if I required a bypass, but at age 55, I had trouble with that concept. My surgeon said it was needed for that reason, but also it was to give him a "good look ahead of time at what he was getting into."

 

[Keithl]

I was happy that after almost 50 years of no exercise and bad eating the catch showed my arteries were as clean as a whistle and they said if I keep up the good habits I would not ever likely need bypass surgery.

 

[Superbob]

I was happy that after almost 50 years of no exercise and bad eating the catch showed my arteries were as clean as a whistle and they said if I keep up the good habits I would not ever likely need bypass surgery.

That
That's great news! It is the report I got on my pre-op cath 15 years ago -- a bright note for sure. Just hoping that the last 15 years of enjoying not-always-heart-healthy food (for instance, baby back ribs) hasn't clogged my arteries. Just as soon not have to have bypass on top of already complicated surgery. But if it's needed, it's definitely needed. And it stands to reason that a cath serves a purpose in giving the surgeon a good look at what he'll be dealing with.

 

[afraidofsurgery]

My ascending Aorta was done @6.7
They were monitoring it for a few years, but had me throttled back with meds so bad I forced the issue of med reduction. I dont know if that's what allowed it to expand or not. I pushed for a med reduction regardless of risk because getting winded and needing a nap after walking to the mailbox wasnt LIVING, it was EXISTING. I was supposed to be getting Echo's every 6 months, but due to changes in insurance companies and policies.....I went around 2.5 years between, and it was during this time that it expanded. Now, to your question....my Dr's didn't want me doing pretty much anything. No planking, no running, no sports, literally nothing except walking, slightly moderate walking was his description. I dont do laying around, so.....I did whatever I wanted, Wakeboarding, rode quads at the sand dunes, yard work, mowing, weed whacking, hiking, etc.
I don't know what part caused it to expand, I don't know if ANY of it did, don't know if it was med reduction, it may have expanded no matter what I did. I won't/can't tell you what's safe for you to do....all I'm saying is I couldn't just "exist"......I needed to "live" ......but everyone is different and you sound like you're not as throttled back as I was. Dr's said not to do anything that involved strain, or any strenuous activities, nothing that would raise my BP.
My AVR was 12/12/2012, my ascending Aorta replacement was 4/16/2018
My ascending Aorta replacement was not OHS, they went in through my left side. The Aorta runs just in front of spine and there is a ton of stuff in the way that has to be moved to gain access to it. I also had damaged arteries to both kidneys, so they replaced those at same time as well.

Gordo, well said re: LIVING. I've felt knocked down by the recent intense scrutiny and new meds from my cardiologist after the discovery of my 5.1 cm ascending aortic aneurism just before Christmas last year. The meds aren't causing fatigue and it's helped mentally that there was no change in the last 3 months, but I've had to fight the mindset that now I'm 'fragile' or about to burst or dissect. I'm a really resilient and very active person and while I'm not a runner, I bike and walk and do yoga and coach gymnastics and generally face life with a very tough attitude. And have NEVER thought of myself as fragile. I'm doing better but I totally get your description of being medically incapacitated by the docs. I'm sure they mean well but it's not them. I am asking for journal references every step of the way to justify new meds, with the additional intention of getting the point across that I am a partner in the treatment not just a 'subject' or passive patient so I don't get run over by treatments. Thanks for the post.

 

[pellicle]

Gordo, well said re: LIVING. I've felt knocked down by the recent intense scrutiny and new meds from my cardiologist after the discovery of my 5.1 cm ascending aortic aneurism just before Christmas last year. ...across that I am a partner in the treatment not just a 'subject' or passive patient so I don't get run over by treatments.

great post and it reminds me of the multi-faceted psychological side of things which we all struggle with and are not really discussed openly with us. Surgeons are not psychologists (even remotely).

Of course it will be different in many ways for all of us, but there will be a "Venn Diagram" type intersection set for all of us I expect.

There is much I could say on this, but I'll leave it for now on observing that our feelings of being a passive subject of treatment is an artifact of the system where we really don't know the details of what is being done and rely on the expertise of those doing the work.

Its important to not slip from being a person seeking wellness to a subject of a system. Its always an uneasy path to navigate.

Best Wishes