Enlarged Aorta

[bob_sixsix]

37 years old, 6'6" tall, 220lbs, no history of heart problems.
I've been going through quite a few tests to rule out Marfan Syndrome. It has been 3 years of tests and I haven't recieved a definitive answer on Marfan!
My doctor at Yale Medical Center put me through fifth ECG and noticed what appeared to be a "bulge" on aortic arch. This bulge was never picked up on previous ECG's or CT scans. He wanted to get a more definitive image of bulge so MRA was ordered. MRA results:
-heart normal in size
-great vessels origin unremarkable
-aorta measured: aortic root 3.8cm,ascending aorta at level of right pulmonary artery 3.7cm,descending aorta at level of left pulmonary artery 2.2cm and descending aorta at level of diaphragmatic crus 1.5cm.
Aortic root is minimally ectatic. No evidence of aneurysmal dilatation seen in remainder of ascending aorta, aortic arch or descending thoracic aorta. No evidence of aortic dissection.

My doctor then ordered an aortogram to get a definitive image of the aortic arch.  I had that done Thursday and preliminary results:
-slightly generous proportions at end of ascending aorta.  No evidence of aneurysm or artherosclerotic disease.
The interventional cardioligist asked me if I wanted hime to "shoot coronaries" while in there, I said no.

1)CT scan measured as high as 4.5cm in ascending aorta. Why is MRA so different?
2)Is ascending aorta normally this large compared to descending?
3)Should I've had coronaries imaged?
4)Femostop used for femoral closure. Is brusing around site and base of scrotum normal?
5)Do I have Marfan?
Thank you!

[pbanders]

I'm due for my first follow-up MRA on 2/1, so I'll post again in the comments to this question and let you know what type of contrast was used, if any.

As for "normal" sizes, your cardiologist should be your first source for that information. In my case, a 5.0 cm dilation of my ascending aorta by CT w/contrast was sufficient to warrant surgery.

[PJmomrunner]

My situation is very similar to yours, TKK.  I am a very active and otherwise healthy 42 year old and I was diagnosed with a 4.7cm or 4.8 cm ascending aortic aneurysm about 4 weeks ago along with a moderately leaky (but not enlarged) "pseudo-bicuspid" aortic valve.  I have had a consultation with one surgeon and am in the process of setting up a consultation with a genetic counselor as well as a second opinion with a surgeon.  I too am going crazy--spending lots of time researching online and as little time as possible imagining symptoms and worrying about whether I should lift that 20lb. bucket of kitty litter.  I am still running 3 miles a day, 5 days a week.  What is your plan for surgery, TKK?

[long]

I am supposed to have thoracic aorta imaged by mri/mra but don't know how it is done. For better accuracy should person stop all aerobic exercise for at least 2-3 weeks prior mri/mra test?Are pulmonary arteries and veins also imaged and measured with thoracic aorta?Thanks

[TKK]

In response to "pbanders" and "pjmomrunner" I was told by my cardiologist and surgeon that surgery should take place soon.  That scared me to death, so I personally took my recoprds to Cleveland Clinc and I'm waiting for the Doctors to review my chart and schedule my appointment and surgery.  I was told by my local surgeon not to do any weight-lifting or running.  I guess by doing all of my research on the web I'm still a little confused as to how serious my situation really is.  From my understanding, my regurgitation on a level of 1-5 is 4.5.  Let me know your thoughts.

[PJmomrunner]

Hey, TKK, I truly DO understand how you are feeling.  My understanding is that standards for operating on the ascending aorta vary some, but not much.  Most seem to operate at either 5cm or 5.5cm, although I have seen criteria beyond both ends of that spectrum.  Valve leakiness is usually measured on a scale of one to six (I to VI, actually).  Mine is a II or III.  My understanding is that the leakier one's aortic valve is, the harder the left ventrical has to work to keep up with both the volume coming into it from the left atrium and the volume being spit back into it from the leaky valve.  This work overload causes enlargement of the ventrical which will eventually lead to heart failure if left untreated.  I believe that determining when to operate on the valve is also tied to one's symptoms--shortness of breath, dizziness, fainting.  At my level of leakiness I have no symptoms and "no significant enlargement" of the ventrical, so my surgery is driven soley by the size of my anyeurism, although both issues will be addressed at the same time.  I would welcome talking with you directly if you are interested.  It's somehow comforting to find someone else in this same little boat!  ***@****

[bob_sixsix]

I have been going through tests to rule out Marfan Syndrome for three years now and still do not have a definitive answer.  I have had 2 CT scans, 6 echocardiograms(at rest and stress), a 24 hour holter, nucleur stress test and just last week an aortogram(angiogram).
The MRA and then the aortogram were ordered by my doctor because he noticed what appeared to be a "bulge" on my aortic arch.  The MRA did not confirm the bulge and neither did the aortogram.  Both tests did note that the end of the ascending aorta, which I assume is the beginning of the aortic arch, was slightly larger than average.  I am hoping once my doctor reviews the aortogram images that he will say the "slightly larger" area is due to my height and weight which is far above average too.  I am 37 years old, 6'6" tall and weigh 220lb.  The results from the 2 CT scans that I have had gave measurements around 4.5cm in the area of the end of the ascending aorta.  The MRA and aortogram did not record a measurement above 3.7 cm in this area.  The aortic root was 3.8cm which has remained this size over the past three years from ECG's, CT scans and the MRA.  My doctor explained to me that the CT scan is not an accurate means of measuring the ascending aorta because the ascending aorta comes off of the heart at an angle unlike the descending aorta which runs axially through the body.  The CT scan captures images that are perpendicular "slices" of the aorta.  Imagine cutting off your neck and look straight down into the aorta.  This would cause an elliptical shape/measurement of the ascending aorta which would result in a larger measurement.  I, like pbanders, am a design engineer and have been over analyzing this too.  I will keep you posted on the final results of my aortogram.  Sorry if I was so long-winded here.

Good luck.

~Bob