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Ascending Aortic Aneurysm Surgery: When To Have Surgery

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There's no simple answer to the question: When can we begin ascending aortic aneurysm surgery? Every person is different. But the simplest way to think about it is, we operate when the risk of surgery is less than the risk of having a rupture or dissection from the aneurysm. In this whiteboard session, Cleveland Clinic's Eric E. Roselli, MD, surgeon in the Department of Thoracic, discusses how they make the decision on when to operate. ➨ Visit Cleveland Clinic: http://bit.ly/XlxDfr ➨ Visit Health Hub from Cleveland Clinic: http://bit.ly/VBQ3nW ➨ Subscribe to our YouTube Channel: http://bit.ly/W0bJ0y ➨ Like Cleveland Clinic on Facebook: http://on.fb.me/WMFkul ➨ Follow Cleveland Clinic on Twitter: http://bit.ly/Uua1Gs ➨ Follow Cleveland Clinic on Pinterest: http://bit.ly/11QqS3A
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Text Comments (44)
Gigi (4 months ago)
I have aneurysmal dilatation measuring 4.2 cm on the right pulmonary and I'm so scare they say for woman is considered to have surgical to be down is that true ? Thank you
Renee B (2 months ago)
Thanks so much Gigi
Gigi (2 months ago)
Renee B you see I know it :) fantastic I which I can give you more support knowing we got the same problem but sometime Doctor scare us for somethings is supposed to happen whit age so I'm so happy the best to your mother
Renee B (2 months ago)
My mom said the doctor said to keep an eye on it and get future scans etc... she thinks my mom will be ok. I feel much better thank you for replying to my comments.
Renee B (2 months ago)
I'm not sure if that's safe either. I googled if u can private message people on here I guess u can. U go to my channel, click the about tab and look for the message icon. I went to your channel there isn't a about tab on your channel see if u can see one on mine. We can try and do it that way. Thank you so much for your kind words. I'm also on my cell phone so not sure if that's why I can't or not.
Gigi (2 months ago)
Everything going to be ok don't worry ok I would like to give you my email address but not sure if that's is safe here
June Llantada (7 months ago)
I am told I have this also. I am 49 y/o 5-5" 170lbs currently in the military. I was discovered at 4.6 cm in 2006 and was monitored every 6 months. Recently 2017 Oct it has grown to 5.2 cm. I was told that I should have open heart surgery. Going to see a cardiologist Nov 14th to see what they say. Just by my brief description does it look like I may have this procedure done?
Bruce Lee (7 months ago)
I have one on my ascending and descending aorta im scared to death and my dr isn't making it any better
David Hoff (9 months ago)
I don't understand the math using his formula for the ratio (Ao area/height). Note I was a BAV patient and did not have an enlarged aortic root, only 4.3-4.5 enlarged ascending aorta. E.g. for a 4.5 cm aorta the area is 15.9 cm. Being 5'10" my height is 177.8 cm. The ratio is 15.9 / 177.8 = .0894 .. you can never get to 10? Or is the formula (height/area)? I've posted my actual heart sounds whacking against my heart cavity. Why am I feeling this? I suspect the graft was not sized correctly and is flopping with each beat. My surgery was in April 2016 so more than enough time has passed. This is like Chinese Water Torture living with this as it even wakes me up from my sleep. I have no confidence in any of this and don't know what to do. My cardiologist in Marshall in Placerville can't even put the correct description in the record and they are even rude to me. They say I'm complaining of palpitations. My heart beats fine so they brush it off and ignore my appeals to them. I cannot live this way... I'm an educated UC Bio major with a second degree in computer science and was a senior DBA consultant for years. I don't make things up. This is in some ways destroying my life and would have rather taken my chances with the BAV and aneurysm. What's worst is I've posted the recording of the knocking sounds and have only got 14 views. 14 views! No responses! In the age of the internet. Maybe I should say I was abducted and Aliens did the surgery LOL.
sdeparis1 (8 months ago)
didnt check your math
David Hoff (8 months ago)
sdeparis1 or just my calc * 100
sdeparis1 (8 months ago)
use mm for the radius and then cm for the height. He should have stated that in the video its confusing. For you it would be ((45/2)^2 x 3.1415)/177.8
David Hoff (8 months ago)
Isn't the ration the same in metric? Should calc the same ratio cm or mm. Right?
sdeparis1 (8 months ago)
use mm for the aortic dilation
John Bensted (1 year ago)
I've been at 5.2 cm for the past five years and my docs clear me each year, yet I have a bicuspid valve. SMH
David Hoff (1 year ago)
This pretty much infuriates me. I have been suffering with an intense knocking with each heartbeat since my BAV valve and dacron aorta graft replacement surgery in April 2016. I have tried several times to plead with the doctors that I have an issue and they deny I'm feeling anything other than a normal heartbeat (because they can't feel what I'm feeling). Now I see with this video that they did not even need to replace the aorta with a dacron graft as my aorta was only 4.3-4.5 cm (less that the size to replace). And possibly there's an alternative to wrap the aorta with support? Yesterday I discovered I could actually record my pounding/knocking heart sounds with my cell phone and will be doing a separate post. I need people to confirm they too can hear the ridiculous knocking with each beat on the recording as I believe the dacron graft is slamming against my breastbone with each beat. The nurse refuses to see me saying I am a difficult patient saying I think I'm smarter than her because I said she cannot feel what I'm feeling and does not want to listen to me (she actually shook her finger in my face). It's hard to believe the battles I've been fighting and trying to be strong. Real life training and pray no one has to go through this, but I know it's the dacron aorta flopping against my body because there's too much slop in there. I have not been able to get a single full nights sleep since the surgery a year ago as it's like a shutter slamming in the wind all night long but is inside my body. I don't know what to do. Murphy's Law is real..
sarah joseph (1 year ago)
Thank you for the info I feel better now I have a AAA and it is 5 cm they are doing another ct scan in 6 months  but I was scared when they told me it was 5 cm because 2 years ago it was  only 2 cm.
Greer Saxon (1 year ago)
hello. my mum is 81 and has a abdominal aortic aneurysm. she wants to stop getting checked every 6mths, and let nature take its course. it's her decision right, but is it safe?
Linda Andersson (1 year ago)
Hello, I really hope i would get an answer to my question. I live in Sweden and my mother has been preskribted medicin pradaxa 150ml 2x a day, and Metropolol orion 50ml 1 x a day. My question is, does my mother really need these two pills?? She has always been very healthy nonsmoking person, untill she one time fainted at work and had the report that it was an epidermoid zyst in her brain. She was operated and during the operation she had ia mini stroke or it looked like it as the doctors said. After 2 years everything was fine except her disiness that she always had sense then. Now she has been diagnosed with a heart-problem bisqupid aorta (from birth). She has a aorta descendens 46mm ubove heart. High blood pressure sometimes (rises without any warning) and irregular heartbeat sometimes. The doctors said she also have fibrillation. When my mother eats the Metropolol she gets dizzier and are very tired. Would it help to reduce the dosis to 25ml? Or should she stop with the pradaxa. My mother is 54 years old. Please help me. We feel that the Doctors doesnt give their best in her situation, she was alot better without these drugs. The pradaxa just give me chills. Is there any way she could only take betablocker (metropolol) and leave the pradaxa out?
O M (2 years ago)
Thank you Dr. Roselli for posting this information for those of us who have this condition or a loved one with this condition. I have been worrying myself sick about my mother who has this condition and might need surgery. I would like to ask you this question: Can a ascending aortic aneurysm that is less than 5 cm be reversed or corrected using diet and medication?
Gigi (4 months ago)
O M and when is damage no reverse is possible unfortunately just control
Gigi (4 months ago)
O M hello I have that same problem of your mother under 5.0 and the only think is medication like for blood pressure or for cholesterol or to control diabetic medicine so good luck for your mother hope the best
Daryl Winn (2 years ago)
I have been diagnosed with an aortic root aneurysm. I receive my medical care from the VA. They check me every 6 months. I am currently at 4.8 cm. There has been no change in the size of the aneurysm for at least 6 months. I am due for another check in December of 2015. I have been told not to worry about surgery because the odds are that I will never have to face surgery. I am a little nervous about this surgery. I was told it is a 6 hour surgery and that kind of worries me. I am also concerned about pain when I wake up and that endotracheal tube in my throat. I know you don't know me and haven't examined me but what is your honest opinion about what I have been told so far. I am a 66 year old male and a 100% DAV. I also have Multiple Myeloma from Agent Orange and Arterioscloratic heart disease. If I have to have this life saving surgery I want to have it done at Cleveland Clinic in Missouri West of St. Louis. Please Reply.
Hippy(Bboomer) (1 year ago)
May God be with you in this, Daryl. I have five years on you and might have to have it too. If you are at 4.8 imo you need to see a cardiologist SOON. Don't let fear overcome you if something happens.
MultiMusik4 (3 years ago)
helpful, thanks!
sharkkiller1 (3 years ago)
i have a bicuspid valve and mine was 10.7 cm
JayeBird (1 month ago)
Hippy(Bboomer) a whale maybe? lol
Hippy(Bboomer) (1 year ago)
!!!!!!!!!!! THAT'S OVER 4 INCHES. Are you a Gorilla or a Grizzly bear??
Kimber Craven (4 years ago)
I have been diagnosed with thoratic ascending aorta aneurism with aortic regurgitation. My root measures 6cm's wondering if I will b able to work or if filing for disability most effective?
Humble one (1 month ago)
Hippy(Bboomer) same thing in America getting disability is next to impossible here for a thoriac aortic aneurysm, if anyone has had a positive outcome please let's talk. Not having an income because your sick... and waiting for the red tape..might as well be dead
Hippy(Bboomer) (1 year ago)
6 cm? Mine is at 5 cm and my ratio is about 11. Why are you still waiting? I have to fight tooth and nail just to get the angiogram. Surgery can't come soon enough.. meaning I hate the wait and the beaurocracy that is the Canadian medical system.. Forget disability, just get to a cardiologist. Disability compensation is the least of your problems.. if you are dead, what good is it?
Maxine Driscoll (5 years ago)
I am an 83 year old female with a Thoracic Ascending Aneurysm of 5.5 or 5.9 cm. (due to difference of opinion). Thoracic surgeons are discouraging me from surgery because of my age. They list complications such as death, kidney failure, stroke, etc. They say chance of rupture is only 20%. Do you agree?
David Needleman (5 years ago)
I should note that, for all that I've been told, I likely have the fusiform type of enlargement/aneurysm. Also, please let me know if, as I've read on Cedars-Sinai.edu site, that any enlargement over 4 cm is considered an aneurysm. Would like to know.
David Needleman (5 years ago)
I'm 48 YO, 6'3", and have been diagnosed with a dilated aortic root measuring 4.2 - 4.3cm, and a very dilated main pulmonary artery from 3.9cm to 4.4cm (these measurements were taken in 2011). Should I be having routine monitoring of my heart with such numbers? I know I'm in the low risk category, but with bp/heartrate control by atenolol, will this stay stable, or will I eventually be looking at surgery to prevent a rupture?
Iizzie Lips (5 months ago)
David Needleman yes you should be having yearly check ups
Hippy(Bboomer) (1 year ago)
I am not a doctor. That said, DO have routine monitoring. Get fit and stay that way so your blood pressure doesn't go too high. Eat healthy, Your ratio sounds pretty safe. Mine isn't and I am 5-10, 170 lbs with a 5 cm Aorta. Am 71, and want to make it to 72. Needing/awaiting surgery. Didn't know I had this problem until last summer. You are very lucky to know your condition, and I wouldn't play games with this. Palpitations, fluttering, and aorta pains are scary stuff. I have the bicuspid too. Do the right things and hopefully, this won't come your way
sheila ross (5 years ago)
@lairthehair what happened?
Im at 5.5cm with a bicuspid valve I have to wait for surgery I wonder how long I can last? the risk factor being so high Im set up for angiogram so Im in line for the surgery but information on people living with high risk is almost zero Im hoping that the aorta has some tolerance to give me the time i need
Don Neary (1 year ago)
Hey thanks for you comments "Hippy(Bboomer)" I've been dealing with the fear factor myself recently and your words of logic struck home. I just got the result of an Echo done last week. I've got moderate AR of Aortic valve plus mild dilatation of the ascending aorta( 3.9 CM). Also another complication of a moderate dilatation of the aortic root (4.9 CM). Now scheduled for first cardiologist visit next week. In the mean time I've been researching the web. Thanks for giving your personal stats as it gave me a good frame of reference as I am close to your age and size at 70 years old, 6ft, 195 LBs. Good luck to you.
Hippy(Bboomer) (1 year ago)
Me too. 5 cm and I am 71, Aint Canada's health care system a hoot? maybe March, for me.. God willing I am still here, Be of good courage, because fear is a bigger killer than an Annurism

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