Enlarged aorta

[Alisbabas]

Hello,

I had my heart echo today and everything seems fine, the cardiologist did say that intervention would be around 4.5 (45mm) for the enlarged aorta which I thought intervention at between 5 and 5.5?

Thanks

Ali

[SpiritoftheFloyd]

Hello Alisbabas

Yes that what I thought too, and according to the NHS below 5.5 it's a case of monitoring the situation, see link below:-

nhs.uk/conditions/abdominal...

I'd suggest you have a chat with your GP .

[Alisbabas in reply to SpiritoftheFloyd]

Hi SpiritoftheFloyd, I have a bicuspid valve with a thoracic aorta not abdominal.

He did day it would be a few years before I reached the stage of surgery though

Ali

[SpiritoftheFloyd in reply to Alisbabas]

Ops! sorry misread your post.

[Alisbabas in reply to SpiritoftheFloyd]

Thank you for your time anyway

Take care

[Rosei in reply to Alisbabas]

I have the same too, my last check was a month ago, it was 4 cm, 3.9 last year.

[Alisbabas in reply to Rosei]

Do you have a bicuspid valve as well?

Al

[MichaelJH Heart Star]

The DVLA will suspend your licence if it reaches 5cm so your cardiologist may be trying to minimise the disruption to your life. Also different cardiologists have different opinions. Personally I would prefer surgery to address the problem earlier as 80% of burst aortas are fatal!

Glad to know you enjoyed my post on "Tablets with Food".

[Alisbabas in reply to MichaelJH]

Hi,

I never knew that about the DVLA and yes I would like it done earlier too.

Thanks

Ali

[Hidden in reply to Alisbabas]

Hi Ali

Exactly where is your aortic enlargement?

My "enlarged ascending aorta" - the first bit of the aorta as it leaves the heart in an upwards direction - was found to be 4.2 cms.

This was discovered, coincidentally, when I had a chest x-ray to check my asthma in 08

I have had 3 yearly scans since then and thankfully, the measurement has remained the same throughout!

Good luck

Alps

[Alisbabas in reply to Hidden]

Hi Alpsholiday, it’s the same as yours the ascending the first bit.

I know they can take years to progress or some people have rapidly deteriorating ones

Thanks

Ali

[RoyM in reply to MichaelJH]

Hi my ascending Aorta was measured at 4.4cm with mild to moderate regurgitation of my bicuspid Aortic valve. It's the same size now as it was 3 years ago I undergo a six monthly CT scan and Echocardiograph at the Liverpool Heart and Chest hospital. I am lucky I don't have any symptoms. I was lead to believe that the size at which you may have your licence suspended was 6cm not 5 cm as previously stated....but I do stand to be corrected. It is recommended that elective surgery should be considered at between 5cm and 5.5cm although the size alone is not the deciding factor. Keep safe. Roy

[Oboebec in reply to RoyM]

I'm at 4.5cm... I think I remember my GP saying I had to inform DVLA at 5cm, but they wouldn't act until 6? I've had to log it with my travel insurers though...

[Alisbabas in reply to Oboebec]

Hi,

Everyone is different, I did think 5 to 5.5 which is why I questioned it.

I had a private echo yesterday so I have never seen my actual cardiologist yet as he always let the nurse see me as he’s busy.

When I do get to see him I’ll ask.

The private cardiologist I seen works for the NHS and said it was the NHS guidelines. He based in Birmingham

Thanks

Ali

[RoyM in reply to Alisbabas]

I have just read the DVLA site on Aortic aneurysms. It states you must notify the DVLA if the aneurysm is 6cm or over. Nothing about notifying them at 5cm. However, if your licence is for HGV, PSV etc you have to notify them of any aneurysm irrespective of size. You're quite right Alisbabas the NHS recommends to consider elective surgery at 5cm to 5.5cm. Stay safe Cheers Roy

[Cliff_G]

Hi Ali.

If your cardiologist found this on echo then he's talking about the ascending aorta, not abdominal as some have said, AAA is an entirely different matter, though just as potentially problematic.

If he did indeed say 4.5 cm then I would definitely question him as to why; he may have a reason for using a smaller figure than normal. The "normal" intervention diameter used to be 5.5 cm (just happens to be the same figure for the abdominal which starts off an entirely smaller size), and is still used, but preventive science on the aorta is adjusting that view. Already some quote 5.0 cm, and some differentiate between male and female and quote 5.5/5.0 respectively. However, there is nothing set in stone on this figure, it is a view of the balance of risks between that of operating and that of dissecting. There are numerous factors affecting the recommendation for you personally.

Firstly, genetic factors. Those with Marfan, Loeys Dietz or Ehlers Danloss will generally be operated on well before 5.5 cm. There is an annual update on these and others, to total of 37 genes in 2019, with the recommended intervention diameter against each gene. The range is from 5.5 down to 5.0, 4.5 and 4.0 depending. ncbi.nlm.nih.gov/pmc/articl... .

Secondly, rate of growth is important if it's high, and accuracy on this is difficult, especially with only echo. At some point they should move you to CT or MRI as well.

If you have a family history of aortic disease that is also a risk factor, as is bicuspid aortic valve, which can accelerate aortic wall degradation. With you, this may be the reason. Unusual vasculature is also a risk factor (e.g. different arch vessel take-offs, coronary artery configurations, etc).

Much of this you can't do anything about apart from get knowledge, but blood pressure is different, you can. You should make sure your BP is 120/80, not the NHS 140/90 figure, since aortic disease changes the balance of risks.

Hope this helps, you're right to find out as much as you can, knowledge is power. And try to get seen by aortic specialists.

ps the DVLA rules are complicated, read them very carefully on their web site, you won't necessarily lose you licence or even have to notify them, but you need to know when to

[Alisbabas in reply to Cliff_G]

Hi Cliff,

Thank you. I have done lots of research and I thought 5 / 5.5 was the average

Maybe it’s because I’m short (5ft) and having family history of heart problems

I will ask and double check.

Take care

Ali

[Cliff_G]

Ali, it's a "specialist subject". Unfortunately formal Guidelines such as ESC and US ones take some time to be brought up to date with the latest discoveries, whereas specialists keep themselves up to date and can make judgements accordingly. A great source of info is IRAD, who kicked off the refinement of the original 5.5 guideline (from2002 I think, John Elefteriades) by the finding that 60% of actual dissections were below 5.5. This created much confusion as to why 5.5 seemed to be statistically valid yet so was the 60% below 5.5, the answer seemed to be in the vagaries around the "tail" of a statistical curve and whole-population vs who actually dissected. The latest work by JE is jtcvs.org/article/S0022-522... Prevention and the non-reliance on diameter alone is a pet interest of mine since I dissected (with a degree of high BP) at 4.6 cm and no strange genes!

[Alisbabas in reply to Cliff_G]

Wow you have such knowledge, did you have any BAV or any valve problems as well?

I just emailed the cardiologist and he said if there is a structural abnormality of the valve the threshold for operating is lower

Ali

[Cliff_G in reply to Alisbabas]

Thanks Ali, yes, had forgotten, if they need to operate anyway, they will take the opportunity.

No, no bav or valve problem but I had such an extensive dissection it was best to do the valve as well, so now I tick!

[Gog40]

I have very recently had a Triple Bypass. During my scans they found I had an Aorta Root Aneurism of 4.2. I was told if it was 4.5 they could repair it while I was already opened up for my Bypass. However, to have an operation just for the aneurism it would need to be 5.5. Your height is part of the calculation and I am 5'3".

[Alisbabas in reply to Gog40]

Hi,

I think because I have a bicuspid valve the threshold is lower

Thanks

Ali