Ascending aortic aneurysm

[Lovenorthern]

In January 2024 I was not feeling myself, a bit dizzy and feeling faint, I was diagnosed with afib. Still not feeling well so I asked to see a specialist. Had an echo and 24 heart monitor in May and got an appt in October to see specialist. He said I was in persistent afib but was on the correct medication and he would discharge me. Four days later I got a letter saying I had to have an MRI on my heart and I had a dilated aorta of 2.25. Got the MRI 3rd of December and have just had the results which show an ascending aneurysm of 44mm, no further intervention and MRI in 12 months. I am so worried, how can this grow so fast and I have to wait another 12 months for a scan!

[JulianM]

I find this very confusing: the suggestion that an aorta at 2.25 cm is 'dilated' is simply wrong and while I don't understand what it is referring to, it makes no sense to me to compare that measurement to the 44mm you have been given for your ascending aorta.

Typically, ascending aortas don't grow much - my own has been stable at 4.8 cm for five years - though sometimes they do: 'fast' growth would be anything from 3 to 5 mm in a year. If your aorta went from 44 mm to 49 mm in a year that would be very exceptional (and could meet some criteria for considering surgery).

Unless you have a family history of dissections or suspect a connective tissue disorder (Marfan or Loeys-Dietz in particular) you would still be considered at low risk and a repeat scan in a year's time may be completely reasonable.

Have you discussed genetic testing? If you are under 60, there's guidance which would say it should be offered to you, and even if you're a little over that age, it can still be considered if the cardiologist thinks there could be a genetic condition underlying your aortic dilation.

[Lovenorthern in reply to JulianM]

I am 63 and do not have any knowledge of any family history of related issues. The text that I received in October stated a mild dilated aorta of 2.25cm had showed on an Echo. The text I received today said according to the Dec 3 MRI it was 44mm. I am really worried, should I ask for a second opinion?

[Cliff_G in reply to Lovenorthern]

Hi, the 2.25 cm has to be a typo error, especially as it was on a text message. 2.25 is below any normal ascending aorta in an adult, which are around 3 to 3.5 cm. I'd ask your GP to check your medical records.

[Lovenorthern in reply to Cliff_G]

Thanks for your reply, I will ask him to check because I was in a bit of a panic because it seems to have grown at an unbelievable rate.

[JulianM in reply to Lovenorthern]

Another point to consider is that the first scan was an echo, which gives a restricted view of the aorta (though it's generally good for the aortic root and for looking at valve structure and function) whereas the MRI gives a complete 3-d set of images which sometimes does result in very different maximum measurements.

[Lovenorthern in reply to JulianM]

Thanks, I didn’t know that and the difference between the readings just freaked me out. I do feel a bit calmer today but will contact the consultant for a clear explanation.

[Lovenorthern in reply to JulianM]

Thank you for you reply Julian, I don’t have any information at all and appreciate your explanation. I am under a cardiologist as four years ago had a heart attack and stent fitted. Do you think I should request a second opinion at a specialist centre?

[JulianM in reply to Lovenorthern]

I think that at your age and at that size yes, you should ask for a referral to an aortopathy specialist; typically, they are cardiologists who work as part of a multidisciplinary team alongside cardiothoracic surgeons who specialise in aortic root and ascending aortic surgery.

At some point it might also be helpful to see a surgeon to get their view on what is going on and the likely options for future treatment, though it's possible this won't be needed.

Genetic testing might or might not be advised, but annual monitoring definitely would be.

These specialists are mostly found in regional aortic centres which are mapped here: aorticdissectionawareness.o...

Hope this is helpful and makes sense!

[Lovenorthern in reply to JulianM]

Thank you for taking the time to reply, it makes a lot of sense and I will ask for a referral. I think I am worried and confused at the minute and your advice is appreciated.

[sandandkev]

I don't know about your AAA but Afib is not persistent or permanent unless you've had for over 12months and have tried cardioversion or ablation!!

[Lovenorthern in reply to sandandkev]

Thanks for your reply, I will ask my GP to explain this as I only have the information given in the consultants letter and he said at my appt that ablation and cardioversion have their own risks and he did not recommend them.