Seeking support for aortic root aneurysm treatment

[CancerConcierge]

I’m posting on my husband’s behalf. He is currently being treated for aggressive prostate cancer.

( had radiation and now on ADT medication) Age 74

He has been monitored by a local cardiologist since 2019, and more recently, this month , is being evaluated by a Cardio Oncology Specialist at Mayo, Arizona. ( where he is also being treated for his prostate cancer)

Echo 12/23/2019, Aortic root 3.9 cm

Echo, 02/03/2023 Aortic Root 4.0 cm

Echo, 08/21/2024, Aortic Root 4.6 cm

CT Chest, 08/27/2024, Aortic Root 4.5-4.6

Echo, 12/02/2024, Aortic Root 4.7 cm

Echo, 01/10/2025, Aortic Root 5.1 cm, also moderate to severe aortic valve regurgitation

CT Angiogram, 01/17/2025 Aortic Root 4.9 cm

He was put on Losartan 25 mg in August 2024, 1x daily, which was increased to 25 mg twice a day on 01/10/2025

His BP is still unstable, Systolic in the mid 130’s most of the time.

The new specialist has referred him for a genetic and vascular consults. Have not heard from scheduling yet. ( will call scheduling next week)

How concerned should we be ? What else should he be doing? His aortic root diameter has increased fairly rapidly.

Any advice or shared experiences would be helpful!

Thanks!

[Cliff_G]

Hi, sorry to hear about this.

The cardiologist's monitoring has been excellent, but that aortic growth is quite fast and you should now seek advice and possibly treatment from a major aortic centre, only at these places will you get the full range of knowledge. I'm not aware of which US hospitals qualify, but you may be able to get advice from the AorticHope.org or Thinkaorta.us people. The centre should be able to work out a plan which also allows for his age and his cancer treatment.

You can find out more on the recognised treatment criteria in the national guidelines, which we listed here aorticdissectionawareness.o... The current recommendation as an intervention point is when the aortic diameter gets to 5.0 cm, but diameter alone is an inadequate criterion, hence the need to see a top aortic centre, as surgery results are also better in these centres.

Please don't delay. My very best wishes to you both.

[CancerConcierge in reply to Cliff_G]

Thanks so much for your thoughtful response.

Mayo is a Center of Excellence here in the USA and is supposed to have a n excellent vascular program. So we are hoping to get a consult soon.

His unstable BP and fast growth of the aneurysm is very concerning of course!

[Cliff_G in reply to CancerConcierge]

No problem. I try to direct my experience of a dissection to the best uses!

The aorta is dealt with by both vascular and cardiothoracic specialisms depending on where the problem lies. The approximate split is at the left subclavian artery. For a root/ascending issue, normally it would be cardiothoracic. Though of course the two should talk to each other. But this knowledge might save you talking to vascular and then being handed off to cardiothoracic?

[CancerConcierge in reply to Cliff_G]

Yes, I think it may be under the same umbrella at Mayo . We may get a couple of opinions from cardio thoracic surgeons.

“The Mayo Clinic Aortic Center is a premier center for diagnosing and treating people with serious and complex aortic disease. Each year, the clinic treats nearly 10,000 adults and children with aortic aneurysm, including those with abdominal aortic aneurysms and thoracic aortic aneurysms.”

I think he should be monitored by a surgeon at this point.

I am inpatient though to get these consults done quickly … and quick does not seem to be the standard speed with some of these larger facilities

[Lexi72]

hi i am not certain whether your husband also has valve issues given his regurgitation and will need the valve replaced too. In case you have not found it already there is also Adam pick’s website in the USA . This is primarily for valve surgery but many people (like me) have valve issues . regurgitation and aortic root issues. I am not a member (as I am in the UK) but they seem to have a very supportive community as well as lots of materials It might be worth reaching out to see if there are any equivalent support groups for aortic root surgery. I have found it helpful just to talk to other individuals who are going through the same or similar issues . best wishes Lexi71

[CancerConcierge in reply to Lexi72]

Thanks for your response.

I will check out Adam Pick’s website, thanks for that recommendation!

I think with the amount of aortic valve regurgitation he has it is likely that he may need it replaced… early days as he has not met with a surgeon yet to discuss if he is a candidate for surgery .