What is an Ascending Aortic Aneurysm [in layman's terms] and how do they fix it?

The Aorta is the main artery that supplies oxygenated blood to your body.  An ascending aortic aneurysm is basically the "ballooning" of the aorta in the region where the aorta first exits the heart, often called the aortic root.  Think of a radiator hose with a bubble in it to get an easy visualization of this.  What happens is that the aortic tissue bulges. 



Ascending aortic aneurysms can be attributed to a few different things, but can be more commonly associated with people who have "bicuspid" aortic valves; meaning that instead of having three pieces of tissue (leaflets) on their aortic heart valve like most people, they only have two (hence the name bicuspid).  Ascending aortic aneurysms can also be found in people who have marfans syndrome and other conditions, however a great many people who are diagnosed with an ascending aortic aneurysm like me are 100% healthy with no underlying conditions.  The cause is unknown.

Whether or not you need surgery to fix the aneurysm depends on a number of factors, but generally speaking, the medical community recommends surgery for anything larger than 5.0cm.  The purpose of this site is not to offer medical advice, but to share experience and offer support and encouragement.  Whether or not you need surgery is a decision that you and your doctors will make.  I denied my own condition for months, coming dangerously close to having a dissection (rupturing of the aneurysm).

There are a number of different procedures that can be done to remove the aneurysm and fix the condition.  My doctor Allan Stewart is a skilled artist in a procedure called the "valve sparing" method.  I say "skilled artist" because I realized after talking to so many doctors, and doing so much research that these guys seem to each have their own little techniques, trademarks, and talents.  For example they may stitch something slightly different than the next doctor, or add their own variation on a procedure.  I did a lot of research and after speaking with Dr. Stewart I felt he was the most qualified surgeon in the country, and his particular procedure for my case seemed like the best one.  I don't want to sound cocky like I obtained a medical degree in 6 months, but you don't have to be a doctor to be able to read and educate yourself on what to expect from a surgery, and have an idea about the benefits and drawbacks of different procedures.  I encourage everyone to do diligence and make informed, educated decisions.  Immerse yourself.  People too often settle for mediocrity. 

Since my aortic valve was tri-cuspid and in good condition, Dr. Stewart "spared" the valve, cut out the bulging diseased aneurysm as well as some of my aortic arch to ensure no future aneurysms further up and replaced it with a Dacron hose.  He cut slits in the Dacron hose and reattached my coronary arteries and "wa-la I'm a new man", lol.  The entire scope of the surgery involves a lot more than that, but ultimately I was very confident in the procedure and I am glad I chose it, and him over others.  In my book "Barefoot in November" I describe the surgery in detail, and you can read my wife's log of everything that transpires while I'm out.  If you happen to have a bad valve, or a faulty bi-cuspid valve, perhaps you will have a different procedure that incorporates replacing your valve as well as the aneurysm.  Maybe you'll opt for a mechanical valve, or another type of tissue valve.  There are many things to consider.

This "ascending aortic aneurysm" is not a clogged artery requiring "bi-pass" surgery, or even "triple-bypass" surgery.  This is an extremely serious surgery in which you are messing with your lifeline, the main artery in your body that supplies everything: the aorta.  The fact that people (like myself) can get this condition in spite of being healthy in every other category can make it even more frustrating to understand and deal with.  If a person has been sedentary and eating cheeseburgers 3x a day for 20 years, smoking, and not exercising,  they are not very surprised when they get diagnosed with a clogged artery or other heart condition.  But when you're the specimen of health and out of the blue a diagnosis of ascending aortic aneurysm rocks your world it is a whole different story.

The truth is that the surgery is one of the most serious, but the reality is that if your aneurysm grows and progresses and you don't get surgery you'll die.  Studies have shown a loose genetic link to aorti aneurysms.  Many people are amazed to find out a relative has one after they've been screened.  After John Ritter died of an aortic dissection his brother Tom Ritter was screened and was found to have one.  He had a successful surgery to correct it.  Many survivors have traced their own family history to find relatives who have died of "heart attacks" or "heart conditions".  The reality is that these relatives may have died from an aortic aneurysm but it's impossible to know since often these deaths are broadly labeled as "heart attacks" for lack of detailed information or autopsies.  The good news is that there are plenty of living examples (some of whom shared on this site) that a successful surgery can leave you a new man (or woman) with no limitations.


4 comments:

manu said...

Various diseases of Aorta

Aortic Aneurysm :
Aortic aneurysm involves the abnormal dilatation of the aortic wall.
Aortic dissection :
Aorta is composed of three distinct layers. In dissection of aorta, a breach in the integrity of the aortic wall allows blood to burst into the middle layer, which is then split in two layers, creating a false lumen.
Aortitis :
Aortitis is inflammation of aorta. It can be due to infection of aorta or a non infectious etiology.

http://heart-consult.com/articles/various-diseases-aorta

Anonymous said...

I was accidently diagnosed with an ascending aortic aneurysm 3 years ago & since then (in Feb this year) it has grown to 4.9cm. I was told that surgery would not be considered before the aneurysm reached 5.5cm & further tests to check the size will be done in August. My concern is, I'd like to attend my sons wedding in Germany at the end of December & I really need to book tickets before August. Would it be too much to expect, that if I needed surgery, I'd be able to travel by 18 December?

Benjamin J. Carey said...

@Anonymous: You sure are fortunate that the aneurysm was discovered, even if it was accidentally. Nearly everyone in the community recommends surgery for aneurysms larger than 5cm, that's just the plain and simple reality of it. Mine was over 5cm when it was diagnosed and I initially found a surgeon who fed into my denial and allowed me to rationalize the condition and postpone surgery. It wasn't until I met Dr. Allan Stewart did I realize just how serious an aneurysm over 5cm can be. Dr. Stewart spelled it out for me and gave me a dose of reality combined with cold hard science and facts. Shortly afterward, I surrendered and accepted that surgery was inevitable. In hindsight it really wasn't that bad, and it was ignorant to have postponed it for so long. It turned out to be over 7cm when Dr. Stewart actually did the surgery. There is no reason to push the envelope. John Ritter I'm sure would have loved the opportunity you and I were afforded (having the aneurysm diagnosed).

It seems right now you are on the cusp. Go with your heart, and go with your gut. Once you get over 5cm I would schedule surgery. Personally I wouldn't travel anywhere away from a good hospital with an aneurysm much over 5cm let alone the U.S., but again that is a personal decision. If you end up having the surgery, I would think that you should be able to fly and travel by a couple months afterward. I had my surgery in November and made a trip in to NYC to see the Christmas tree, rock center, etc... a week before Christmas. I did a lot of walking and overall felt pretty good. Good luck to you, and pick up a copy of my book Barefoot in November. I talk candidly of having to deal with these same issues and emotions during my own ordeal.

Anonymous said...

As of a few years ago, the AMA recommends surgery for anything over 4.5cm.

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