Expanding Thoracic Aortic aneurysm

On 2-12-13 I found I have an aorta aneurysm located on the ascending aorta measuring 3.9cm at the level of the pulmonary arteries. The CT scan prior to this one was done on 8-4-11 showed it to be 3.6 but was not shown on the report until my cardio had them recheck the scan and there it was.  It was either missed or not worth mentioning. I currently am on BP meds and Lipitor. I would not be too worried about this as everything I have read lists 5cm as the size for considering treatment, except that my mother died for a ruptured aneurysm which was too small for treatment. There were extenuating circumstances with her, but nonetheless, I am a bit worried as I have read that I could be of higher risk due to my Mom having one.  I also have sarcoidosis and was wondering if this disease could cause it to grow faster or rupture sooner. Is there a need to have follow ups sooner than annual and what kind of precautions can I take?  Would I have restrictions on lifting things, etc?

Hi Carol,

  • While general recommendations are indeed to advice aortic root replacement when the ascending aorta reaches a size of 5cm diameter, it appears yours is expanding rapidly (almost 10% in 6 months). It is therefore reasonable to consider surgery earlier rather than later when dangerous complications such as a dissection are more likely:

  • Interval treatment, such as avoiding straining (and a high blood pressure in general) is important.
  • An underlying systemic disease (such as Marfan Syndrome or possibly your sarcoidosis) would not change my opinion whether to operate now or not, but may have future implications for follow-up management.  
  • Consider to have your surgery at a major medical center and a surgeon with extensive experience with thoracic aortic surgery.

Hope this helps,
Dr T


Hi Carol,
No. Statistics are irrelevant: for individuals an event is always 50/50 - it is either going to happen or not. For an individual analysis you need a full consult with a CT surgeon and even he would have to guess about your odds. Instead, you should focus on whether the operation is safer if done earlier and what the odds of surgery are in his/her hands. More questions need to be answered by your doctors - I can't help you any further.
Hope this helps,
Dr T

What is the estimated % of ruptures for a TAA? one that is larger then 5cm and smaller than 5cm if you can give me that info....  Can you give me the percentages for dissection also?

Hi Carol,
I misread the dates! Under those circumstances I am much more relaxed about recommending surgery at this point. Among others, things like your age, general condition and other illnesses play a more important role in the process. A TAA (contrary to a AAA) rarely ruptures, but dissection is more common, also a potentially lethal complication.
My advice:
1. Echocardiogram every 6 months *2, than yearly if no change.
2. If the nearest hospital is a major medical center with the expertise for this type of surgery, I'd ask for a consult with a CT surgeon and discuss planning for the future. This is a good time to select where you'd want to go and who you'd like to have as your surgeon.
3. A CT surgeon should part of the team that decides your future even at this point! Contrary to popular opinions, a surgeon doesn't always only want to operate and he or she is the only one on your team with hands-on experience!
4. Although I don't think your sarcoidosis plays a role, there is no harm to wait and see if it "burns itself out" if your TAA is otherwise stable.
5. As a (now retired) CT surgeon, I'd probably recommend an operation at any further enlargement from here on.
Hope this helps,
Dr T

Dr T:

Actually, it has been 1 1/2 years between CT scans - 8-4-11 to 1-30-13 so it really has not grown as fast as you indicated.  Nonetheless, I am still concerned about an early rupture for the reason I mentioned about my Mom.  It is my understanding that if one ruptures, you have a matter of minutes to get help and living in the country, the nearest hospital is 15 minutes away.  With the guidelines of 5cm as the majic number, how do you convenience a doctor to reconsider?

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