If you’ve been diagnosed with an enlarged aorta, you likely have many questions about your condition: How big is too big? When should I be worried? What does “watchful waiting” mean? Are there any early warning signs before it bursts?
Most of the answers to these questions depend on a variety of factors, including your age and body size, medical history and the position and size of your aorta, among others.
University of Michigan Frankel Cardiovascular Center patient Bob Stephens found he had all of these questions and more when diagnosed with a total of five aortic enlargements.
“It’s awfully scary, but you don’t have a choice,” Bob says. “When I was first told about my condition, it worried me, but I knew the U-M team of doctors was watching me closely, especially my abdominal aortic aneurysm, which was large.” Bob admits that “watchful waiting” can be stressful, but “I knew I had the right people taking care of me.”
Sizing it up
Bob’s U-M cardiologist, Dr. Michael Shea, says he hesitates to use the word aneurysm when consulting with patients about an enlarged aorta, instead referencing an aortic dilation or a blood vessel issue. “It’s a scary term,” he says, “especially if a patient has a relative who has died from it.”
Regardless of the terminology, when the aortic diameter is greater than 50 percent of what is considered normal for a patient, Dr. Shea says he begins to consider surgery. Watchful waiting, he says, is the typical protocol when aortic dilation is below 50 percent of “normal” for the specific patient. “But every case is different, which causes a lot of angst among patients.”
For example, a patient with connective tissue disorders such as Marfan or Loeys-Dietz syndromes typically experiences ruptures at a much lower diameter than a patient without one of these conditions. A patient with a bicuspid valve may also experience rupture at a lower diameter. For example, a person with a 5 cm dilation and a bicuspid aortic valve is more at risk than a person with a 5 cm dilation with no underlying conditions. Overall, patients with these conditions, as well as those with a family history of aneurysm, would be considered for surgical intervention at 4 to 5 cm.
Cardiologists also consider whether the dilation is stable or growing. According to Dr. Shea, growth can range from 0.1 to 1 cm a year, with measurements done on a regular basis, beginning with a baseline evaluation via echocardiogram, CT scan or MRI.
Dr. Shea points out that many patients with a slow-growing aortic dilation never undergo surgery, but are monitored on a regular basis as a precaution to measure any growth.
Other important factors
Other risk factors that come into play include:
- Where the aortic dilation is located: chest (thoracic aortic aneurysm), abdomen (abdominal aortic aneurysm) or a combination of the chest and abdomen (thoracoabdominal aortic aneurysm)
- Whether the patient is feeling chest pressure
- Whether the patient’s blood pressure is under control
- Whether the patient is smoking
- The patient’s overall lifestyle
Take the next step:
- Read frequently asked questions about aortic disease.
- Hear the story of a two-time aortic aneurysm survivor.
- Watch a video about one man’s journey from Egypt to U-M for complex aortic aneurysm and valve surgery.
The University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.