Question 1

Can an ascending aortic aneurysm shrink by itself?

Accepted Answer

This is very unlikely. Aneurysms treated endovascularly (stents / endografts) do often shrink because they are depressurized.

Question 2

Is it possible for an ascending aortic aneurysm to shrink?

Accepted Answer

Aortic aneurysms are generally degenerative processes. We use medications like beta blockers to keep it from expanding as quickly, but once begun, the process is usually progressive.

Question 3

How should i deal with an ascending aortic aneurysm?

Accepted Answer

Management of ascending aortic aneurysm his typically dependent on the size of the aorta.  Assuming this is not a dissection, the diameter of the aorta is assessed by ct scan or mri.  If the diameter is less than 5 cm, the management typically involves medication.  If the diameter is over 6 cm, and management often requires surgery.  Regular measurements are required for patients treated medically.

Question 4

What can be done to repair an ascending aortic aneurysm?

Accepted Answer

Usually a procedure, varying in complexity, that involves resecting the affected portion of the aorta and replacing it with a tube graft made of gortex.  Depending on degree of involvement, this usually involves stopping the heart on circulatory bypass and some times cooling the body and brief arrest of circulation.  There is a less invasive "endovascular" sheath in developmental phase that may be.

Question 5

Is a descending aortic aneurysm more dangerous than an ascending aortic aneurysm?

Accepted Answer

Aneurysms are dangerous because many people don't know they have them until they rupture. Screening is important for people over 65 with family history of aneurysm, smoking or htn. Ascending aneurysms and para visceral (upper abdomen) aneurysms are probably the most challenging to repair.

Question 6

How do you deal with an ascending aortic aneurysm?  to operate or not to operate?

Accepted Answer

If it is truly an ascending aneurysm, it is life threatening and needs an operation. Type b or descending aneurysms in the thorax can many times be managed with blood pressure control but not type a. Type a can cause heart attack and strokes or rupture.

Question 7

Is it possible to repair a mitral valve and an ascending aortic aneurysm together through a right anterior mini thoracotomy or better to do via a median sternotomy, i see both have been done by this method but not at the same time, possible reasons?

Accepted Answer

I would have it done by a surgeon with lots of experience and let them choose the approach as they know your anatomy and I do not.  They also know what has worked best in their hands (and knife).

Question 8

How does an ascending aortic aneurysn differ from a descending aortic aneurysm?

Accepted Answer

Size and location matters in this regard check with your surgeon.

Question 9

I have a 4cm ascending aortic aneurysm at what size does it need to be repairde?

Accepted Answer

Typically an ascending aortic aneurysm is repaired after it becomes between 5.0 to 5.5 cm in size, depending on other factors such as age, how quickly it is expanding, and the presence of other conditions such as marfan's disease.

Question 10

I have a 4cm ascending aortic aneurysm at what size does it need to be repaired?

Accepted Answer

Other factors are important:
valve leakage( aortic regurgitation)
increasing size or pain
hypertension( high blood pressure)
other cardiac or vascular, or lung disease
other significant risk factors for a major operation
in general, ct follow up about every 6 months until > 5.5.

Can an ascending aortic aneurysm shrink by itself