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Aortic Aneurysm (Drs. Eagleton and Svensson 3/7/11)

Monday, March 7, 2011 - Noon

Lars Svensson, MD, PhD
Director, Center for Aortic Surgery, Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart & Vascular Institute

Matthew Eagleton, MD

Matthew Eagleton, MD
Vascular Surgeon, Department of Vascular Surgery, Sydell and Arnold Miller Family Heart & Vascular Institute

Description

An aortic aneurysm can cause life threatening bleeding or even death. It can also develop blood clots that can cause severe health problems, including stroke or heart attack. Take this opportunity to learn more about aortic aneurysms, including diagnosis and treatments, and have your questions answered by Dr. Matthew Eagleton and Dr. Lars Svensson from Cleveland Clinic.

More Information

Cleveland_Clinic_Host: Thank you for joining us, lets begin with the questions.

Dr_Matthew_Eagleton: Thank you for having me. There are a lot of questions and we will try to answer as many as possible.

Note: Dr. Svensson came later and stayed to answer questions post chat.


Symptoms of Aneurysm

jcl: If a person has an aortic aneurysm and it is not big enough to operate on and the person is having daily chest pain, how does a physician know if the aneurysm is causing the pain?

Dr_Matthew_Eagleton: This is a difficult question to answer. Aneurysms do not typically cause pain, unless they are leaking or have ruptured. Most imaging studies we use to evaluate aneurysms will show us that it is leaking or ruptured. Occasionally, however, some aneurysms can cause some chronic pain, but this is not typical. If we exclude aneurysms that have ruptured, there is no easy way to determine if the aneurysm itself is causing pain. Again, though, this would be rare.

dorothy: What are the symptoms of an aortic aneurysm///Aside from surgery is there any other treatment?

Dr_Matthew_Eagleton: Most aortic aneurysms do not cause any symptoms until they rupture or leak. At that point, the most common symptoms is pain. Aneurysms are typically diagnosed because patients are undergoing an evaluation for another problem, and the aneurysm is discovered incidentally.

dopplerdefect: Are nonopacified thrombi within thoracic aortic aneurysms likely to become or produce an embolus?

Dr_Matthew_Eagleton: It is not uncommon for aneurysms to become lined with thrombus. This is due to the way the blood flows through aneurysms - faster in the center and slower near the edges. Blood clots typically form along the outer walls of aneurysms. It is very rare for this thrombus to embolize.

steve: I have an aortic aneurysm measuring 4.6 cm . If it were growing would blood pressure change.

Dr_Matthew_Eagleton: While high blood pressure is a risk for growth of an aortic aneurysm, an enlarging aneurysm does not cause high blood pressure.

dopplerdefect: In the event of rupture of thoracic aortic aneurysm, will the person suffer much pain? Does death occur in a matter of minutes?

Dr_Matthew_Eagleton: This is variable and sometimes difficult for us to answer. It is estimated that about 50% of patients die from ruptured aneurysms prior to making it to the hospital. Most of these deaths occur very quickly. About half, though, make it to the hospital and can be operated on to try to repair the aneurysm. On average the survival if you can reach the hospital, though, is only about 50%.


Cause of Aortic Aneurysm

donnielin: WHAT CAUSES AORTIC ANEURYSMS?

Dr_Matthew_Eagleton: We do not entirely understand what causes aortic aneurysms to occur. We do know that at some point, for reasons that are not clear, there is damage to the wall of the aorta. This leads to inflammation within the aortic wall which causes it to weaken and ultimately enlarge. We do know that there is a familial association with aneurysms - i.e. if your brother/sister or mother/father had one you are more likely to develop one. In addition, smoking is a large risk factor for developing an aneurysm.

Sneakers1a: I was treated for cancer and my aortic node is now enlarged. Does that increase chances of aneurysm

Dr_Matthew_Eagleton: I am assuming that you mean there is a lymph node near your aorta that is enlarged. This would not cause you to develop an aortic aneurysm.

Sneakers1a: Does obesity increase chances of aneurysm and also if surgery is needed, is it detrimental to a successful procedure.

Dr_Matthew_Eagleton: We do not have any data to show that obesity directly affects aneurysm development or growth. Obesity, however, is associated with high blood pressure, which we know is a risk factor for aneurysm growth. In addition, obesity is a known risk factor for the development complications following all types of surgery.

savonp: In my research into this I found that blunt force trauma is a potential cause. I have two such cases...one in the military from an RPG (Rocket Propelled Grenade) hitting a wall 5' in front of me and sending concrete into my chest. The other one from a head on car accident pushing the steering column into my chest. Could this be a cause of my ascending aortic aneurysm and would there be any evidence of this in a CAT scan?

Dr_Matthew_Eagleton: You are correct in that traumas can cause aortic aneurysms to develop. These typically occur because a small tear develops in the aorta (not always large enough to see at the time of the accident) that eventually enlarges into an aneurysm. Unfortunately, other than trying to associate the location of the aneurysm with the time of the injury, there is no good way to say whether the aneurysm is a direct result of the trauma. If you are a young, otherwise healthy person with no risk factors for the development of an aneurysm, it may be the cause.

peggy: Dr. Svenssen performed an aortic valve replacement and ascending aortic graft (due to an aneurysm) on me in May, 2009. In our pre-op visit he stated that this aneurysm was likely related to fibromyalgia and polymyalgia rheumatica, both of which I had previously been diagnosed as having. Would you please explain this in more detail, and also, is there a likelihood of further problems developing due to this?

Dr__Lars_Svensson: Fibromyalgia is associated with aneurysm development in about 10% of patients. It usually restricted to the thoracic aorta. It occurs typically about 10 yrs after the acute phase of fibromyalgia. Re-operation for new aneurysm formation is rare.

gardenia: does kidney dialysis and history of many TIA's affect aneurysms.

Dr_Matthew_Eagleton: Having a history of kidney failure requiring dialysis, or having TIAs, do not directly affect the presence or development of an aneurysm. These other problems, however, can increase the risks associated with surgery for all types of aneurysms.


Diagnosis of Aneurysm

Karen: My CT Scan showed a small amount of tissue around the aorta. I have a history of pulmonary embolisms. The CT scan showed no embolisms. The PET scan came back negative. My physician just wants to just watch it. Should I pursue it more?

Dr_Matthew_Eagleton: Without knowing more specifics about your medical condition and being able to evaluate the imaging studies, I am not able to answer this question.

lorraineh: How reliable is a given CT measurement of an aneurysm? Is there a range of error? What would explain decreases in measurement size?

Dr_Matthew_Eagleton: CT scans are typically very reliable in assessing the size of an aneurysm. There are, however, different ways to determine the actual size. If your aorta is very tortuous, or curvy, that can cause some of the measurements to be falsely larger than they really are. In addition, whoever is evaluating the CT scan should take the measurements in the same locations - often multiple measurements are taken along the length of the aneurysm. It would be very rare for an untreated aneurysm to shrink.

donnielin: IS A CT SCAN NECESSARY OR CAN AN ECHOCARDIOGRAM SEE HOW AN ANEURYSM IS GROWING

Dr_Matthew_Eagleton: It depends on where your aneurysm is located. Echocardiogram can be used to accurately assess an ascending aortic aneurysm and is frequently used to follow patients with this problem. Ultrasound can be used for assessment of abdominal aortic aneurysms. The only good way to assess a descending thoracic aortic aneurysm is with either a CT or MRI. Frequently, however, if an aneurysm has enlarged enough to require surgery, we will get a CT or MRI (regardless of the location) because they provide more detailed anatomic information that help us plan our surgeries

Sept14: How do the accuracy of echo, CT scan, and MRI compare in measuring aneurysms, particularly thoracic? Would it be a significant problem if a patient has a pacemaker and cannot do an MRI?

Dr_Matthew_Eagleton: The accuracies of echo, CT and MRI are very similar. Frequently we will use echo or ultrasound to follow aneurysms. Depending on exactly where your aneurysm is located, an echo or ultrasound may not show us the aneurysm (such as in the descending thoracic aorta). In these cases an MRI or CT is necessary. If an MRI cannot be performed, a CT is a good alternative.


Abdominal Aortic Aneurysm

Franco: Greetings ,my name is Franco I was born in Cleveland and at the age of 14 moved to Italy with my parents. knowing that Cleveland Clinic is the best and for the reason that we are far away I need some information about a problem that my father has. My father is 70 years old and suffers of high blood pressure but keeps it stable with the meds, the real problem is that he has a Abdominal aortic aneurysm of 5.2 and soon the doctors here in City of Catania want to fix this problem with a operation. They said that there are 2 kinds of operations the first is an Open Operation, and the second is Endovascular repair with a stent my question is which operation is better to have ?and what are the consequences? Waiting for your response thanks Franco

Dr_Matthew_Eagleton: This is a difficult question to answer without knowing the medical condition of your father. Endovascular and open (conventional) aneurysm repair are both effective repairs. Endovascular repairs are typically less invasive, but may not be possible in every patient due to anatomic constraints. In addition, the long-term outcomes from endovascular repair are not as well known as the excellent results from open surgery. Patients who undergo this will require routine follow up to assess the results of the repair. Open surgery is more stressful to the body, but does not have the same anatomic constraints as endovascular repair. The hospital stay is longer and it takes longer to recover from the surgery. Your physicians should discuss the risks and benefits of both procedures, specific to your father’s situation, with your father so that he can make an informed decision. Sometimes, one type of procedure is not a good option.

Frank: I have an Abdominal Aorta Aneurysm 7.7 cm. I also have right Renal Artery involvement of occluded 95%. What surgical options do you offer in this condition? Is this true the Clinic is doing repair with newly designed stent which has perforations at top to allow blood flow to renal artery?

Dr_Matthew_Eagleton: The main surgical option for the type of aneurysm you describe is conventional or open surgical repair. This requires an incision in the abdomen and replacement of the aneurysmal section of the aorta with reattachment of the kidney arteries or bypasses to them. At Cleveland Clinic we do have a research program that evaluates the use of specialized stent grafts, or endografts, that allow the treatment of these types of aneurysms through incisions in the groins. Enrollment in this research trial is not available to everyone, but we would be happy to evaluate you for consideration for enrollment.

davmos: What follow up is required after endovascular repair? Can it be done near my home in Florida, or must I go back to Cleveland?

Dr_Matthew_Eagleton: Follow up after endovascular repair of an aneurysm is recommended. Repairing aneurysms in this fashion is relatively new (within the past decade), and we don't know a lot about the durability of the repair years after it is performed. Following an initial post-operative visit, most patients are evaluated yearly with a CT scan. In many instances, if the aneurysm gets smaller we can often follow up with an ultrasound. While we prefer to have patients follow up with us after their surgery, in special circumstances follow up has been arranged for patients closer to their home. That is often more dependent upon finding someone suitable to perform the follow up evaluation.

bostonterrier: what role does gender play in deciding when to operate and whether to do OSR or EVAR?

Dr_Matthew_Eagleton: Gender typically plays almost no role in the decision whether to perform open or endovascular surgery. One caveat to that is that women tend to have smaller iliac arteries. These are the arteries that we have to work through in order to place an endovascular graft. We see that women will more frequently have arteries that are too small to safely perform this procedure in the standard fashion. As the endografts have evolved over the past several years, the systems we use to insert them have gotten smaller, making this much less of an issue.


Thoracic Aneurysm, Ascending Aortic Aneurysm and Aortic Root Aneurysm

Charles: I am a 71 year old male in fairly good health with a 5.2 cm thoracic aneurysm that can be repaired with the endovascular procedure. However, they would not know the outcome until the procedure is done and indicate a 10% chance I could be a paraplegic. Are you able to determine the artery supplying the blood to the spine prior to the procedure and generally able to predict the outcome of the surgery. Would I be able to work with a local doctor for the after surgery care you require or return to the main campus or the Florida location. Would I be able to obtain the operation in either location? Thank you for your help in this.

Dr_Matthew_Eagleton: There have been numerous studies using preoperative imaging to try to identify arteries to preserve in order to prevent the development of paraplegia. Unfortunately, none of these are fool proof and we often cannot reliably predict who will develop paraplegia. Without seeing your specific CT scan, I cannot reliably predict your specific risk of paraplegia, but you are correct in that we would not know until the surgery was over. When patients have surgery here, we prefer that the follow up occur with us so that we can more effectively monitor your outcome, although other arrangements have been made in certain circumstances.

Sept14: Is endovascular repair an option for aneurysms of the ascending aorta or only in other locations? Is the increased risk of endovascular repair expected to lessen over time and become a more pervasive surgical option for all types of patients in the future?

Dr_Matthew_Eagleton: Endografting for ascending aortic aneurysms is available as part of a clinical research trial at Cleveland Clinic. There are strict enrollment criteria, and it is generally reserved for patients that are considered too high risk for conventional surgery. It is anticipated that the availability of endovascular repair of ascending aortic aneurysms will improve over the next several years as the technology available to perform these procedures continues to improve. Currently, however, it is not available in the United States outside of research trials.

ConnieW: Thank you for taking the time to host I have a daughter 18, diagnosed with Turners Syndrome at birth. She was diagnosed with aortic aneurysm with bicuspid valves min. leakage in Jan 2010. She is followed by cardio team every 6 months, has echo and mri done. Also sent her medical records to Dr Svensson about 7 months ago (appreciated the advice and info from you and your staff) Her last measurement was 3.8cm and asi 7.9. She had mri done week ago waiting on results. Recently a 16 in TS support group passed away from dissected aorta. (She had been diagnosed with bicuspid 5months earlier but reportedly no aneurysm noted. This has caused great concern and fear for myself and daughter. I would like to know if there are very specific guidelines you use when determining when surgical intervention needs to take place on this type of patient. I know this condition is treatable and highly successful with today’s technology.

Dr_Lars_Svensson: I understand your concern and the problem is that we don't have accurate data on when we should operate on patients with Turner Syndrome. We have tended to use the same criteria as for Marfan Syndrome as far as recommendation for surgery and the same applies for patients with Bicuspid aortic valves. We try to deal with this issue with the Thoracic Aortic disease guidelines published by the American Heart Association and the American College of Cardiology. With our current level of knowledge, we continue to believe that a good way to decide when a patient should have surgery is taking their cross sectional area of the aorta in centimeters and dividing the height in meters and if that ratio exceeds 10, we recommend surgery. The issue is weighing out the risk of surgery vs. the benefits of preventing aortic dissections.

ConnieW: Thank You for taking the time to answer my question. I can always breathe a sigh of relief after the astounding staff at Cleveland Clinic answer questions in web chats. The service you provide is priceless to the community.

Sept14: To what extent are aortic aneurysm patients (specifically the ascending aorta) who have had successful surgery at risk for other aneurysms in the future, i.e. other locations?

Dr_Lars_Svensson: The risk of further aneurysm formation of the ascending aortic surgery is low if any aorta above 4.5cm is repaired. In a study we did of our patients, the risk of further surgery out to 10 yrs was 2%.

Rss: Has any benefit been shown to simultaneously replacing the aorta at an aortic area/height ratio of 8 in the setting of a patient who has severe aortic stenosis and needs to have the valve replaced?

Dr_Lars_Svensson: Our recommendations based on a large series of patients supported also by studies from Canada is that the aorta should be repaired if at the time of surgery it exceeds 4.5cm. In our recently published journal article, a ratio of 8 seemed to be a reasonable cutoff size.

Jac: if the aneurysm is located at the aortic arch, is it considered ascending or descending?  what is the surgical procedure recommended?

Dr_Lars_Svensson: The thoracic aorta is basically divided into the aortic root containing the aortic valve the ascending aorta, the aortic arch, the descending aorta and the thoraco-abdominal aorta. The timing of surgery is dependent on the risk of surgical procedures in the various segments. We have talked about the root and ascending aorta and the excellent results of the less than 1% risk of death in these segments. In most surgeon's hands, the aortic arch is associated with a greater risk of death or stroke. At Cleveland Clinic, we recently completed a study of patients having complex aortic arch replacements usually with the elephant trunk procedure and the risk of either death or stroke was less than 2%. For most patients with degenerative aneurysms of the descending aorta, we usually recommend a stent graft repair, unless the have chronic aortic dissection or a connected tissue disorder and occasionally if they are particularly young. Based on our experience, the risk of death and paralysis are equivalent but stent grafting is less invasive. For patients having second stage elephant trunk procedures, the long term survival is slightly better with open repairs. For thoraco-abdominal aneurysms, the procedure of choice is very dependent on the patient’s age, co-morbid disease, blood clot in the segment and chronic dissections. Dr. Eagleton has answered some of the questions related to this. In our most recent analysis of 400 thoraco-abdominal repairs done in the last 10 yrs, the risk of death was 6% sand paralysis also 6% using the most modern methods including spinal cord protection. Patients with thoraco-abdominal aneurysms require careful evaluation to determine which is the most appropriate procedure for them.

Gs55: Please explain how Aortic roots are repaired/replaced. Recovery time? How serious is this?

Dr_Lars_Svensson: If you go to our website and YouTube, you can have a look at the two most common valve preserving and root operations we do. For three leaflet aortic valves, we usually do a aortic valve re-implantation operation and for bicuspid valves, we do a valve repair and aortic replacement. The videos show the operations.

Donnielin: ARE ASCENDING ANEURYSMS THE MOST DIFFICULT TO REPAIR?

Dr_Lars_Svensson: In experienced hands, minimally invasive replacements of the ascending aorta are neither difficult or risky. We do about 950 thoracic aorta operations a year and about 700 of these are on the ascending aorta and aortic arch. For most patients, the risk of death is 1% or less. For patients under the age of 70 who have aortic valve replacements as a first operation, in over 700 patients the risk of death was 0.28%.

peg2635: What is the best method to monitor an aortic root aneurysm & how often (i.e. CT, echo..etc)?  At what size would surgery be considered.  (good health/no symptoms)

Dr_Lars_Svensson: The best method of monitoring aortic size is a combination of MRI and trans-thoracic echo. However, when I first see patients, I like to get a CT because it is more accurate and gives better 3-D information. We do not however, like to get multiple CT scans for monitoring because of the potential risk from radiation.


Aneurysm – Abdominal and Thoracic and Aneurysms Affecting Other Vessels

Kathy: How many often would be thoracic aortic dissection extends into the abdomen? I am looking for a number or %. Thank you. Kathy

Dr_Matthew_Eagleton: It is difficult to give an exact percentage, but it is likely in the range of 60-75% of the time.

davmos: If planned endo involves attachment including the renal artery, what problems can that create?

Dr_Matthew_Eagleton: Endovascular repair of an aortic aneurysm that involves the kidney arteries is a complicated procedure that should be performed at centers involved in clinical trials evaluating these types of devices. Certainly any time the kidney arteries are involved in an aneurysm repair, whether that be via an endovascular or conventional surgical approach, there is a risk of injuring the kidney artery resulting in losing that kidney. While many people can live with only one kidney, some patients end up needing dialysis. We have an active research program evaluating the use of endovascular grafts for aneurysms that involve not only the kidney arteries, but also ones that goes to the intestines. We would be happy to evaluate you at any time for consideration for this clinical trial

Kelly: Hi There, I have BAV, the dilated ascending aorta is 4.02. I am 148cm tall, no leakage and insufficiency. When is the best time for surgery? Thanks!! Kelly

Dr_Lars_Svensson: Please see the previous post. You would be at a ration of less than 10, according to your height. So we would not recommend surgery. The only other factor would be if you are planning a pregnancy, then we potentially would need to be more aggressive about fixing your aorta. This is because during pregnancy, the aorta may grow more rapidly.


Marfan and Connective Tissue Disorders

jcl: If a person has Marfan's does an aneurysm usually grow over time?

Dr_Matthew_Eagleton: All aneurysms, given enough time, usually grow. This is true in patients with Marfan's as well. What we have a difficult time predicting is how fast they will grow and when they will grow.

Mary659837: My sister and niece have Marfans. I was diagnosed with Myofascia (the connective tissue disease) in 1995 and it has been in remission for many years. I also have a leaky aorta value along with two ascending aorta aneurysms that are 4.8 and 4.9 cm. My last CT was December 2010. I did have a stent placed in August, 2010 for a descending aorta aneurysm. University of Arizona told me Cleveland Clinic and Stanford are involved with studies for stent placement for ascending aneurysms. How long before this procedure is approved by FDA? If I need stent surgery before then, could you perform it? Doctors say that open heart surgery is not an option for me. Other than these issues, I am in excellent health and very active. Thank you.

Dr_Lars_Svensson: Stenting of the ascending aorta is highly experimental and has only been done in patients who have no other surgical options. The results have been mixed with a number of disasters. It will still be a long time before the results approach that of minimally invasive aortic valve and ascending aorta surgery. In our series of 4600 patients with bicuspid aortic valves with or without ascending aneurysms, the risk of death was 1.1%. For most patients under the age of 65, the risk of death is 1% or less.


Aorta Surgery Questions

char: do you have non-invasive aorta surgery?

Dr_Matthew_Eagleton: No aortic surgery is non-invasive. We do provide a wide number of options with regard to endovascular surgery of the aorta, which are considered less invasive as they are performed through an incision in the groin as opposed to one through the abdomen or the chest.

George: 3years ago Dr Svensson implanted an Aortic valve into my heart I have been doing extremely well, living BASICALLY A NORMAL LIKE This winter I noted a coldness in my chest when I exerted my self, like walking briskly uphill is this due to the cold, and my age, or could it be another issue other than that, I feel excellent thank you

Dr_Lars_Svensson: I'm pleased to hear about you doing well. Not sure why you should be having any feeling of coldness in your chest. One possibility is if you lost weight that could be a cause. If you don't feel better in the spring, I recommend that you get evaluated by your cardiologist,

savonp: With the size of my aneurysm, 46 mm, I was told I would need surgery in 10-15 years. One doctor wants to monitor it yearly while the other says it should be monitored every 6 months for the first year to establish a growth rate since I am still lifting weights? What is your recommendation of when I should be seen next?

Dr_Matthew_Eagleton: It is difficult to say when you would need surgery to repair your aneurysm. One of the things we have a difficult time with is evaluating when and how quickly aneurysms will grow. Your aneurysm should be evaluated yearly to assess it for growth. It is not unreasonable to check it in 6 months to be sure it is not growing faster, and if not then check it yearly. There is no right or wrong answer for that. We do, however, recommend patients who have aneurysms should limit weight lifting activities as this can potentially cause aneurysm growth.

steve: in 3 yrs my aortic aneurysm has grown 4.3 4.4 and 4.5 . Do you think it could stop growing or is surgery likely in a few years

Dr_Matthew_Eagleton: It is difficult for us to predict how when and how quickly aneurysms will grow. Some, like yours, grow slowly. Some grow quickly, and some grow intermittently (start and stop). Most aneurysms, if given enough time, will eventually grow.

sharris7: Sheila asks, how do you prevent stroke during and after surgery? what puts you at risk?

Dr_Matthew_Eagleton: The risk of stroke at the time of surgery for an aortic aneurysm varies depending on the location of the aneurysm and the type of surgery being performed. Frequently, the surgeon can use specific techniques to assure continued blood flow to the brain during more complex procedures to help reduce this risk. In addition, blood thinners (heparin) are used during the procedures which help to reduce the risk. After operations, we use standard medical therapies to reduce the risk of stroke - such as the use of aspirin.

donnielin: AT WHAT SIZE ANEURYSM DO YOU RECOMMEND SURGERY?

Dr_Matthew_Eagleton: It varies on the location of the aneurysm (ascending, descending thoracic aortic, abdominal or thoracoabdominal aortic aneurysm). It also varies based on the patients overall health status. Some very basic guidelines are 5 cm for an ascending, 6 cm for a thoracic and thoracoabdominal, and 5.5 cm for an abdominal aortic aneurysm. Again, though these are not hard and fast rules but a very generic guidelines.

tonton: I have read that your height and weight is a factor in when to do surgery on aneurysm Is this true?

Dr_Lars_Svensson: There have been several questions about the timing of surgery according to various sizes of the aorta. My recommendation is that if you bicuspid valve or a connective tissue disorder such as Marfan Syndrome or Loeys-Dietz then a ratio greater than 10 is a reasonable size for consideration for surgery. If however there is a family history of aortic dissection or a pregnancy is planned in women, then we would recommend surgery at the smaller size. If the growth of an aneurysm exceeds 0.5cm in a year, we would also recommend surgery.

jac: do aneurysms ever naturally reduce in size?

Dr_Matthew_Eagleton: This would be very uncommon. Most aneurysms, if given enough time, will grow.


General Aneurysm Questions

lorraineh: Is there any evidence that dietary changes can affect aneurysm enlargement for better or worse? lorraineh

Dr_Matthew_Eagleton: There is no strong evidence to suggest that diet affects the growth of an aneurysm, and no data to show that it would cause an aneurysm to shrink. Diet, however, can affect your blood pressure, and we know that high blood pressure will place an aneurysm at risk for growing.

savonp: Is having sex on a regular basis a risk factor for a ascending aortic aneurysm?

Dr_Matthew_Eagleton: I hope not! There is nothing to suggest sex would place you at risk for developing an aneurysm.

donnielin: I THINK THE PERSON THAT ASKED ABOUT SEX MEANT WAS THERE A DANGER OF HAVING SEX FOR SOMEONE WITH AN AORTIC ANEURYSM. WHAT DO YOU THINK?

Dr_Matthew_Eagleton: I do not think that having sex will adversely affect your aneurysm.

savonp: let me rephrase my question on having sex, I already have an ascending aortic aneurysm at 46cm is there any risk factors?

Dr_Matthew_Eagleton: No, I don't think having sex will adversely affect your aneurysm.

lorraineh: If a parent had a renal artery aneurysm and offspring has thoracic aneurysm, is it probably that there is some genetic cause for the offspring's aneurysm? There are no other medical reasons/history in the offspring. lorraineh

Dr_Matthew_Eagleton: We often see aneurysms that are familial - they run in families. There is likely a genetic cause for this, but we don't know (yet) what those genetic defects are. With recent advances in mapping the human genome, we may be able to gain a better understanding of genetic defects that cause certain familial disease processes, such as aneurysms. More research, however, is clearly needed.


Aortic Aneurysm in Children

heartmomrn: My 6 year old son has an aortic aneurysm and the nurse at his school has asked whether or not CPR should be performed if he collapses with a cardiac event on the playground at school, or if this would put him at greater risk of aortic dissection. Can you answer this question?

Dr_Matthew_Eagleton: If your son were to have a cardiac arrest at school he should undergo CPR, even in the setting of a ruptured aneurysm or dissection. If his heart stops and nothing is done to help pump the blood his outcomes would be worse.

Cleveland_Clinic_Host: Thank you for joining us.

Dr_Lars_Svensson: I apologize for being late, I will try my best to get through more questions for the transcript. Thank you for having me.

Dr_Matthew_Eagleton: Thank you all for your questions and hope this was helpful.


This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of Cleveland Clinic institution or other Cleveland Clinic physicians.


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