Eric Roselli, MD
Vidyasagar Kalahasti, MD
Tuesday, March 7, 2017 | Noon
The aorta is the largest artery in the body and is the blood vessel that carries oxygen-rich blood away from the heart to all parts of the body. An aortic aneurysm is an abnormal enlargement or bulging of the wall of the aorta. An aneurysm can occur anywhere in the vascular tree. Cardiac Surgeon Eric Roselli, MD and cardiologist Vidyasagar Kalahasti, MD answer your questions about aorta disease and treatment.
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Procrastinator#1: I am a 72-year-old male and was diagnosed with severe COPD/Emphysema, and Sleep Apnea seven years ago. I am also a former smoker (stopped when I was diagnosed). I was hospitalized with DVT Pulmonary Embolisms in 2014. As you can imagine, I am under the care of several doctors. An Aortic Aneurysm was found three years ago and I have an ultrasound performed and visit the thoracic surgeon recommended by my PCP. The aneurysm is approx. 3cm. My question is, "Given my pulmonary issues would it be best for me to have the aneurysm corrected now, rather than wait until it enlarges? I also have a hiatal hernia which my PCP doesn't think needs to be corrected. Please comment. Thank you.
Eric Roselli, MD: Unless there is something particularly unusual about the shape of that aneurysm, 3cm is way too small to treat.
GraceP: Aortic Aneurysm: I was diagnosed with heart murmur with aortic insufficiency. Around 1988, I had annual echo cardiograms and occasional treadmills. Each time a measurement would be mentioned, and need for eventual aortic valve replacement when and if measurement reached 5.0 or if I experienced certain symptoms. I never remember hearing the words "aortic aneurysm" until 2013, although over the years I'd had four different cardiologists give me results of annual testing. Is there some reason for not using the tern aneurysm up until then? When first diagnosed, measurement was about 3.5 slowly increased ‘til in 2013 at age 80, it was 4.4. The doctor who used the term aneurysm at that time was new to the practice and standing in for my regular cardiologist for that appointment. Thanks for taking my question.
Vidyasagar Kalahasti, MD: Aortic dilation, enlargement and aneurysm are often used interchangeably to describe your condition. At Cleveland Clinic, we sometimes have used aneurysm for aortas greater than 5 cm and used dilation/enlargement for aorta size less than 5 cm.
Johann: I was diagnosed with a thoracic ascending aorta aneurysm two years ago when I was 66. I entered the hospital for Afib, and during testing for the Afib, the aneurysm was picked up. It measures 4 cm. I have had annual testing and it hasn't changed. I'm currently on Xarelto and Carvedilol. I try to forget I have this diagnosis, but it pops into my head at least once a day. I am active, but wonder if there is anything else I should or could be doing to make sure this aneurysm doesn't get any larger.
Eric Roselli, MD: Try not to worry about it.
DPerry12005: My question is as follows: Is it a given that an aneurysm 4.5 cm will continue to grow and you will have to have surgery at some stage?
Eric Roselli, MD: No, but they don’t shrink and we don’t live forever.
Suehopeful: Are there any vitamins or mineral supplements that can help heart health and the overall health of the aorta?
Vidyasagar Kalahasti, MD: We have not routinely recommended any vitamin or mineral supplements to help with health of the aorta.
TatyanaYana: Hi. I have a question. I live now in Sacramento, California. Here in the summer, it s too hot for me. I can't take it anymore. I want to move to Honolulu, Hawaii. There is a great climate and in summer is not hotter than like about 80 degrees. Some people are telling me that Hawaii is bad for my heart, but i really need advice please, is it really that bad for my heart? I had aortic aneurism surgery bypass about three years ago btw. Thank you in for fast response in advance.
Eric Roselli, MD: Can I visit you in Hawaii?
Aortic Valve and Aorta
4nalien: How many ascending aortic repair and valve replacements (combination operation) are performed each year at Cleveland Clinic? Are there specific teams which are particularly skilled for such an operation?
Eric Roselli, MD: I don’t have the exact number but probably close to 500. All of our cardio-aortic surgeons are excellent at performing these operations and several also focus on valve repair in combination with aortic repair.
Mike_T: I am a 34-year-old man with a prosthetic aortic valve (St. Jude) and a 4.4mm mid-ascending aortic aneurysm. I was born with BAV and had significant regurgitation, I had my first heart surgery at eight years old to repair the aortic valve. A year after the surgery it was discovered the surgery was not successful and I had a 2nd surgery at 10 years old to have the valve replaced with the prosthetic valve. Unfortunately it was brought to my attention three years ago, that I would eventually need another heart surgery down the road (possibly 20 years) due to pannus growth and I was shocked to learn I had developed an aneurysm. This has been devastating to my life as I have spent all my life being very physically active (weightlifting) and made my living through labor intensive work (industrial mechanic). I am current trying to reconfigure my life at this inconvenient juncture. My question is what a likely prognosis is for someone like me with my history. Thanks.
Vidyasagar Kalahasti, MD: Bicuspid valve patients are at risk for developing ascending aortic aneurysm and requires surgery when the size is greater than 5 cm. You will need surveillance to determine the rate of growth and at the current size risk of dissection is still low. You may be able to continue with your work if dimensions are stable. We would need to evaluate you to provide you with specific prognosis and treatment options.
4nalien: My current aortic valve is bovine, when a third one is inserted will it have to be mechanical?
Eric Roselli, MD: No.
Trix: Hi, I am writing from South Australia. I have an ascending aortic aneurysm measuring somewhere between 4.2-4.4cm and a bicuspid aortic valve that is working well. I had a heart attack in 2015. I'm slim, female, 54 and 5 foot 2 inches. My cardio thoracic surgeon says that, if I can't get my stress level under control, he is willing to do the surgery now but he's also happy to wait until the aneurysm reaches 4.5-5cm. What are your thoughts on stress affecting my outcome? Also, he used to do the smaller chest incision with a trap door but now only does a full sternotomy as he finds it to be less painful for the patient as less muscle is cut, have you found this to be so? I'm trying to make a decision and your input would really help. Also, can I fly with the aneurysm? Thank you.
Eric Roselli, MD: If your valve is working well, we wouldn’t recommend repair until your aorta is much closer to 5cm and we will commonly perform it through a mini approach as long as the CT predicts good exposure. Yes, as long as you are flying in a commercial plan (i.e. pressurized compartment) it should not be an issue at all.Golfplayer: I had AVR at CC exactly 10 yrs. ago at age 65 (Bovine Pericardial). Model 2700. Dr. Marc Gillinov. Have annual with cardiologist. Last exam was four weeks ago; everything is OK. Anything I should be aware of or follow-up. I understand replacement (from what I read is 12 to 15 years). Is that correct?
Eric Roselli, MD: No limit on the valves – 15 years is average – I’ve seen them last as long as 23-24 years.
chester32: I have a bicuspid aortic valve and ascending aortic aneurysm measuring approx. 4.4 cm. I am a female in my 40s and 5'5" tall. I have been genetically tested for connective tissue disorders such as Loeys-Dietz, Marfan's, Ehlers-Danlos, etc., and results were negative. I have also been diagnosed with FMD of the carotids, vertebrals and renals. I had an internal carotid dissection four years ago. At what size threshold would you recommend surgery of the aortic aneurysm? Would you use the Canadian threshold for bicuspid valve of 5.0-5.5 cm or should the smaller size threshold for other genetic conditions such as Ehlers-Danlos, Loeys-Dietz, and familial aortopathy of 4.2-5.0 be applied? There is confusion about where FMD would fit on the spectrum e.g. is it a genetic condition/connective tissue disorder. As well, do you think that I would be higher risk to have a stroke during OHS because of the carotid dissection/FMD? Thanks so much for your time.
Eric Roselli, MD: I would use the 5cm threshold unless your valve requires surgery first then take care of both.
Blacksheep: I am a 59-year-old male with ascending aortic aneurysm at 5.1, Afib and bicuspid aortic valve. Had heart attack Feb. of 2015. Since, I have lost 60 lbs., trying to keep BP down. Last yearly cat scan showed it did not get any larger, doctor said keep it up and I may never have to have the surgery. Only meds on at the time are warfarin for Afib, Effient and baby aspirin for the stent, metoprolol and losartan. What I would like to find out is since it didn't get bigger, did it not get weaker, and was that statement true about the surgery?
Eric Roselli, MD: I suspect this will eventually require an operation and we will often repair them at that size.
HappyGirl@56: Once you know you have an aortic aneurysm with aortic valve stenosis, how long should you wait before having surgery?
Eric Roselli, MD: Depends on how severe each of them may be.
Marie21: I'm a 42-year-old female with a 4.4 cm ascending aortic aneurysm. I also have a BAV that is stable. I will need surgery to correct the aneurysm and maybe the valve at some point. However, I worry about the risk of stroke with the surgery especially with the recent tragic news of the death of actor Bill Paxton, who died of a stroke following surgery to repair an aortic aneurysm and a BAV. Have there been any advances made to greatly reduce the risk of stroke during aortic aneurysm surgery? Is it possible to eliminate the risk?
Eric Roselli, MD: It is most important to have an experienced team but the risk of stroke is always present with any cardiovascular disease process.
jp123: What percentage of people with an aortic bicuspid valve and aneurysm require surgery?
Eric Roselli, MD: Most eventually will – could be in your 20’s or could be in your 80’s.
smittym67: I have an ascending aortic aneurysm with a bicuspid aortic valve. If you go in to repair the aortic aneurysm and the aortic valve is still working properly, would you typically leave it in place or will you always replace. Isn't always better to keep your original valve as long as possible?
Eric Roselli, MD: We prefer to leaving the living valve in place if on direct (intraoperative) assessment, it looks worthy of salvage and will even repair many of them.
Aorta Disease Risk
shepkejt: I am 67 years old and have a slightly enlarged Aortic Aneurysm. In July last year it was 4.6CM, up from 4.3CM in the previous year. My blood pressure is controlled with 20Mg of Lisinopril daily to 122/71 and my cholesterol is controlled with 40Mg Simvastatin daily to 120. I weigh 192 lbs. and I am 6'1" tall. I am concerned about being a candidate for Aortic surgery in the future and what more can I do to retard the progression of this situation ?? My brother who is 10 years younger than I, had an Aortic Aneurysm at 8.7CM last year which was operated on at your clinic and a mitral valve repair with an LAD bypass at the same time. He did have a bicuspid Aortic Valve which was also replaced at the same time, which I have been checked for and my Aortic Valve is tricuspid. What should I do and should I worry????
Vidyasagar Kalahasti, MD: We would recommend you to be seen to discuss further treatment. With the family history of aneurysm and bicuspid aortic valve, you may need surgery earlier.
Exercise: Weight Lifting and Exercise
donnaJ99: Why is there not a lot of information available about what you should or shouldn't do when you have an aortic aneurysm? When you look it up on the internet there is virtually no information available. I am seeing a doctor at Cleveland Clinic once a year, but there are only so many questions you can ask. Just about every day something comes up and I wonder if I should or shouldn't do something.
Eric Roselli, MD: This is a great question that we do not have very specific answers for, and the reason is that it is difficult to study directly with objective evidence. We are currently designing a research study with new tools in collaboration with physicians in the Sports Cardiology Center to provide more objective data to guide the recommendations. In general, if your aorta reaches a size where operation is indicated you should avoid serious straining. If it is more moderate and being monitored expectantly then you can do most activities but should avoid those that will significantly raise your blood pressure like heavy lifting. Heavy lifting is poorly defined but is usually restricted to something like no more than half your body weight.
az85: I recently had an echo which showed a Sinus of Valsalva dilatation of 44mm, and an ascending aorta dilatation of 42mm. Four years prior, an echo showed "mild" Sinus of Valsalva dilatation of 40mm. I am male, 49 years old, and 6'5". I usually weigh about 240lbs (although I am heavier now, and am in the processing of losing weight). I am active, to include weight lifting, and various aerobic training. Blood pressure is around 110/70, and resting heart rate of about 55bpm. I consulted the cardiologist about this, and he suggested continued aerobic-type training, and also continued weight lifting, although to lower the weights to something I can lift twelve times per set rather than five times per set as had been my usual load. I will have a follow-up echo in August of this year. My questions are 1) would I be considered to now have aortic disease (or increased risk of aortic event), and 2) are my current restrictions (lifting lighter weights) reasonable at this time?
Vidyasagar Kalahasti, MD: 1) Yes you would be considered to have aortic disease and you would need continued surveillance. 2) Restrictions would include no lifting weights more than 50 pounds. Please keep in mind the weight limitation is not written in stone and it is individually designed; you may get different opinions as there are no scientific studies looking into this. In general, we recommend lower weights with more repetitions for weight training.
hadley: Is there a weight lifting exercise regimen that is safe for someone with an aortic aneurysm?
Vidyasagar Kalahasti, MD: As noted before, restrictions would include no lifting weights more than 50 pounds. Please keep in mind the weight limitation is not written in stone and it is individually designed; you may get different opinions as there are no scientific studies looking into this. In general, we recommend lower weights with more repetitions for weight training.
Chriscollins2233: My name is Chris, 52 years old, 6'4 240 lbs. Incidental echo April 2015 revealed 4.1 aortic root. Cardiac MRI/ MRA June 2015 showed 4.6 aortic root, normal non leaky trileaflet aortic valve. All other areas of aorta normal size. First follow up seven months later, Jan. 16 via CT scan revealed 4.6 again. Next one year follow up Feb. 2017 chest MRA revealed again 4.6 aortic root. Valve, etc., all stable. Five siblings tested via echo Aug. 2015 and one shows stable 4.5 aortic root. Both of us went for genetic testing. All negative results. Extensive family tree with no indication of sudden death or heart attack. At this point, what would you recommend next time frame for MRI monitoring? What size threshold would you consider as an indication for valve sparing surgery in my case? Lastly, I joined a gym August 2016 and do aerobics and spin classes, where my heart rate sometimes exceeds 150 bpm. Also, I lift up to 70 lbs strength training but sets of no lower than 12-20 reps. Do you approve this?
Vidyasagar Kalahasti, MD: I would recommend surveillance annually as the dimensions of the aorta remain stable. Current guidelines would recommend elective surgery when the aorta reaches 5.0 cm. At Cleveland Clinic, we have used aortic cross sectional area index which takes into consideration your height to determine surgery. Heart rate threshold should be up to 75-80% of max predicted heart rate (220-age is max predicted heart rate). If your heart rate reaches that limit then cool down and restart exercise. In some patients we have done exercise treadmill testing to determine heart rate and blood pressure response and made recommendations for exercise. Up to 50 lb. strength training may be better at your size of the aorta. Heart rate and blood pressure control are important to prevent progression.
jdvolpe: For those with thoracic aortic aneurysm, who normally would train for and compete in sports and want to lift heavier weights, what are recommendations for these activities post-surgical repair?
Vidyasagar Kalahasti, MD: We have done stress testing to assess heart rate and blood pressure response before recommending return to sports and training. We also have a sports cardiology center to evaluate athletes or sports people.
MB7113: Hello and thank you in advance. I am 41-year-old male (6'0, 185) currently monitoring a BAV and 4.7cm aneurysm (stable for three years) at CC. I stopped all heavy weight lifting but still want to assist coaching HS wrestling two days a week. I do not engage in extremely competitive wrestling, just break a sweat with some light grappling while maintaining good breathing. I know there are no guarantees in life and do not intend to put you on the spot, but what would YOU do if it was YOUR favorite hobby. Thank you again for all that you do at your great institution!
Vidyasagar Kalahasti, MD: In your case, I would suggest our Sports Cardiology evaluation as they would evaluate you in more detail in relation to your specific sport/hobby.
DonnaJ99: Is cardio exercise good or bad for you when you have an aortic aneurysm?
Vidyasagar Kalahasti, MD: Aerobic exercise is recommended.
Idvolpe: Where does thinking stand on exercise limitations with aortic aneurysm? For someone who previously trained and competed in a college, then a masters sport, is any semblance of intense exercise still advisable? Is any approach to lifting? Are some sports completely contraindicated? (rowing, sprinting, contact sports?)
Eric Roselli, MD: See previous comment.
Carolawho: I have a 4.7 ascending aneurysm at the root. I use to lift 200 lb. weights 3x a week. What can I lift now?
Eric Roselli, MD: You should limit lifting to no more than half your body weight and stick to dumbbells and lots of reps – stop the “maxing out”.
MissAmerica: Sorry, I forgot an important question. I am active, and would like to know an exercise program that would be acceptable. Can I do push-ups, rows with weight, light jogging on the treadmill and the elliptical? Thank you once again.
Eric Roselli, MD: Yes go for it.
Indygirl: Are there any exercise restrictions for an ascending aortic aneurysm measuring 4.9 x 4.8 cm?
Eric Roselli, MD: See above answers re: weight lifting limitations.
sam2: History of a 36-year-old male. History - 2008 supracoronary tube graft with non coronary sinus replacement (Hemi- Yacoub, 2016-valve sparing aortic root replacement) (34mm Valsalva graft). Meds- Avapro 75mg and Nebilet 2,5mg. I am his mother and he says his BP is normal and only complaint is he has constant feeling of pounding in chest at every heart beat and says he feels and hears it. Would magnesium be beneficial for him? Thank you in advance for your answer.
Vidyasagar Kalahasti, MD: Many patients feel different symptoms after surgery. Feeling their own heart beat is not uncommon. I am not aware of any studies that looked at Mg for this.
655800: At 4.2 cm after swimming or extensive house cleaning, I feel AGONIZING. I can't even sleep, rest. I have to just in bed for about one hour to start feeling a bit better, then, I can sleep to wake up rested. I am a slow swimmer/learner at 62 years old. I that normal?
Vidyasagar Kalahasti, MD: In general, 4.2 cm aortic dilation should not cause any symptoms. You should be evaluated for other etiology for your symptoms.
Suehopeful: I am severely obese (over 350#) 5' 31/2" tall, 50-year-old female. I just found out I have a 3.8 ascending aorta ectasia via CT scan. I started metoprolol in addition to fosinopril and furosemide. I also have stage 1 left heart stiffness. I started having panic attacks and numbness in my right arm and face. I also found out I have severe B12 deficiency. Neurologist thinks B12 causing numbness, etc. I am on shots now. My mom had stent for AAA in early 70's and my aunt had stents at age 80 in aorta near kidney. I am very scared and want to get healthy. I have just lost about 30 lb. I am concerned numbness could be from the aorta. Also, what is safest way to lose weight? My cardiologist wants to repeat an echo in a year. Does this sound reasonable? Also could this be hereditary?
Vidyasagar Kalahasti, MD: It is good that you are losing weight and will help your blood pressure control a great deal. 3.8 cm aortic may be in the upper limits of normal for you and should not cause symptoms. Repeat echo in a year is very reasonable. Based on your family history it is possible that hereditary factors may be playing a role.
Pstrand: I had a Bovine Pericardial Heart Valve inserted 11-30-2003. I also have an ascending aortic aneurysm measuring 4.7 cm that has not gotten any bigger in last two years. My question is what are the most common symptoms of an aortic valve replacement that is wearing out? I'm assuming that either my aneurysm will enlarge and require surgery or my replacement aortic valve will become problematic and require surgery. I'm assuming that both the aneurysm and valve would be repaired same surgery. I am currently 74 years old and leading an active life.
Eric Roselli, MD: Keep being active (except for heavy lifting – see prior posts) and imaging will find your valve or aneurysm getting worse before you will feel it (as long as it doesn’t get infected).
HappyGirl@56: What is the best test to view a Bicuspid Aortic Valve?
Vidyasagar Kalahasti, MD: It is variable and echocardiogram is one of the common modalities to assess bicuspid valve anatomy and function.
nodule: I am a 54-year-old healthy male, 5-11, 165 lbs., 120/80 BP. In January, a CT scan showed a ectasia of 3.9cm at the ascending aorta. My calcium score was 0, NO bicuspid valve or connective tissue disease. In February, I followed up with my Cardiologist, I did a both a treadmill stress test with great results (got to 98% of targeted heart rate) and an echocardiogram. The echo came back with "normal study" result, BUT found "mild aortic root dilation" (3.9cm) and stated the ascending and arch aorta "normal in size". So I am a bit confused as to why the CT scan showed the dilation at the ascending aorta and the echo is showing the dilation at the root? Which report do you think is the more accurate? I always read that CT is the most accurate for detecting aorta dilation and echo are not the more accurate for that. The good news is my cardiologist told me that with my weight, height and body mass, that for me, 3.9cm dilation is at the outer limits of normal.
Vidyasagar Kalahasti, MD: CT in general is more accurate for assessment of aortic dimensions. If echo images are excellent, then it is good for assessment of aortic root and ascending aorta. Technique of acquiring echo images is variable and this may lead to suboptimal visualization of the aorta leading to erroneous results.
655800: Difference between MRI and MRA? MRA is the one that should be done for Ascending aortas? Thx
Vidyasagar Kalahasti, MD: MRA is usually done for assessment for aorta.
4nalien: I am 71 years old and, owing to a birth defect, I have had two aortic valve replacement operations (2000, 2011) and have developed an ascending aortic aneurism that is borderline for operation according to my cardiologist. The surgeon stated that he measures differently and we can wait a year since he deems it not borderline. How can there be two methods of measurement and which is more dependable?
Vidyasagar Kalahasti, MD: You need to be evaluated to determine treatment options. Imaging with CT would be the best to determine the size of the aortic aneurysm.
ewes91: Hello, I am a 47-year-old male with aortic root dilation/aneurysm to 4.3-4.5 cm (CT measurement with pulsation artifact), maximum ascending aortic dimension is 3.7cm, aortic arch measures 3.0cm, maximum descending thoracic aortic dimension is 2.5 cm. CT scan was performed in Jan of this year 2017. Hypertension now controlled with 10mg Lisinopril daily. Questions:
1. cardiothoracic surgeon I saw at Emory Atlanta indicates likely would not recommend surgery until 5.5cm aortic root aneurysm and recommends another CT scan for baseline in Jan 2018 and if no further dilation every other year. Is this a similar approach Cleveland Clinic would recommend?
2. In terms of management of the aortic aneurysm, is there anything recommended specifically outside of healthy diet, moderate exercise, and blood pressure control? Do you recommend a beta blocker over ace inhibitor?
3. Regarding exercise, I have lifted weights for over 30 years. Received recommendation of no heavy lifting due to blood pressure increase, however is it ok to do high repetitions weightlifting (10-15 reps) at a lower weight amounts?
4. Regarding valve sparing methods for aortic aneurysm surgery, are there any latest studies that indicate the long term viability versus valve replacement methods. I understand that Cleveland Clinic advocates valve sparing when applicable given patient fit?
Vidyasagar Kalahasti, MD: 1. In patients without family history or genetic syndrome, current recommendation for surgery is 5.5 cm. Recommendation for CT seems appropriate and a similar approach is followed at Cleveland Clinic.
2. We routinely use beta blockers as first line therapy. In patients who develop side effects with beta blockers then we have used ARBs (losartan) and ace inhibitors.
3. Yes you are correct with doing more repetitions at lower weights.
JeanD: I have an ascending aortic aneurysm 4.5 cm via CT scan. Is it possible to have ultrasound instead of CT?
Vidyasagar Kalahasti, MD: You can have an echocardiogram for follow up of aortic aneurysm.
gsl1956: I am a 60-year-old man, 6'2" and 230lbs. Ten months ago, I had a TTE revealing 4.3cm dilation of ascending aorta. Have family history of aneurysm - mother (deceased-abdominal aortic aneurysm) and grandfather (deceased cerebral aneurysm). Had a cardiac cath last April after symptoms of unstable angina that lead to discovery of the aortic dilation). Watchful waiting since then. Had another TTE 2 weeks ago that now shows dilation has increased to 4.5cm in 10 months. Getting an MRA on Thursday for better evaluation. In the past month, developing significant, constant overall fatigue - weak feeling in arms and legs, lack of stamina. Past week, increasing levels of moderate chest and upper back discomfort - no tearing pain but periodic stabbing pains. Worried about dissection and not getting early surgical intervention before complications arise. Very stressful job. What are your thoughts on my case? Thanks for great information you provide aortic disease.
Vidyasagar Kalahasti, MD: MRA should give more details about the size of the aorta. In general at the size you have mentioned most people do not have any symptoms. I am assuming you did not have any Coronary artery disease on your cath. If you are worried about dissection, that pain is usually severe and usually will not go away until treated with pain medications and blood pressure control. The pains you are experiencing may not be related to your aortic aneurysm.
Verne: I am a healthy 80-year-old woman patient at a cardiovascular center of a major university teaching hospital. Diagnosed with a 4.8 cm ascending aortic aneurysm 7 1/2 yrs. ago, I had frequent CT exams and Echos early on, but after the aneurysm was judged to be stable, only receive annual Echos (which in my case often fail to measure much of the aorta). Last CT was 2 1/2 years ago and none is scheduled for this year. This situation makes me nervous, but the provider cites risks of the CTs and only uses MRIs with younger patients. My family urges me to get a second opinion at a place like Cleveland or Mayo. Comment?
Vidyasagar Kalahasti, MD: We would be more than happy to see you for a second opinion. CT scan is reasonable test to be done this year to re-assess size of the ascending aortic aneurysm.
TravelerDX: With an ascending aorta dilation of 4.2 cm, how often and why should the dilation be measured and by which technology to maintain consistent measurement accuracy assuming tricuspid aortic valve and no connective tissue disorder?
When and why would surgery for ascending aorta aneurysm be recommended assuming tricuspid aortic valve and no connective tissue disorder?
What are the current aorta aneurysm surgical methods?
When should Repatha be prescribed?
What specifically can be done to slow the growth rate of a dilated ascending aorta besides following a plant based diet, exercise, managing blood pressure with medication, and taking a statin?
Vidyasagar Kalahasti, MD: We initially follow patients at six months with repeat imaging, and if stable, then do annual follow up.
The imaging modality used for follow up varies in different individuals depending on how well we can visualize the aorta. In some patients we have used only echo or MR (rather than CT) for follow up.
More than 5.0 cm is when surgery is considered at centers of excellence like Cleveland Clinic.
Repatha is one of the newer medications for cholesterol control and is recommended for patients who are unable to tolerate statins and have familial hypercholesterolemia.
You have correctly stated the treatment methods for preventing growth of dilated ascending aortic aneurysm.
DPerry12005: When you measure an ascending aortic aneurysm, do you take into account the wall of the aorta in that measurement? Thank you in advance.
Eric Roselli, MD: Yes but it is hard to measure wall thickness.
Medications for Aneurysm
ejgeeze45: What are your thoughts on the drugs metoprolol and losartan in combination to help with a 4.2 ascending aortic aneurysm?
Vidyasagar Kalahasti, MD: Metoprolol is a beta blocker and very commonly used in patients with aortic aneurysm. Losartan has been studied in Marfan syndrome and is a good alternative if you are unable to tolerate metoprolol.
ejgeeze45: If losartan is an alternative to metoprolol, why would I be taking both at this time?
Vidyasagar Kalahasti, MD: In some patients, combination therapy with metoprolol and losartan is used for optimal heart rate and blood pressure control.
Chriscollins2233: Aside from the presence of a cough do differentiate in any meaningful way between prescribing ace inhibitors or ARB's for aortic root aneurysm treatment?
Vidyasagar Kalahasti, MD: Yes cough is more commonly noted as a side effect for ace inhibitors. Losartan may be a reasonable alternative.
Blood Pressure and Aneurysm
DonnaJ99: I understand it is important to control blood pressure when you have an aortic aneurysm. What is the ideal range? I have heard that the top number should be 110 or below. Mine is 120 to 130 while taking metoprolol. My doctor does not seem concerned. Should I be?
Vidyasagar Kalahasti, MD: Blood pressure under 130/80 mm Hg is reasonable. Lower blood pressures may cause side effects such as dizziness. It also depends on the size of the aorta and rate of growth of the aorta.
Ollie+me: Is there a new surgery for a thoracic aorta aneurysm that is more laparoscopic for a shorter recovery time?
Eric Roselli, MD: Endovascular approaches are available for many thoracic aneurysms and are least invasive. For the ascending aorta, we are also performing many of these through mini incisions in the chest and recently published excellent results with our experience performing these.
Size of Aorta for Surgery
Nodule: Hello, I know Cleveland Clinic performs minimally invasive surgery on the ascending and arch aorta with great success rates, BUT what about aortic root? Can this be done minimally invasive with the same success rate as ascending and arch? I ask this because even though I mostly likely do not need surgery, my aortic root is "mildly dilated" at just 3.9cm. However, when my cardiologist adjusted for my age, height, weight and body mass, he tells me 3.9cm, for me, is just at the outer limits of normal range. I am 54, 5'11'' 165 lbs., Average B/P right around 122/82, NO bicuspid, NO connective tissue and a recent calcium score of 0 from my CT scan. At 54, he feels it’s VERY unlikely that I would ever need surgery. What you agree?
Eric Roselli, MD: I agree that it sounds as though you don’t have too much to be worrying about if what you describe is accurate and you do not have a family history or other features suggesting potential problems from your aorta. 39mm is upper limit of normal.
Rhebuck: I am female, 124 lbs, 5 feet 2 inches, always been active and athletic, never smoked, take statins to reduce cholesterol, eat healthy, 65 years old. No family history for AAA. Yet I have three ascending and descending aorta, and thoracic/abdominal. The latter is 4.2 cm. I heard that petite females should be concerned about smaller diameter AAAs compared to the standard for men. At what diameter should I be concerned?
Vidyasagar Kalahasti, MD: Yes. Petite females may need to be intervened on earlier with regards to aortic aneurysm. We have used aortic cross sectional area index to decide on operative intervention if patient have aortic root or ascending aortic aneurysm but this has not been validated in thoracoabdominal aneurysm. The cross section area index uses patient height into consideration for surgical decision. We would be more than happy to see you here for evaluation.
Marie21: In Sept. 2016, I learned my ascending aortic aneurysm had grown to 4.4 cm from a previous reading three years earlier of 4.2cm. I also have a BAV that is stable. I'm a 42-year-old female who is short and a tad overweight. I'm 5 ft. 2 inches, weight of 173. No other health problems. Will I have to have surgery to repair my aortic aneurysm sooner than the recommended 5.5 cm mark due to being a shorter, smaller person?
Eric Roselli, MD: Perhaps – it depends on some other details.
Marc56: I am a 78-year-old female, height 4' 11", moderately overweight (30 pounds). Generally very healthy (no diabetes, high BP, GERD, bowel problem, etc.) My cardiologist is monitoring an aneurysm in the ascending aorta now measuring 5.1 cm (4.7 cm when first discovered about 8 years ago). Mild aortic insufficiency. History of serious scarlet fever and rheumatic fever in childhood. Recently diagnosed with paroxysmal Afib, significantly affecting life style. History of untreated mild-to-moderate sleep apnea. Questions: Are all these cardiac conditions/histories related? Does one cause another? Is treatment of the AFib affected by the existence of the aneurysm? Does my short stature suggest an earlier intervention?
Eric Roselli, MD: Probably separate issues. Yes, short stature may drive us to earlier intervention depending on other factors as well.
Nimbus: What is the recommended size (cm) of an aortic aneurysm in order to perform surgery? If you have a bicuspid valve will that change recommendations for surgery?
Vidyasagar Kalahasti, MD: Recommended size depends on underlying conditions such as genetic condition (Marfan syndrome), family history of aortic dissection, etc. In patients with bicuspid valve, surgery has been performed at 5 cm if there is rapid growth or dissection at smaller diameters in the family. Aortic cross sectional index which takes height into account has been used to make recommendations regarding surgery in patients with bicuspid valve.
JeanD: I am a 63-year-old female and have a stable 4.5cm ascending aortic aneurysm. What is the size that you recommend surgery? And open heart?
Eric Roselli, MD: Simplest answer is 5.5cm or greater, but for many patients we lower the threshold to 5cm or even less if there are other extenuating circumstances like a strong family history or confirmed genetic trigger. Yes, these are best approached with an “open heart” approach for most patients. In 2016, our operative mortality for elective aortic repairs was 0.3% - approximately one tenth of that predicted from data at other centers.
roserob: I have an ascending aortic aneurysm which I check each year with an ultra sound in order to track the size. I have known about it since 1999. At what size should I be considering having surgery to fix the aneurysm? Also has there been any advances made in this surgery that are less invasive than in the past. Is the surgery still full open heart. Thank you
Vidyasagar Kalahasti, MD: See previous responses regarding what size when surgery is recommended. We do offer minimally invasive options. We would need to evaluate you to determine your options.
Costanza: I have an AA that has measured 5 for the past nine months. We are monitoring at six month intervals since it was discovered. At what size is operating a must? And is operating the only option? And if it is does it have to be open heart surgery?
Eric Roselli, MD: 5cm is the threshold where we may consider repair. Re: approach, see earlier comments.
MIKE1963: What are the current parameters of an aortic aneurysm for moving from "monitoring" to surgery? (i.e. size of aneurysm, familial history, etc.)
Eric Roselli, MD: See earlier comments about absolute size. Also, if it grows at a rate of 5mm in a year’s time then we consider that rapid growth and will often recommend intervention.
Jurgis: At what point should an 83-year-old consider surgery to repair a growing (approx. 1mm per year) ascending thoracic aortic aneurysm at the root which current MRA shows it to be 47mm. Thank You
Eric Roselli, MD: Probably still too small to intervene.
coop2011: For a male that is 6.2 in height, that has a bicuspid valve and an ascending aortic aneurysm measuring at 4.9, when would you typically recommend surgery generally speaking?
Eric Roselli, MD: When it exceeds 5cm.
az85: I have read about both aorta size index (diameter controlled by an estimate of body surface area), and the cross sectional area index (area controlled by height). I realize both are statistical measurements and are only part of an evaluation process, but what might be considered upper-end-of-normal, and what might be considered indicative of need for surgery based on those two methods? Thank you for taking our questions.
Eric Roselli, MD: More data is suggesting that it is better to index to height than BSA.
Ollie+me: Is there a new surgery for a thoracic aorta aneurysm that is more laparoscopic for a shorter recovery time?
Eric Roselli, MD: Endovascular approaches are available for many thoracic aneurysms and are least invasive. For the ascending aorta, we are also performing many of these through mini incisions in the chest and recently published excellent results with our experience performing these.
Nama4: Please say something about any new procedures/approaches for addressing ascending arch aneurysms, including any promising research.
Eric Roselli, MD: See above. Also, we have several branched devices under investigation to treat the aortic arch for higher risk patients and have developed novel hybrid techniques incorporating the best of open and endovascular operations into one stage repairs.
4nalien: I live in Virginia Beach and have all the diagnostic tests done at the Sentara Heart Clinic in Norfolk; will I still need tests done at Cleveland Clinic? If so can the tests be done a day preceding a scheduled operation?
Eric Roselli, MD: Most tests do not need to be repeated if they are recent and of acceptable quality.
Roguefiddler: I was a patient of Dr. Roselli in 2015. He performed the two stage elephant trunk repair on my aorta of a near 6cm aneurysm. A had a CT scan two weeks ago revealing another 6+cm aneurysm.
Eric Roselli, MD: Did you come to see me? I need to know more details to discuss. Any untreated areas may be at risk. Call my office if we haven’t already discussed this.
Costanza: The death of Bill Paxton, is that a fluke or is the danger of a stroke a big issue after AA surgery?
Eric Roselli, MD: It is real but usually very low and related more to the overall health of the patient and the experience of the center.
Endovascular Aorta Stent Graft
Roguefiddler: In Oct 2015, I had phase 2 of elephant trunk repair. Also stent placed in the right renal artery. Last week I had a CT (thorax) w/o contrast. It is showing a 6.1 cm aneurysm in the aortic arch and a 6.3 cm aneurysm in the descending aorta. Since I have stents from the mechanical aortic valve to the abdominal aorta, does this seem unusual?
Eric Roselli, MD: Hard to say without seeing the actual images especially after the complex procedure you had. If you have a dissection, the aorta could still be at risk, if not, it is still a bit early to see reverse remodeling of the aorta around the stent grafts.
Idvolpe: How far are we from endovascular approaches to repair for ascending thoracic aneurysm? Is 3D printing stents based on MRI of an individual's aortic structure, including better ways to secure and keep the graft in place, anywhere on the horizon?
Eric Roselli, MD: For most ascending aneurysms, the current technology is severely limited for various reasons. However, we are going to see some better devices for high risk patients like the elderly or frail patients who present with acute dissections. 3D printing of devices is currently limited by many issues and is better as a preparatory or research tool for now.
Trey3: Is endovascular stent surgery available to treat an aneurysm in the ascending aorta?
Eric Roselli, MD: See previous answer. It is feasible for some patients and we have one (if not the) largest experience with 39 patients to date. Newer devices will begin trial this year for higher risk patients.
Bypassme: What is the overall long term success rate when using an Aortic Stent Graft I lieu of a surgical repair?
Eric Roselli, MD: This depends on the location and shape and other features of the aneurysm. The two treatment options should be considered as complementary to one another and not competitive because each has advantages and disadvantages that may allow it to be best tailored for each patient. That’s why it is good to have surgeon/surgical team who can do both.
Clay: Is TEVAR going to be an option for root repair? Will it ever be a preferred method for the surgeon? What is the latest mortality and quality data for root repair at Cleveland Clinic?
Eric Roselli, MD: Not for quite a long time for the root. Our mortality rate for root surgery has been as low as 0.2% for valve preserving root replacement, and is consistently less than 5% even for emergency indications.
Bypassme: I had an aortic stent repair performed 10/2016. Over the last month I have been experiencing a slight muscle spasm intermittently. No pain, but I definitely feel the sensation, most often when I am sitting. Could this be related to the procedure?
Eric Roselli, MD: The aorta doesn’t typically cause symptoms unless it is unstable.
MIKE1963: Are there any non-invasive (or less invasive) treatments for aortic aneurysms and if so who is a candidate for these types of procedures? If not are there any non-invasive treatments on the horizon that you are aware of and how do these compare with full open surgery?
Eric Roselli, MD: See above.
Bypassme: I had an aortic stent graft placed in aorta and both iliac arteries in Oct. 2016. What has been your experience with long term results with this procedure?
Eric Roselli, MD: Excellent so far but each patient’s aorta is unique and surveillance imaging is important.
Re-operative Aorta Surgery
Wineplyr: I have an Aortic Aneurysm measuring 5.8cm, spring 2016. Spring of 2015 it was 5.6cm. Is that a huge increase? I've had triple valve replacement surgery in December 2012 at St. Francis Medical Center, Hartford, Ct. I'm 6'3" tall, 285 lbs. My blood pressure runs around 110/70 with medication. I've been on a low sodium diet since 2001. I eat healthy, just too much. My arteries are pretty clean and my cholesterol is around 170. I try to do cardio work-outs three days a week. My next CAT scan will be in May. I'm not looking forward to another surgery. (I'm already playing with the Casino's Money). I've been lucky so far.
Eric Roselli, MD: Sounds like a pretty big aneurysm but would have to see the films and get more details about your condition before rendering an opinion about what is the best strategy. Even in reoperative situations, our rate of mortality for aortic aneurysms is 3% or less, but I do understand that having heart surgery is something you don’t get used to. Regarding the Casino’s money - #winning!
Mike_T: I am a 34-year-old man with a prosthetic aortic valve (St. Jude) and a 44mm mid ascending aortic aneurysm. I was born with BAV and had significant regurgitation, I had my first heart surgery at eight years old to repair the aortic valve. A year after the surgery, it was discovered the surgery was not successful and I had a 2nd surgery at 10 years old to have the valve replaced with the prosthetic valve. Unfortunately it was brought to my attention three years ago that I would eventually need another heart surgery down the road due to pannus growth and I was shocked to learn I had developed an aneurysm. This has been devastating to my life as I have spent all my life being very physically active (weightlifting) and made my living through labor intensive work (industrial mechanic). I am current trying to reconfigure my life at this inconvenient juncture. My question is what is a likely prognosis for someone like me with my history?
Eric Roselli, MD: I’ve operated on some patients for their sixth operation and gotten them back into action so your good health and an experienced surgical team is in your favor.
Surveillance, Screening and Follow-up
Nimbus56: My aorta measures at 4.3 and 4.6, root and ascending aorta. The aorta has been stable for five yrs. since testing. I've been under doctor’s care and check twice a year. I'm very active and fit. What is your recommendations of future care?
Vidyasagar Kalahasti, MD: As your aorta has been stable for five years, you may space your surveillance annually. Continue with your activities and follow up.
kmd31: I'm a 46-year-old female with a 3.4 cm ascending aorta ectasia. I have hypertension (diagnosed at 28 years old, but controlled), a calcium score of 26, and family history (mother) with an aortic aneurysm. Father died at 52 from heart attack. Since I have been diagnosed so young, is there a need to be concerned about faster enlargement of aneurysm? What other factors affect enlargement?
Vidyasagar Kalahasti, MD: 3.4 cm may be at the upper limits of normal for you. Surveillance will determine if there is change in size and if there is rapid growth, then you may need surgical intervention. Blood pressure control is important in preventing progression.
rbradley57: I have an Ascending Aortic Aneurysm, was diagnosed 3.5 yrs. ago, and had Cat Scans each six months for couple yrs., then 1x per yr. since. Dr suggested I may wish to go to 1x each 2 yrs. as has not shown growth in measurements. Depending on whom measured the smallest interpreted 4.2 in size, and the largest measure was 4.4 Should I be considering any surgery, and is 1x every other year enough? If surgery is likely to be suggested in future, what are the options, and success/long term survival rate?
Eric Roselli, MD: Still a pretty small aneurysm – since stability is established, once a year or two is probably ok. See other answers re: options. Long term survival is also very good especially if it is isolated ascending disease.
MissAmerica: I am a 62-year-old female diagnosed with an Aneurysm of the Ascending Aorta. It was a 3.7 in 2011 and now it is a 4.0. I understand it is not large enough for surgery, but, I also have leaky valves, heart murmur, aortic sclerosis, and leaky valves which have gotten better with blood pressure medicine. My descending thoracic aorta is mildly ectatic and the arch is mildly ectatic. I also have tortuosity of other blood vessels. I had genetic testing at Johns Hopkins Hospital in 2012 for TGFBR1, TGFBR2, SMAD3 and TGF-Beta 2. All negative for Loeys-Dietz Syndrome. I also have a hernia, scoliosis, loose joints, and Dural Ectasis of spine. Based on the above, is there another genetic test for Connective Tissue Disorder and would I be a candidate for early surgery based on the above? Thank you for your response.
Eric Roselli, MD: Even if you had an identifiable syndrome that is probably too small to operate. We now screen for about 23 different genetic abnormalities.
ann karen: I will turn 70 in Sept. of 2017, and I have a dissected aneurysm which was discovered on a scan between five to eight years back in time. No particular treatment other than an aspirin of 325mg daily and I take high BP medication and a statin. I had/or have (?) Controlled Diabetes and my A1C is 5.8 sometimes less for several years. I am 5'4' in height and weight 147 to 150 lbs. My dissected aneurysm appears to have damage to two of the three layers of the aorta and or the aneurysm, I am not sure. I am starting now to have pains in my legs and I am having pains in my shoulder, parts of my upper arm and neck area plus the pain radiates to my upper back which is very uncomfortable. I must stop standing and working with my right hand and right arm and rest sit down or rest in bed. So my question is in your opinion, are these symptoms possibly related to my dissected aneurysm and the vascular system in general??????? Thank you in advance to your reply.
Eric Roselli, MD: Hard to say without seeing a CT scan. You should be getting one on a regular basis – typically yearly if you still have a residual dissection.
BK41: My ascending aortic aneurysm diagnosed in 2009 measuring 4 cm. Confirmed as stable by CT Angiography in 2011. Reexamined at Cleveland Clinic in 2012 by CT and echocardiogram and 2013 by echocardiogram only with continued "stable" diagnosis. Examine by 2D Echocardiogram locally) in 2014 with "stable" diagnosis. 1) When should I have another CT examination? 2) What measurement suggests consideration for surgical intervention? 3) What preventive measures and activities to be avoided are suggested? 4) Should my next CT scan be at Cleveland Clinic or locally (I live in Detroit area)?
Eric Roselli, MD: 4cm is small but if you haven’t had a scan in five years you are probably due. Getting it here will allow for a direct comparison but is not mandatory.
Millgre: I have an Aortic Aneurysm in both my ascending as well as several abdominal. My Thoracic surgeon mentioned the one I have in the iliac (left) that is slightly dissected is fairly unusual and might suggest special consideration. My vascular surgeon did not seem to this the same. Is the iliac uncommon, and might a special consult be wise? Obviously the Thoracic surgeon does not do. Vascular surgeon I like, and have other abdominal Aortic Aneurysms. Thanks for your opinion.
Eric Roselli, MD: In our institution, we treat the entire aorta as a single organ and approach it with a multi-disciplinary approach. In other words, our aortic surgeons typically will treat the whole patient and their aorta whether our training is primarily cardiothoracic or vascular. With these team approach we can develop the best life-long approach to your problem. And, it is quite common that we see patients with aneurysms of varying degrees involving the entire vascular tree from the left ventricle and beyond.
Abdominal Aortic Aneurysm
Dillard: I'm a 73-year-old male and was diagnosed with a 3.5cm AAA three (3) years ago. The condition has remained the same and is being monitored via ultrasound on a yearly basis. As I age, should I expect this condition to worsen or will it remain the same? Also, could this be congenital? (What size does an AAA have to be before surgical intervention?) Thank you in advance.
Vidyasagar Kalahasti, MD: Yes it may worsen in the future and recommend continued and periodic surveillance with ultrasound. Abdominal aortic aneurysms are sometimes hereditary and run in families. In general size greater than 5 cm is considered for surgical intervention.
shepkejt: What is the best way to control the growth of an AAA?
Vidyasagar Kalahasti, MD: Blood pressure and cholesterol control, smoking cessation are the main factors.
tedanlou: I am an 83-year-old male. Weigh 200 lbs. Height six feet. Active. How much at risk for a rupture am I with an AAA 4.6 cm?
Vidyasagar Kalahasti, MD: Rupture risk increases when aortic size increases to greater than 5 cm. Blood pressure control is another important factor and decreases the risk of rupture.
gm3: I had AAA open type Flank surgery 3 1/2 years ago and have maintained an exercise program consisting of cross country ski machine, (55 minutes) - high reps of core type exercises, (25 minutes) - and high reps with light weights, (40 minutes). This program is executed every Sun-Mon-Wed and Fri. Is this too much exercise or is there no limitation on same after the AAA open type surgery?
Eric Roselli, MD: Great work!
Aorta Disease and Roller Coasters
edmkelly: I have a non-operated descending aortic dissection that runs from just below the bend where the aorta comes out of heart to my lower abdomen. I am 75, so I am not very physical anymore. I have driven to Florida. I have flown to Florida and I have taken the auto train to Florida. I love roller coasters. How much must I avoid physical stress and excitement? Can I go on a roller coaster if the opportunity arises? I would also love to go for a ride in a bi-plane. Is this something I could do?
Vidyasagar Kalahasti, MD: We do not know the size of the aorta; nor do we know if you are on medications for heart rate and blood pressure control. Due to change in rapid movement in a roller coaster your heart rate and blood pressure may swing rapidly and this may not be the best for you.
Flying and Aneurysm
DonnaJ99: I have heard mixed messages in regards to flying when you have an aortic aneurysm. Can flying cause your aneurysm to expand?
Vidyasagar Kalahasti, MD: No data to suggest flying causes aneurysm to expand. In fact, we see many patients from all over the world for this condition, who flew in to Cleveland Clinic for evaluation and/or treatment.
Hot Tubs and Aortic Aneurysm
DonnaJ99: Are hot tubs dangerous when you have an aortic aneurysm?
Vidyasagar Kalahasti, MD: There is no evidence to suggest that hot tubs are dangerous. To be more specific we would need to know your medical history size of aneurysm and medications you are on.
DonnaJ99: I am a 62-year-old female diagnosed with 4cm ascending aortic aneurysm almost one year ago. Currently on Metoprolol er 50mg. Borderline high blood pressure diagnosed six months ago. With discovery of aneurysm began Metoprolol. No other significant medical findings. Is hot tub ok?
Vidyasagar Kalahasti, MD: Yes.
Low Oxygen and Aneurysm
Procrastinator#1: Is a low oxygen concentration an added risk factor for a person with an aortic aneurism?
Vidyasagar Kalahasti, MD: No specific data about this.
Aorta and Other Medical Conditions
Procrastinator#1: Is the risk of an aneurism rupture more likely if the patient also has a hiatal hernia?
Vidyasagar Kalahasti, MD: No evidence to suggest this increased risk with hiatal hernia.
OpenHearted: I am a survivor of a ruptured brain aneurysm and I also have a thoracic aneurysm measuring 4.2 distal and proximal (not quite sure what this means). My question is how great does the risk of my thoracic aneurysm rupturing/dissecting having had a type vascular rupture already. I also have aortic valve disorder both mild/moderate stenosis and regurgitation, trivial mitral and pulmonic valve regurgitation and other co-morbidities. I am 5.9 ft (70 inches) tall and I weigh 260 lbs.
Eric Roselli, MD: Previous brain aneurysm would increase our suspicion but 4.2 is still probably too small to intervene. Proximal means upstream or close to the heart, distal means downstream or away from the heart.
Danny57: I have a 5.1 cm aortic aneurysm along with moderate regurgitation of my aortic valve, which was repaired in 1992, that my cardiologist has been monitoring closely for six years. My cardiologist says that I can go ahead with inguinal surgery now. Does that sound okay to you?
Eric Roselli, MD: I have to defer to your cardiologist who knows you but probably if it has been monitored closely.
naillil: I have CAD and have a stent in place. What's the chance of having an aorta aneurysm?
Eric Roselli, MD: Not directly related.
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