By: Kathy Hubbard
It happens every day, and to many people you know, but until it happens to you, it’s impossible to describe how it makes you feel. What am I talking about? I’m talking about feeling absolutely fine and then finding out you have a potentially fatal condition.
A couple of weeks ago, I got an email from a dear friend of mine. She suggested that I write about ascending aortic aneurysm to create awareness of this condition. Why? Read on.
“I recently was to undergo a complete knee replacement,” Margaret wrote, “however, my new doctor requested an echocardiogram because she detected a murmur. The test showed a 6.3 centimeter aortic aneurysm.”
Typically, that diagnosis would make Margaret a candidate for surgery. But she added, “The heart surgeon told me that I would have a 50 percent chance of surviving surgery.”
She was also told that if she did survive the surgery, her recovery would be lengthy, including having to spend time in a nursing facility. Not great news for this independent and hitherto healthy woman. Apparently the surgeon had recently lost a patient after similar surgery and was perhaps understandably cautious taking into consideration that Margaret is 85 years old.
Before I explain the surgery, let me back up and tell you what an aortic aneurysm is. Cleveland Clinic explains, “An ascending thoracic aortic aneurysm (ATAA) is a bulging area in the first part of the aorta, the main artery in your body. An aneurysm is a weak spot in a blood vessel wall.”
Margaret calls these aneurysms silent killers. So does Tufts Medicine who says they’re called that because they typically develop without symptoms and are difficult to detect. That is until they rupture, which is then a medical emergency.
Men over 60 and women over 70 are more likely to develop ATAA which affect about 10 out of 100,000 people each year. Other risks include having a family history of ATAA, having a bicuspid aortic valve or connective tissue disorder, heart disease, high blood pressure, and smoking.
“ATAAs develop when a blood vessel wall becomes weak or damaged. Aging and heart disease can make the aorta less elastic. The force of blood against the weak area causes the blood vessel to bulge outward,” Cleveland Clinic says.
Like Margaret said, there are often no symptoms. However, you will want to talk to your healthcare provider right away if you have chest pain, or pain high in your back; are coughing or wheezing; having difficulty swallowing; experiencing hoarseness or being short of breath as some people experience these symptoms and they shouldn’t be ignored.
Now about surgery. Cleveland Clinic explains, “During aneurysm repair surgery, a surgeon makes an incision in your chest to access your aorta. They remove the aneurysm bulge by cutting it out and in its place sew a graft. Depending on the location of the aneurysm, your surgeon may need to detach and reattach your two coronary arteries. This type of open procedure requires cardiopulmonary bypass. This is a procedure where a machine takes over your heart and lung function during surgery.”
All the sites I read recommend surgery for patients whose aneurysms are 5.5 centimeters. Margaret’s, as she said, is 6.3 centimeters. Studies say that 79 percent of people who have surgery before it ruptures or dissects survive for at least 10 years after treatment.
Margaret said that because of her age, she’s concerned that the odds are not in her favor. She is also reticent to spend a long term recovery in a nursing home. She is keeping an open mind, however, and doing a lot of research.
Although the cardiothoracic surgeon Margaret met with said in her report, “I do think that surgical repair is not unreasonable at her age,” Margaret is taking the wait and see option for now.
“I have chosen to continue without surgery and hope my artery is strong. Since I do not have any of the symptoms yet, and am in good health otherwise, I’m going to wait, take my blood pressure daily, and watch for the warning signs. Then in three months they’ll do another test to see if the aneurysm has grown,” she said.
Meanwhile, Margaret is living her life, visiting friends and family, and generally doing the things she loves to do. I’m one of her biggest cheerleaders.
Kathy Hubbard was a charter member of Bonner General Health Foundation. She can be reached at [email protected]. This article was written for publication in the Bonner County Daily Bee on February 4, 2025.