Nancy S., RN:
Dr's I am a RN with Marfans Syndrome and a descending aortic repair done awaiting ascending repair. Mr. Ray has typical Marfan outward appearence. How come no mention of Marfan's? His one daughter looks possible Marfans. Good job but, make the public aware of Marfans. Thank you.

Irving M. Herling, MD:
Mr. Ray does not have Marfan's Syndrome although he is tall. He has a bicuspid aortic valve and as a result, has a diseased ascending aorta. Bicuspid valves are identified easily by echocardiography.

Marfan patients are at very high risk for aneurysms of their aorta and are more easily identified due to their stature, visual problems and family history.

Nancy A.:
I was diagnosed last April with a abdominal aorta anuryism. It is now 5.3 in size. I will probably have the surgery at Cooper Hospital soon. I also was diagnosed with emphysema. What are my chances of coming through this surgery safely? I also have a carotid artery on the left side of my neck, which they want to do first. Is this correct or should I have the aorta first? Any help you can give me would be appreciated. I am a 58 year old woman. Thank you

Thomas Gleason, MD:
Thank you for your question. Based on the limited information you have provided, the proposed approach is reasonable depending on the severity of the carotid lesion. Lung disease does increase the risk of any major aortic operation, however appropriate preoperative testing should help predict your particular risk. Penn physicians will be happy to provide a second opinion if desired. Best wishes for good health.

Dot R.:
I am a 55 year old female in relatively good health - on no medication but my blood pressure is a bit high - what should be my first step in checking my heart health?

Irving M. Herling, MD:
I would make sure that your blood pressure is agressively treated but I would also make sure your blood lipids have been tested and treated if necessary. You should also lose weight (if you are overweight) and exercise routinely. Your physician could determine whether any additional cardiac testing is required.

Magie:
Are all anuerisms complicated? Would an abdominal aortic aneurism less complicated?

Thomas Gleason, MD:
Not all aneurysms require as complex surgical management as aneurysms involving the aortic arch, necessitating cooling down the brain. However, abdominal aortic aneurysms, depending on their extent, can be complex.

Holly:
My son who is 11 years old has had a history of pneumonia for the past 6 years. Recently they found he has a right aortic arch with a vascular ring. Surgery has been recommended to split the vascular ring which may relieve him from getting pneumonia so frequently. Do you feel that this is a good recommendation? How long would do you feel recovery would be?

Thomas Gleason, MD:
For vascular rings, when they are symptomatic as appears to be the case with your son, division of the ring is recommended and seems appropriate in this case. Children recover very quickly from cardiac surgery and I would anticipate a recovery of only a few weeks.

Cheryl:
I have a tumor in my heart. How rare is this and how concerned should I be? I am under the care of a U of PA doctor but am still concerned something may happen to me suddenly. Is this a possibility?? Thank you for your time.

Irving M. Herling, MD:
One cannot counsel you without more details about what kind of tumor it is and where it is located. Since you already are cared for by a Penn doctor, your questions might best be answered by him/her.

Cindy M.:
My father died of a dissection of the ascending aorta (aneurysm). He presented first as a seizure, then they thought a stroke because of temporary paralysis on the left side. Is this the normal presentation? His heart stopped almost 19 hours later. He was revived by a short into the heart. Then remained on life support for 36 hours. It was almost 30 hours after first presentation that they found the aneurysm. Did his intital presentation throw off the detection of the aneurysm?

Thomas Gleason, MD:
Thank you for your question. Dissection of the aorta can present with neurologic symptoms when the dissection extends into the aortic arch and involves the head vessels. This is probably what happened in the case of your father. Identification of the dissection can be difficult if there are no symptoms referable to the chest prompting suspicion of dissection.

Dolores:
I am a very healthy 53yr female. A few months ago my sister went to her doctor to be cleared for a execise program. It was found that she had a hole in her heart, she had surgery and everything went well. A month ago I went to my primary doctor. I told her about my sister and she decided that I should have a echo done. The echo showed that I have a interatrial septum aneurysmal, the pulmonic value was not well seen. I am scheduled for the TEE. The aortic root is moderately calcified. What information can you give me?

Irving M. Herling, MD:
You already have a cardiologist who has much more information about you then we do. If you are unhappy with the communication you are currently getting, contact Penn Cardiac Care for second opinion. Call 1-800-789-PENN (7366) or use the online appointment request form.

John J:
52 old male. Completed carotid artery/stroke ultrasound screening by LifeLine Screening Radiology, LLC in May 2003. No abnormalities noted. What's your opinion of these type of screenings? Are they useful?

Irving M. Herling, MD:
These tests can detect the presence of atherosclerothic disease in the carotid arteries. These arteries may at times become obstructed and produce stroke. Stroke may occur from many other causes as well. At times, thickening of the carotid arteries may indicate the early presence of vascular disease before symptoms develop.

Pat D.:
My father died of an aortic aneurysm in his late sixties; my brother had a brain aneurysm in his late forties. What are my chances of having one; do I have the right to request testing to detect one; would insurance company cover tests based on family history? Thanks!

Irving M. Herling, MD:
At times, the tendency to develop aneurysms runs in families. Often high blood pressure and atherosclerosis accompany the development of these aneurysms. Therefore, blood pressure needs to be monitored and aggressively treated in patients with such familial tendencies and testing (echo, CAT scanning and MRI scanning) may identify early aneurysmal disease. Insurance coverage is variable and should be reviewed with your carrier.

Bob M.:
I had an aortic dissection in 1996. They repaired it with a graph. After surgery, the damage to my T8 section of my spinal cord left me confined to a wheelchair, but not paralyzed. I am unable to reach a standing position or walk. How common is this result and what do you feel are the possible causes? Thanks so much!

Thomas Gleason, MD:
This was an unfortunate complication of your aortic repair. Paraparesis, which is your condition, occurs in less than 10 percent of aortic dissections that reach repair. The cause of this is a loss of adequate blood flow to the spinal cord. Typically the intercostal arteries are torn off the aorta by the dissection process. Once repaired with a graft, a certain percentage of patients will have inadequate residual blood supply to the spinal cord, resulting in your condition.

Carol W.:
I was diagnosed with a mitral valve prolaspe years ago. I am 56. My father died at 59 with a heart attack after several angina attacks. What should I expect in the future? I do take antibiotics prior to dental work.

Irving M. Herling, MD:
To prevent heart attacks, you should have your blood pressure under good control, have your lipids tested and treated, exercise and eat properly. You should be seen on a routine basis by your physician who can order appropriate testing when necessary. With these measures, we can prevent heart attacks and strokes in patients who might be at risk due to their family histories.

Rae B.:
My dad will most likely have his aneurysm surgery soon at Penn. He is going through his battery of testing, e.g. PFT, echo cardiogram. His abdominal aortic aneruysm is about 6 centimeters. I am hoping that his doctor will be able to perform the stent graphing since he has been a heavy smoker. Is this the least complicated of the two surgeries available?

Thomas Gleason, MD:
Yes, the stent graft procedure would typically be less complicated than the open repair. Best wishes for your father.

Ed:
Does the aortic stent also work with an abdominal aneurysm?

Thomas Gleason, MD:
Yes, in fact the endovascular technique of repair was first used in the abdomen. Only recently have we begun using this technique on an experimental basis in the chest.

Lisa M.:
A very clsoe friend of ours recently died skiing. An autopsy revealed a massive heart attack, with the major arteries blocked severely. It was a shock with no signs. I worry about my husband now. He gets yearly physicals and bloodwork every six months. How else would you know the arteries are clogged? Especially in our friend's case, there were no signs. Thank you for an excellent and infomative show.

Irving M. Herling, MD:
Stress testing is an effective way to identify the presence of asymptomatic coronary disease. Patients who are at risk are often monitored this way. They often have a family history of coronary disease or multiple risk factors predisposing them to its occurence. There are other markers in blood work that can identify patients at risk. Speak to your physician about these tests, or contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form to schedule an appointment.

Jane:
I am a 35 year old female a with heart mumur - venticular septa defect - diagnosed at age 11. I have no major current health issue. I am overweight. I was wondering is there and way to close the VSD. I was told it might lead to congestive heart failure if I were to become pregnant, and also later in life. If surgery is possible, what are the risks?

Thomas Gleason, MD:
The VSD could be closed from a technical standpoint without much difficulty, however it is correct that at your age, closure of certain VSDs (particularly those with a lot of blood flow across them) could result in severe congestive heart failure.

Bill B:
Can cardiomyopathy be repaired?

Irving M. Herling, MD:
It depends upon what produced the cardiomyopathy. Certain medications or excessive alcohol consumption can damage the heart. Stopping those medications and stopping drinking can sometimes allow the heart to heal. In addition, there are medications that can treat cardiomyopathy. Speak to your cardiologist, or contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form to schedule an appointment.

Liz:
What kind of cardiac care should a 56yr old man that had quad bypass surgery 3 yrs ago be getting?

Thomas Gleason, MD:
Typical follow-up after bypass surgery at three years would be annual or biannual visits with a cardiologist. Any testing should be directed by the cardiologist.

Carol:
Why must one wait until the abdominal aorta aneurysm is size 5 to 7 before surgery? I would think if I had a small cancer, surgery would not be held off until it was a large cancer. Thank you from all of us who wonder.

Irving M. Herling, MD:
The risk of rupture is virtually nill when the aneurysm is 4.0 to 4.5cm in diameter. The risk of surgery at that point exceeds the risk of aneurysm rupture. We can monitor the growth of an aneurysm accurately by ultrasound to determine when the measurements are exceeded. At that point, surgery is usually recommended.

Pat:
Does repairing restonis of the aorta in an adult with congenital heart problems require the patient to be put on the bypass machine??

Thomas Gleason, MD:
Depending on what area of the aorta you are referring to, many would require the heart-lung machine to some degree.

Alan C.:
I am a 49 year old male with a previously diagnosed abdominal aortic aneurysm. How often should Ibe seen by a doctor?

Irving M. Herling, MD:
You should be seen at least twice a year by an internist to have your blood pressure checked and treated if necessary and have your blood lipids tested. Usually the vascular surgeon who performed your aneurysm surgery will ask you to return periodically for follow up. I would contact his/her office in that regard.

Maureen:
My mom is 87 yrs old had radiation 35 yrs. ago was diagnosed with aortic aneursyms 5yrs ago 6.2. Saw Dr Bavaria recently was a little skeptical about procedure due to radiation & age. Nothing was mentioned about stent grafting. Would this be an option or still dangerous because of age?

Thomas Gleason, MD:
Age is often not a limitation of stent grafting. The location of the aneurysm is the limiting factor. Currently only aneurysms of the decending aorta are potentially treatable by this method depending on their specific location and demension.

Cindy:
Mom father had a leaky valve, high blood pressure controlled by medication and annual echocardiograms due to the valve problem, but yet the aortic aneurysm was never found until death. How long does the aneurysm grow that can be seen on the echocardiogram before disection? Is a year too long in between to have been found?

Irving M. Herling, MD:
Certain areas of the aorta are not easily visualized by echocardiography or chest X-ray. It is in these patients that aneurysms can be missed. The occurrence of chest pain or back pain may trigger other tests may identify those aneurysms.

Sandy:
I have a AAA. I have had 2 measurements taken within the past two months: 4.2 with an ultra sound, 3.5 with a cat scan. When should I start to consider surgery and should I consider the cat scan the true measurement?

Thomas Gleason, MD:
Abdominal aortic aneurysms typically are considered for repair when they are over 5-5.5cm in greatest diameter. Based on your information, surveillance is all that is indicated at this time. We would recommend consultation with a vascular surgeon.

Gregory G.:
I am a 45 year old male who has recently been diagnosed with an aortic dilation. The measurment is at 4.0 and has been stable, no growth since November. I am an avid runner about 20-25 miles per week and my doctors have told me I could resume running at a nice easy pace. I was a powerlifter for 20 years but have not competed since 1995. I have been told to never lift heavy again. I would appreciate any input to my matter you could offer. Thank you.

Irving M. Herling, MD:
Heavy lifting raises the blood pressure to high levels which could result in tearing (dissecting) an enlarged aorta. That is why we recommend against that form of exercise in patients like you.

Keith:
Doctors and staff of Penn Hospital,

Comment: I want to say that you are all incredible in what you do. Your committment is incredible. All of you are truly amazing. You are doing some of the most vital work in the world. Your average day of work does more than many achieve in a lifetime!!!!

Take care and good health to you all,
Keith

Dee:
Watched the show this evening about the surgery for the aneurysm. I have a aneurysm myself, I'm glad to see that this problem can be corrected and the person can recover and go go for their life. Thanks.

Frank:
My mother was recently diagnosed with an aortic anuryism approx. 8 CM in size and is 73 years old. She also was diagnosed with COPD and emphysema and was told the surgery was more risky than living with the anuryism. Is there any value in her being evaluated at this time at your hospital, or is there anything that could be done for her with her other conditions? She was in Crozer-Chester Medical Center for 2 weeks, and sent to a nursing home for rehabiliation, and is now at home.

Thank you for any information or direction you can provide.

Thomas Gleason, MD:
An 8 cm aneurysm is a very serious problem. The location of the aneurysm is the most important piece of information needed to answer your question. If the aneurysm is in the decending aorta it may be possible to treat it with a stent graft. It's impossible to give you an exact answer in this setting. An evaluation in our office can provide you with the answers to your questions. Call 1-800-789-PENN to schedule an appointment, or use the online appointment request form.

Tina:
Does an aching pain in the leg which was not due to injury an indication of a hearth problem? I have high blood pressure, smoke, and history of heart disease in my family.

Irving M. Herling, MD:
Usually pain due to bad circulation is first noticed when walking or climbing stairs. Circulatory problems that are responsible for pain in the legs can be easily diagnosed. See your doctor or contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Pat H.:
At what age should you be tested? Plus my father died from AAA and my one uncle died at age 60. My father was 69, also my other uncle has one and also my aunt. I had a ultrasound recently, but the tech said there was a part she couldn't see but said that's not where they usaully are. My father's was at his lower back. Shoud I have any other tests done?

Thomas Gleason, MD:
A more definitive means of determining the presence of an aneurysm is either a CT scan or an magnetic resonance angiogram (MRA).

Jack B.:
I have an AAA 3.6 cm x 2.9 cm aorta. Is that too large and if not when am I in trouble and have to have something done? Thank you for your answer.

Irving M. Herling, MD:
The risk of rupture is virtually nill when the aneurysm is 4.0 to 4.5cm in diameter. The risk of surgery at that point exceeds the risk of aneursym rupture. We can monitor the growth of an aneurysm accurately by ultrasound to determine when the measurements are exceeded. At that point, surgery is usually recommended.

Sharon:
At 32 I had heart failure due to a probable viral infection. With drug therapy my ejection fraction improved within a year from 15% to 45%. Now, at 43, I have had another episode of heart failure; when discovered EF was 30%. Due to accompanying ventricular fibrillation I had an ICD implanted in August. The device is working in the left ventricle 74% of the time. My doctors are pleased with the device's function, but I want to know: what are the possibilities that my heart function will improve, and, if not, what other treatment options might be available further down the line? Thank you for your time.

Irving M. Herling, MD:
We have a team at Penn specializing in heart failure that can evaluate your case and provide a second opinion and answer your questions in more detail. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Dave:
My mother-in-law is 75 years old. She had a St Jude's artificial aortic valve replacement in 1992. She has a 5 cm thoracic aneurysm. Her condition is stable. We have been told by her cardiologist that surgery is not an option. Any comments?

Irving M. Herling, MD:
I would seek a second opinion from our aortic program at Penn. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Clifford:
I'm an 82 yr old man in fairly good health and my cardiologist says I have a leaky aortic valve. I also have very high blood pressure, up to 173/55 at times. Should I consider surgery to replace the aortic valve?

Thomas Gleason, MD:
Depending on the degree of valve incompetence (leak), I would recommend evaluation by a cardiac surgeon to determine whether or not your valve should replaced.

Cindy:
Another question, is an ascending aortic aneurysm a hereditary condition? Are there any symptoms beforehand? My father had excruciating headaches for about one month before the disection. Could this have been a symptom? Any pain in the arms like a heart attack presents? Thank you so much for your answers. I've had so many unanswered questions and your show has helped me to understand.

Irving M. Herling, MD:
Most aneurysms that develop late in life are due to poorly controlled hypertension and atherosclerosis. Therefore, we are better able to prevent this complication from developing. There are some hereditary diseases such as the Marfan's Syndrome which predispose to early aneurysm development. If there is a family history of early aneursym disease screening tests can be done to determine whether you are at risk.

Anna B.:
Could falling forward and hitting your chest and abdomen on the ground bring on an aneurysm?

Thomas Gleason, MD:
Falling does not cause aneurysms, but it can cause an aortic disruption which could then predispose to dilation of the aorta and aneurysm.

Alf:
Terrific episode. Can minimally invasive surgery be used for repair of a PFO?

Irving M. Herling, MD:
PFO's can now be closed in our cath lab without the need for surgery. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Kevin:
I have a friend 50 yrs old diagnosed with ascending aneurismal arch disease. Some recommendations have been made for a valve sparing operation. Can you give any insight to this operation and is there any expertise with this procedure in your practice? Thanks

Thomas Gleason, MD:
I would recommend valve-sparing aortic root reconstruction whenever feasible. This happens to be my own area of particular interest and expertise. I would be happy to offer a second opinion.

Magie:
I have an abdominal aorta aneurism it was almost 5 centimeters that was last August. I just had another CT to see if it has grown. There is a history of heart disease. Two brothers passed at 56 years of age and my mother at 62. I was told that no one does anything until it gets to 7 centimeters. Funny how I have never heard much about it until recently, when I've been worried as to who to go to or what to do or just keep going til it ruptures. I really have a lot to do yet and I was wondering if its just as complex as what that man had or is it simpler surgery. I only decided to go to Penn State because I know of the reputation. Can you tell me if I should go with a stent and is it possible to have more than aneurysm?

Irving M. Herling, MD:
By most standards, aneurysms are repaired when they exceed 5.0 cm in size. I suggest you consult with a vascular surgeon at Penn for their opinion. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Michael P.:
My question is more related to vascular problems. Currently being treated for severe DVT's on both sides. Does Penn have a history of successful removal of the clotting either chemically or surgically? My current doctors believe the best treatment is to wait and see if it will go away simply by use of the blood thinning medication. I am seeking other advice.

Irving M. Herling, MD:
People with recurrent DVT may have an abnormality of their blood clotting mechanism which predisposes them to this problem. Perhaps consultation with a hematologist at Penn would be worthwhile. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Peggy:
A close friend of ours has benn diagnosed with aortic abdominal anuryism and she was told it has measure at 5.0 before they would operate. Why does it have to measure a certain size before they would operate?

Irving M. Herling, MD:
The risk of rupture is virtually nill when the aneurysm is 4.0 to 4.5cm in diameter. The risk of surgery at that point exceeds the risk of aneursym rupture. We can monitor the growth of an aneurysm accurately by ultrasound to determine when these measurements are exceeded. At that point, surgery is usually recommended.

David J.:
I have been diagnosed with an aortic aneurysm. My heart doctor tells me it is 4.5 and that if it is 6 that I will need an operation. He now is treating my high blood pressure with Diovan and Topril and Asprin with checkups every four to six months depending on how I feel. My question is compared to the patient's aortic aneurysm in the program which looked very large what was the number assigned to its size? I just want to say I am very comfortable with my doctor and confident with his assessment of my condition so far. Thank you for your response.

Thomas Gleason, MD:
Size is not the only criteria we use to determine when to intervene. Location, diameter, extent, and growth rate are all important factors. It is reasonable that your aneurysm may not require intervention at this time, but we would recommend consultation with a thoracic aortic surgeon. The aneurysms in the program were between 5.5 and 6.5 cm.

James J.:
Doctor, thank you for such an informative show and your time also. I am a 27 yr. old African-American male and former smoker whose father passed at 44 of sudden heart complications. My question is at what time should I begin looking seriously into my heart health?

Thomas Gleason, MD:
Heart disease certainly does run in families. I would recommend a history and physical exam yearly by a primary care physician who can perform an initial screening to determine your specific risk at this time. Once any concern of cardiac disease is raised, it would be reasonable to consult a cardiologist.

Germaine:
I've got a bicuspid aortic valve, and supposedly some slight aortic stenosis. Had polio before I was a year old, wound up with one leg slightly shorter than the other. I've been told I possibly have Marfan's, but that is open for debate. My cholesterol level is probably a bit high. I'm tall for my generation, with long arms and legs, which is what caused one physician to suspect Marfan's. Due to a complete bundle branch block, and occasional failure of the heart to beat at all, I depend on a pacemaker. What other sort of things am I likely to face over time, and are there any hereditary markers that can be looked for, or tests that should be done? I'm currently 66 years old.

Irving M. Herling, MD:
You already are being seen by a cardiologist. I would direct your questions to him/her. If you would like another opinion, feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Jane:
I am a 35 year old female with a murmur (ventricular septa defect) diagnosed at age 11. I was wondering if there is any procedure available to close the defect. I was told that if I were became pregnant it could lead to congestive heart failure. I am also overweight and wondering if the added weight is putting more stress on my heart. I would appreciate any feedback that you can provide. Thank you.

Irving M. Herling, MD:
You should see a cardiologist to determine whether your concerns are valid. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Bob M.:
Yes very unfortunate--guess I'm lucky to be alive--any new studies on repairing paraparesis due to aneuryism surgery?

Thomas Gleason, MD:
Unfortunately, there is little that can be done at this point. There is currently much research that is ongoing in this area, and there may be some treatment options in the future.

Kathy:
I have a heart murmur that is a regurge of blood to the aorta. I am 60 years old. How serious can it become?

Irving M. Herling, MD:
You should see a cardiologist to determine whether your concerns are valid. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Jose B.:
I have a high blood pressure problem, but is under control with medication. Also an abnormal platelet count. Could I be a candidate for an aneurysm?

Irving M. Herling, MD:
By treating your blood pressure, aneurysms can be avoided. Your platelet count does not predispose you to aneurysms.

Tanya:
My father is going in soon for a stent graph repair on his thoracic aortic anuerysm (at Penn w/Dr. Bavaria). After the surgery will he need to be on any medications associated with it, other than blood pressure medication (which is currenty on)?

Thomas Gleason, MD:
After surgery the primary care revolves around blood pressure control and surgical wound care. There is no special medicine required for a stent graft itself. It's not unusual to have a change in his medication for a short while.

Stephanie:
How often do arrhythmias occur after cardiac valve replacement surgery? How often do these arrhythmias resolve on their own? How often is cardioversion required after valve replacement?

Thomas Gleason, MD:
Cardiac arrhythmias occur at a rate of 20-40 percent following cardiac surgery. Most arrhythmias are benign in nature and can be controlled and converted with appropriate medications. Decisions about electrical cardioversion are made on a case by case basis, and I would recommend with consultation with a cardiologist or cardiac surgeon regarding the specifics of your case.

Robert G.:
The question is: should I be taking a daily "baby aspirin?"

I'm 52 year old male and in good cardiac health and have low cholesterol (159) on 10mg lipitor. I exercise a lot. I'm overweight somewhat (size 40 waist). My blood pressure lately has been 140/90.

Everyone says it's good for the heart to take a daily baby aspirin. However, we know that aspirin promotes bleeding. My father died at age 72 of a hemorralgic stroke while engaging in sexual activity. He had angioplasty at age 61 but was otherwise healthy, non- diabetic, and thin.

My mother is age 80 in excellent health and plays tennis 3 times a week. Given that my dad died of a "bleeding" stroke, should I take daily aspirin or not?

Thank you so much.

Irving M. Herling, MD:
I would suggest that you discuss your concerns with your physician. Feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Lauri M.:
I am 68 with HBP, high cholesterol, and diabetes. On medication for all. Have constant discomfort in chest area and shoulder blades. Have had heart catherization, yearly stress test. Exercise program in effect and no weight problem. Constant discomfort is source of high anxiety. What should I do?

Irving M. Herling, MD:
If your interpretation of these results is accurate, you are at low risk of a cardiac problem. Perhaps your symptoms are due to your back. In addition, perhaps treatment of your anxiety may be of benefit.

Steve:
Just finished watching the show, last Monday night I spent 5 hours in the emergency room for chest pains. EKG, chest x-ray and blood work showed nothing. Tuesday visited my heart doctor, Wednesday stress test, fluid was injected, a machine monitored my heart before and after the stress test, guess everything is ok, my doctor is now on vacation and will follow up when he returns. I'm 50 yrs old, male, 6'1", 203 lbs and a smokers for 30 yrs. Have always been very active, in good shape but lately short of breath and still having pressure in my chest. What is my next step in this process? Need to make sure I am going to be OK.

Irving M. Herling, MD:
If you want a second opinion, feel free to contact us at PennHealth at 1-800-789-PENN (7366) or use the online appointment request form for an appointment.

Nancy F.:
My husband is due to have his AA taking care of next month, by your team.Great timing with your show! In your program the whole procedure took 5 hours, but what if you only need the arota repaired and your valve is ok. How long will the procedure be then?

Thomas Gleason, MD:
The length of the procedure would depend entirely on the extent of the aneurysm and could be shorter or longer. I would recommend discussing your questions with your husband's physician when he comes in for his operation.

Dennis P.:
49 yr old asymptomatic male with family history of CVD, elevated total cholesterol (orig 425) managed with aggressive combination therapy (lipitor, niaspan, zetia - now 150), high calcium score (725), should I entertain a diagnostic cath, or just wait for first event/symptoms???

Irving M. Herling, MD:
Exercise stress testing is a safe and useful way to monitor for the development of important coronary artery obstruction. We usually use this technique to determine when a patient requires catheterization.

Pattie:
I want to thank you doctors, you've put my mind at ease. I'm glad you held this Q and A. I very much appreciate and I will be visiting Penn soon, I'm not that far away. Thanks again.

Gregg:
I'm a 45 yr old male with an aortic aneurysm 6.0 cm. I am going to have surgery at Penn. My question is I have 2 boys 13 & 17. The 17 year old is an iddm with hyperlipidema and elevated liver enzymes. At what age should he be checked?

Thomas Gleason, MD:
Many aneurysms, particularly in younger patients, do have a genetic or hereditary basis. In order to answer your question, I would need to know more details about your situation. I would recommend discussing your concerns with your surgeon.

Nancy:
The episode mentioned that Mr. Wray's aorta was twice the normal size at surgery-- what does that mean? What is considered "normal"? Is it different for men and women?

Thomas Gleason, MD:
The diameter of a normal aorta is dependent on age and location. For a 50-year old adult male, the normal ascending aorta measures 2.5-3.8cm, typically.

Jackie:
Could you elaborate on the different valve choices Doug Wray had to choose from? The show said he picked one because he wouldn't need to take medicine for the rest of his life. What kind of medicine is it and is one valve better than the other? How long do they last? Do you need to have another surgery?

Irving M. Herling, MD:
We use tissue valves--such as was used in Mr. Wray's case--to avoid the need for anticoagulation. These valves tend to last for about 20 years in people Mr. Wray's age. If we used a plastic and metal valve, he would need to take anticoagulants but his valve would last him the rest of this life. This was his choice to make.

Cindy:
How long can a person have the enlarged aorta before dissection occurs? Is this days/weeks/months? In specific the ascending aortic aneurysm.

Thomas Gleason, MD:
This is not always predictable, however based on large populations of patients, we know the annual rate of dissection, rupture, or death based on aneurysmal size. I would recommend consultation with a thoracic aortic surgeon for risk assessment for a specific case.

Irene:
Sorry I missed the program. Will it be re-broadcast or can I obtain a copy?

Moderator:
Thank you for question. This episode will rebroadcast Sunday 2/15 at 5:30am on WPVI6 or you can order a free copy of the show.

Lori:
I am in my early 50s and healthy too. The story kind of spooked me. What kinds of test do you need to have to see if you have an aorta aneurysm or the defective aorta valve? Do I need to have a CAT scan or MRI or can my primary doctor do an EKG in his office?

Irving M. Herling, MD:
Usually a defective valve can be diagnosed with a stethoscope and thereafter an echocardiogram. Mr. Wray's problem was detected this way.

Linda:
I am a 44 year old. My father died at 58 from an aortic aneurysm. I do not know any details due to his estrangement from the family prior to his death. Is there a hereditary component? Is there screening that I should look into? Thank you for taking these questions.

Irving M. Herling, MD:
It depends what kind of aneurysm he had. Abdominal aneurysms occur in patients with high blood pressure and atherosclerosis as well as a history of smoking. If you do not have these problems you are not at similar risk.

Greg G.:
Another question if I may. Is there a difference between an aneurysm and a dilation or is it the same thing? And is it possible for an ascending aortic measurement of 4.0 to stay at the same size for many years? Thank you so much for your time and help.

Thomas Gleason, MD:
No, dilation refers to any size which is larger than normal. The term aneurysm is used only when the dilation has reached a specific size depending on the location. Typically this will be close to twice the normal diameter.

Peter:
The episode mentions that heart disease is a risk factor for aortic aneurysm. Are there other risk factors? The first post mentions Marfan's syndrome. What is that and can that be treated by either of the procedures discussed in this episode?

Irving M. Herling, MD:
Marfan's syndrome is a connective tissue disorder. Many areas of the body are affected by this problem. Other areas include the eyes and joints among others. The most serious of these problems involves the aorta. The entire aorta is subject to Marfan's syndrome. Different surgical treatments are used depending upon where the aorta becomes seriously diseased. Until some area of the aorta actually becomes dilated or aneurysmal no surgical treatment would be necessary. Close following by your cardiologist or surgeon is very important to identify a potential serious problem.

Moderator:
Thank you for participating in our live question and answer session with Drs. Gleason and Herling. Dr. Pochettino was called into an emergency case and was unable to join us this evening. If you have further questions about complex aortic surgery, logon to pennmedicine.org. You can also order a free copy of this show or call 1-800-789-PENN (7366).

Look for the next episode of Penn Vital Signs on Saturday, March 20 as we follow two patients as they struggle to overcome epilepsy.