Do I Need An Operation?
Do I need an operation? And Other Common Questions From Patients
- Why Do I Need to see an Aortic Surgeon?
- Do I Need Surgery?
- I feel fine why do I need an Operation?
- I can't sleep at night. I feel there is a time bomb in my chest.
- What do I do in the meantime?
Q: Why Do I Need to see an Aortic Surgeon?
A: Your doctor has referred you to see a surgeon because of an abnormality on either a chest X-Ray, a CT Scan, and MRI, or an Echocardiogram. The presence of an aneurysm does not absolutely mean that an operation is necessary. It is important, though, to meet with an aortic specialist. This evaluation will outline a plan for the future. Possibilities may include careful follow up with CT scans to assess the stability of the aneurysm's size, lifestyle modification to decrease stress and control blood pressure, and surgery.
Q: Do I Need Surgery?
A: There are cases where surgery is necessary, but this is determined on an individual basis. The size of the aneurysm is an important factor, but other variables also contribute to the surgeon's decision-making process. In the first portion of the aorta (the root), for example, an aneurysm that is over 5 cm begins the conversation about an operation. We then consider the function of the aortic valve. If the valve is diseased, meaning it leaks or is stuck (stenotic) we then may advise an earlier surgery. If the valve is a bicuspid valve (meaning it has two leaflets, rather than three), we would advocate for an earlier operation. If a patient has evidence of a connective tissue disease, such as Marfan syndrome or a family history of an aortic problem (aneurysm or dissection), we recommend earlier surgery. On the other hand, if a patient has been followed with CT scans for some time, and the aorta is stable, we may continue to recommend follow-up instead of surgical intervention. In a large individual, a 5cm aneurysm may not be as concerning as it is in a smaller individual. In such cases we may not recommend any further treatment at all. We prefer to have an in-depth conversation, where we can look at all of the studies with the patient, and formulate an individual plan that will provide assurance and safety.
Q: I feel fine why do I need an Operation?
A: Aneurysms are often discovered incidentally during a medical test performed for an unrelated reason. Patients may have a cough or a chest cold, and an x-ray is performed that reveals an aneurysm. Or your doctor may hear a murmur, which prompts an echocardiogram, which reveals an aneurysm. If you are in this position, you now may be thinking, "I wish I never had that x-ray, because now that this aneurysm was discovered."
Let me assure you that you are, in truth, very lucky. This cannot be overstated. Aneurysms rarely cause any symptoms. It is far better for you to find your aneurysm than for it to find you. The operation to fix an aneurysm is much less complicated than the operation to fix an aortic dissection. Moreover, you have a choice now, and you can take proactive steps to prevent life-threatening complications from occurring. You can seek several opinions and find a surgeon and a hospital where you are comfortable. Once a complication of an aneurysm occurs, however, your life is in jeopardy. In the event that you survive the initial tear, you will be taken to the nearest hospital and an emergency operation will be performed. Your surgeon may not specialize in the disease and may not be familiar with some of the advances in the field of aortic surgery.
Because your aneurysm has been detected before it became a life-threatening emergency, your situation now is far better. You can meet with a surgeon, discuss the options, meet with your family, arrange time away from work, and then schedule a procedure at a time that makes sense. Elective surgery is far more safe and convenient than emergency procedures.
Q: I can't sleep at night. I feel there is a time bomb in my chest.
A: It is common to feel anxious after receiving the diagnosis of an aortic aneurysm. Let me assure you that it did not occur overnight. You have been living with an aneurysm for some time now. The rate of growth is very slow, and not all aneurysms progress to dissection. Of course, we understand this is a stressful time. The most important advice is not to rush into surgery. Seek a few opinions. Find a hospital and a surgeon with whom you are comfortable and then get psychologically on board with the procedure. There is not reason to expect less than a perfect recovery and a normal quality and length of life after the procedure.
Q: What do I do in the meantime?
A: Live a more serene life!!! Avoid stress as much is possible. The prospect of having an operation in your future is stressful enough. There is no need to make it worse.
When an aneurysm is over 5 cm, I recommend aggressive control of blood pressure. Avoid doing anything to raise your blood pressure above 120/80. That means not over-scheduling. It means not rushing to make the train or flight. It means not having multiple play-dates with tight connections for pick-up and drop-off. It means not arriving 5 minutes before the doors close to the movie or play.
In addition, you need to avoid the exercises that make you tense your abdomen. No heavy weightlifting, no aggressive sex, no straining to empty your bladder or bowels. If you have prostate problems or constipation, aggressive medications to alleviate those symptoms are required. Avoid nasal sprays or large amounts of red wine, as both will raise your blood pressure.
If your doctor has recommended surgery, then I would advise against taking a cruise or travel outside of regions where good medical care is easily accessible. There will be plenty of time for travel after the procedure. The most important advice is to relax! The stressful part is over. You know the situation and are well on your way to definitively dealing with the problem.