Thoracic aortic aneurysm

[shhya1]

During a routine chest x-ray and confirmed through a echo-cardio gram, I have been told I have a thoracic aortic aneurysm. My doctor has indicated that it's no big deal at this time and we will watch my blood pressure and have a cat scan every 6 mths. I asked him about my diving and he said he would consult the thoracic surgeon who looked at my echo. I've not been told to limit my excersizing. How do I find out more about any diving considerations?

 

[DocVikingo]

Hi shhya1,

Of course rupture is the primary concern with a thoracic aortic aneurysm. The likelihood of this occurring is largely dependent upon its size, and to a much lesser degree on its exact location. You might wish to obtain this information and then submit your question to DAN at https://www.diversalertnetwork.org/myaccount/mscc/emailmedic.asp. Alternatively, your physician could make the inquiry.

If the aneurysm is small, not fragile in appearance, blood pressure is not an issue and no limitations have been placed on physical activity, this would appear to bode well for continuing SCUBA.

Please let the board know what you learn.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Aeolus]

Hi shhya1,

I had an aneurysm in the ascending aorta over six years ago. It was "swollen" to 4 cm and required surgery to repair it. They replaced the entire ascending aorta and the aortic valve, which also was defective. I was back diving in a few months and have made numerous dives since. Hopefully, yours will not require surgery; but I wanted to let you know that even if it did, you can still dive afterwards. Take care and best wishes in your treatment whatever it is.

Joe (Aeolus)

 

[Manta Man]

Hi all
I have just been diagnosed with aortic aneurysm in the ascending aorta. Not only this but my aorta happens to be bicuspide too. Currently, the size at its max width is 52mm. My doctor has recommended me not to dive, although he also states he really does know much about how descending pressure is likely to effect the aorta. My blood pressure is normal & I have also had a strength test done - normally too. I am looking for some advice on diving with this condition and also when I have my operation done, will I be able to dive post.

 

[cutlass]

To be safe, your doctor's advice should be followed. I don't believe that submerged pressures are as significant an issue as is the athletic exertion of diving. Aneurysms of the ascending aorta (DeBakey type II/Stanford Type A) are more problematic than the descending variety because of flow dynamics and the nearby presence of critical structures. Medical (i.e. non-surgical) management commonly tries to limit blood pressure and heart pump force; medications wouldn't be unusual. In terms of surgery, an open procedure is usual for the ascending aorta or its arch; endoscopic options may be available for the descending. As for return to activity, medications (e.g. blood thinners, blood pressure), the nature of the surgery, the involvement of the aortic valve, and more must be considered. But generally, return to normal and light activity is common. Restrictions on heavy lifting or high-intensity aerobic activity are usual; anything that greatly elevates blood pressure or pump contractility. Scuba diving may fall into this category.

Aneurysm size and growth rate give the basic decision points of surgical intervention. A size of 5.2cm is well within the caution range. Surgical intervention is commonly urged at about 5.5cm, strongly urged at 6cm or at smaller sizes with high growth rates (e.g. greater than 0.1-0.5cm/yr, ); heightened urgency would also accompany comorbid health conditions such as a family history of such problems, Marfan's Syndrome, chronic obstructive pulmonary disease (COPD).

 

[Manta Man]

Hi Cutlass, Thx for the all that info and yes just as you stated above I've been put on medication to reduce the blood pressure. Interesting to find out that physical exertion is more of an issue than pressure. With my month's 'diving holiday' ahead - August - now it looks like I will just be limited to watching my wife dive while I do a little bit of snorkeling now & then - or do you think snorkeling is even pushing it? Since putting up the post, I've seen a Heart surgeon and he, as you, has stated that I will need surgery soon, like between now & then end of the year. He claims that because my aortic valve is bicuspid, over the years the outer aortic wall has been put under increased pressure and therefore there seems to be a higher possibility of rupture after 5cm, however, with a normal tricuspid valve this happens at 6cm. He also said that my return to diving will depend on how damaged or not the aortic valve is and whether I can continue for a least another 20 years with my own bicuspid valve or if it need to be replaced now. If the latter, which involves medication for the rest of my life, then returning to diving would be impossible. So, lets just hope that when I finally get "fixed" I won't need a replacement valve. The trouble is I won't know that until they open me up. I also got in touch with DAN & they said that diving wouldn't be a problem after the aneurysm was cut away. They claimed that the material used to "patch the aorta" together is actually stronger & more resistant than our own.

So, it seems that whoever I ask, that seems knowledgeable of the matter, agrees, & more or less has the same opinion. Anyway, thanks very very much for your valuable advice and anything else you can think of or if you know of any articles related to diving & this problem I would be really grateful for any advice/help. Let us know what you think of the snorkelling, going to Thailand in August.

Thx

 

[TSandM]

Manta Man, the medication you would have to be on if they replace your valve is Coumadin, and, once your levels are well regulated, it is quite possible to dive while taking it. You have to recognize that, as with ANY activity on that medication, any injury is likely to bleed much more than it would in an unmedicated person, so you have to be more careful and avoid situations likely to produce injury.

 

[Manta Man]

Hi TSandM, thanks for that. My spirits have been pretty low, as you can imagin with all this new news. But now thanks to the forum I am beginning to see light at the end of the tunnel & my spirits are now not so low. Thx very much all, you can't imagine how much I appreciate this. It looks like the operation isn´t gonna happen til Nov/Dec time- Surgeons say I need the surgery asap but not urgently. Thx for the links I'll check em out when I get back from Thailand - going to look at some businesses out there and if the operation is a success & the business plan goes ahead, you guys are my guests to come out & dive. Thx big time. Keep in touch. MM

 

[Cruisin Home]

As a medical imaging pioneer I have been on the forefront of this aneurysm question whether in brain or body for quite some time. Fact is that we have much better technology now to find these things (multi-slice CT) therefore presenting more people with the dilemna you are both in. Fact is we dont yet have real good data on the long term likelihood of rupture. there are many clinical trials going on now to try and answer these questions. But these would just provide statistisical probabilities. But in the end even if the probabilities are in your favor something bad can happen. Bottom line you cant let it rule your life. Do what they recommend, primarily controlling your BP. And get it fixed ASAP. But dont stop living your life.

I am not telling you what to do, just trying to enlighten you as to what the medical world knows, but more importantly doesn't know, about aneurysms.

Godspeed

 

[Manta Man]

Hi Aeolus,
As you can read from my posts I am pretty much in the boat as you were some years ago. Could you let us know a little more about your case, like what did they replace your valve with & the kind on medication your are on & how this has affected your diving. Would be really great to hear a little more about your story.

Cheers