More on My Aneurism

The written report of my cardiologist, Dr. Michael Kelemen, says that I have an "aneurysmal dilatation of the aortic root," beside the printing of which is handwritten, "sinus of Valsalva aneurysm." This is from an echocardiogram done very recently, on 9/26/05.

I have a radiologist's report from a 2/22/05 CT scan of my chest, made due to a "fullness in the mediastinum [shown up] by plain chest radiograph [X-ray]." This was an "evaluation for mediastinal mass" — i.e., they were looking for a tumor or cyst in the space between the lungs, which thankfully did not show up. The CT scan findings included, "Mediastinal window shows normal enhancement of the aorta. Pulmonary artery. No aneurysm. There is no filling defect in the enhancing vascular system."

If both these findings are correct, it looks as if I may have developed a sinus of Valsalva aneurysm in the aortic root between February and September of this year.

I will be taking the CT scan films/report (and also the echocardiogram tape/report, along witha 2003 chest X-ray) to my appointment with cardiac surgeon Dr. Laschinger this coming Monday. If he confirms that I had no aneurysm before February and I do have one now, it seems likely that my taking up running as aerobic exercise during the intervening period might have had a lot to do with it.


A sinus of Valsalva aneurysm (see this Wikipedia article) is fairly rare and is typically congenital, i.e., present at birth. The congenital version of the aneurysm is discussed in this e-Medicine article.

If my aneurysm wasn't there in February, then it was acquired, not congenital. "Acquired aneurysmal dilatation of the sinuses of Valsalva may occur because of Marfan Syndrome, syphilitic aortitis, or as a function of aging," the e-Medicine article says. I apparently don't have Marfan Syndrome or syphilitic aortitis, so if my aneurysm is an acquired one, it's presumably related to aging.

I assume that, whether congenital or acquired, a sinus of Valsalva aneurysm will tend to have certain common characteristics. The e-Medicine article says, "Aneurysm of a sinus of Valsalva is a rare ... cardiac defect that can rupture, causing heart failure or other catastrophic cardiac events. If the aneurysm remains unruptured, it occasionally causes obstruction of cardiac flow resulting from compression of normal structures. Dissection of the aneurysm into the cardiac tissues may occur, causing obstruction or destruction of local structures."

"Dissection" seems to be what happens when the various layers of the aortic wall and/or associated tissue separate catastrophically from one another, once an aneurysm has formed. Dissection is not the same as "rupture," but apparently is equally fatal.

I am not at all sure, but the propensity for aneurysm and dissection may be related to what the Wikipedia article says is a possible cause of a sinus of Valsalva aneurysm: cystial media necrosis: "a focal degeneration of the elastic tissue and the muscle in the tunica media (the middle layer of the artery), with the presence of mucoid material in the media. It is more frequent after 40 years of age and is twice as common in males as in females. In the aorta, this condition may lead to weakening of the artery, resulting in the formation of a fusiform [i.e., spindle-shaped] aneurysm."

My primary care physician, Dr. Moore, says he thinks the aneurysm to be related to problems in "connective tissue." The "elastic tissue and the muscle in the ... middle layer of the artery" would seem to qualify as connective tissue.

The part about "obstruction of cardiac flow resulting from compression of normal structures" might go along with another finding from the echocardiogram: "moderate aortic insufficiency." I interpret that as meaning that not enough blood actually gets passed through the aorta on each heartbeat.

Perhaps Dr. Kelemen's third echocardiogram conclusion, "mild left ventricular dilatation with normal left ventricular systolic function," is also related: my left ventricle, which connects to the aorta, is larger than normal when the heart muscle is relaxed, implying perhaps an attempt by the heart to fill with more blood in compensation for my "moderate aortic insufficiency."


So there would seem to be three possibilities. One, the diagnosis of an aortic root aneurysm of the sinus of Valsalva, based on an echocardiogram reading, is just wrong. I think that possibility unlikely.

Two, I have a congential aneurysm that was missed on the CT scan. I think that to be a real possibility ... one which can most likely be checked, and checked conclusively. As I say, Dr. Laschinger will review the CT scan films.

Three, I have an aneurysm I just acquired this year, at age 57/58. Since I took up aerobic running just this year, the possible connection seems obvious.

It is this connection which may interest middle-aged folks who start doing aerobic exercise for the first time. The lesson here is that it might be a good idea to have a cardiologist's staff give you an echocardiogram before starting the exercise and then another one after undergoing the exercise regime for a month or two.


An echocardiogram is a diagnostic method that is non-invasive and basically not at all uncomfortable. You don't have to fast. You don't have to swallow anything. You don't have to have dye, or anything else, introduced into your body. You don't have to lie claustrophobially in a noisy tunnel. You don't have to hold your breath. You don't have to mash your chest into a machine, as with a mammogram.

You simply remove your shirt or blouse and lie on your side on an examining table. The technician attaches a few stick-on electrodes to the skin around the area of your heart. Then she puts a gob of jelly on a wand that she slides along the front of your chest, while looking at a monitor to view the image it is producing of your heart's actions.

The images that are picked up are being recorded on a magnetic tape cassette which can be played back, copied, and reviewed by the cardiologist or cardiac surgeon.

The whole thing takes about 20 minutes. The wand and jelly may feel a bit cold at first. But the only moments of minor discomfort come if the technician asks you to lean your shoulder away from her temporarily, a position that feels a bit unnatural. After she is done manipulating the wand to generate the images, you simply sit up, peel off and discard the stick-on electrodes, wipe your chest off with a paper towel, get dressed, and leave.

An echocardiogram can show up abnormalities that don't reveal themselves on a "heart scan," which I also had one of recently. It's basically a CT scan, I believe ... and it's also a good idea to get one, since it can show whether you have too much calcium clogging up the arteries of your heart. In my case, my health insurance didn't pick up the cost of the heart scan; be advised.

Nor does an aortic root aneurysm necessarily show up in any way on a cardiac stress test — another diagnostic I "heartily" recommend. Stress tests and echocardiograms are, in my experience, things your health insurer will pick up much of the cost of.