Aortic Aneurysm: Travel and Treatment Options in Taiwan

The width of the ascending aorta is approximately 5 cm?

Hello, doctor.
My mother-in-law is a 62-year-old Chinese national who recently experienced chest discomfort and was diagnosed in China with an ascending aortic width of approximately 5 cm.
We are considering coming to Taiwan for diagnosis and stent surgery.
There are two points to consider: 1.
Currently, her daily life is manageable, with occasional discomfort, but we are unsure if her condition is suitable for flying to Taiwan for consultation.
2.
What would be the estimated cost for self-paying diagnosis and related surgeries at your hospital, to assess whether it is financially feasible? My family is overwhelmed and unsure how to proceed.
The hospital in China suggested open-heart surgery, but we would like to know from a medical perspective if it is advisable to come to Taiwan for evaluation, or if stenting could be an option to avoid major surgery.
Thank you, doctor.

The diagnostic findings from China are as follows:
Ultrasound findings: Measurements (in mm) - Aortic valve annulus: 24, Aortic sinus: 36, Left atrial anteroposterior diameter: 26, Ascending aorta: 50, Pulmonary artery: 20, Right ventricular anteroposterior diameter: 18, Right ventricular outflow tract: 18, Right atrium: 34 x 44, Left ventricular end-diastolic diameter: 43, Left ventricular end-systolic diameter: 27, Interventricular septum: 10, Left ventricular posterior wall: 9.

2D and M-mode characteristics: The dimensions of the heart chambers are normal.
There is no left ventricular wall thickening, and left ventricular motion is coordinated with normal amplitude.
The interventricular and interatrial septa show good continuity.
There is an aneurysmal dilation of the ascending aorta, with widening of the aortic sinus, and the relationship between the pulmonary artery diameter and the aorta is normal.
No significant thickening of the valves is observed, and their opening and closing function is good.
M-mode of the mitral valve shows a double-peaked pattern, with equal E-E interval spacing.
No abnormal echoes are seen in the pericardial cavity.

Color and Doppler characteristics: During systole, a small amount of blue color flow is seen at the mitral and tricuspid valve orifices, with a negative filling broad-spectrum turbulent signal; during diastole, a small red flow jet is observed at the aortic and pulmonary valve orifices, with a positive filling broad-spectrum turbulent signal.

Mitral valve flow velocity (cm/s): E peak: 71, A peak: 41, E/A ratio: 1.75.
Valve flow velocities (cm/s): Tricuspid valve: 34, Aortic valve: 211, Pulmonary valve: 100.

Left heart function measurements: EF 66% (>50%), FS 36% (>25%), SV 53 ml (30-90 ml).
Tissue Doppler imaging of the mitral valve annulus (cm/s): Interventricular septum lateral e: 8.6, lateral wall e: 10.8, E/e ratio = 7.

Yang Xiansheng, 40~49 year old female. Ask Date: 2024/04/12

Dr. Wu Xueming reply Cardiology

For details and costs related to aortic aneurysm stent placement surgery, it is recommended to consult with a cardiovascular surgeon.

Reply Date: 2024/04/12

More Info

When considering the case of your mother-in-law, who has been diagnosed with an aortic aneurysm measuring approximately 5 cm, there are several important factors to address regarding her travel to Taiwan for diagnosis and potential treatment.

1. Suitability for Air Travel
The primary concern regarding air travel for someone with an aortic aneurysm is the risk of complications during the flight. While your mother-in-law is currently stable and only experiences occasional discomfort, it is crucial to evaluate her overall cardiovascular health. The pressure changes in an airplane cabin, particularly during takeoff and landing, can potentially affect individuals with cardiovascular conditions. However, if she is asymptomatic and has no significant risk factors for acute complications, she may be able to travel.
It is advisable to consult with her healthcare provider in China before making travel arrangements. They can assess her current health status, review her echocardiogram results, and determine if she is fit to fly. If she experiences any severe symptoms such as chest pain, shortness of breath, or significant changes in her condition, it may be best to postpone travel until she is evaluated further.

2. Treatment Options and Costs in Taiwan
Regarding treatment options, the management of an aortic aneurysm often depends on its size, growth rate, and the presence of symptoms. For an aneurysm measuring 5 cm, surgical intervention is typically recommended, especially if there are concerns about its stability or if it is symptomatic. The two primary surgical options are open surgical repair and endovascular aneurysm repair (EVAR), which is less invasive and involves placing a stent graft within the aorta.

In Taiwan, many medical centers offer advanced cardiovascular care, including the treatment of aortic aneurysms. It would be beneficial to contact hospitals that specialize in cardiovascular surgery or vascular surgery. Some of the well-known hospitals in Taiwan include National Taiwan University Hospital, Taipei Veterans General Hospital, and Chang Gung Memorial Hospital. They can provide detailed information about their capabilities, the experience of their surgical teams, and the specific procedures they offer.

As for the costs associated with diagnosis and treatment, these can vary significantly based on the hospital, the complexity of the case, and whether the procedure is performed as an inpatient or outpatient. Generally, the costs for diagnostic imaging (like echocardiograms and CT scans) and surgical procedures can range from several thousand to tens of thousands of US dollars. It is advisable to inquire directly with the hospitals for a detailed breakdown of the expected costs, including pre-operative assessments, the procedure itself, and post-operative care.

Conclusion
In summary, while your mother-in-law may be able to travel to Taiwan for evaluation and treatment, it is essential to ensure she is medically cleared for air travel. Consulting with her healthcare provider in China is crucial for assessing her fitness to fly. Additionally, reaching out to reputable hospitals in Taiwan will provide clarity on treatment options and associated costs. Given the complexity of her condition, a thorough discussion with a cardiovascular specialist will help in making an informed decision regarding her care.

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