My son is desperate to be able to play sports without any restrictions. A bicuspid aortic valve (BAV) is the most common congenital heart defect, occurring in approximately 1%-2% of the general population. thanks for sharing all this interesting info. Yesterday, for example, I spoke with a 71-year old patient who just had aortic valve replacement surgery due to this . Athletes in this circumstance should collect opinions from their doctor(s) and make very careful considerations before returning to exercise. Very often, the specialists office will make note of the patients problem and make appropriate decisions about whether routine or urgent appointment scheduling is needed. Thanks, New guidelines from 2015 are in accord with your doctors recommendations about vigorous exercise as well as periodic imaging to measure the aorta. In 1997, Dr. Starnes led a team of three surgeons who replaced the aortic valve in then-actor Arnold Schwarzeneggers heart. I have also had a stress test, which showed no issues at all. And what would moderate weight lifting be defined as? Down side: durabilitythe borrowed valve doesnt last forever; it will deteriorate and need re-replacement at some point. This can be a life-threatening problem and is more apt to occur with progressive enlargement of the aorta and with uncontrolled high blood pressure. This has caused me a great deal of anxiety because I feel like I am being told to act like an old man before my time. All severe aortic stenosis patients who are experiencing symptoms should ask for a TAVR evaluation. That would include weightlifting. She advised us we should start to consider surgery but would follow up with us again in 3 months. I am considered elite in my age division. Aortic valve repair is sometimes possible. I am 31 years old and had my BAV repaired at The Cleveland Clinic in 1999 when I was 15. My resting HR is 60-70 BP 110-70, according to doctors have no tissue problems, never had hypertension and was told that I was born with weak threskupid valve. looking forward for healthy life without surgery any possibilities??? Thank you for your ideas and I apologize for my gramma errors (English is not my first language). Obviously, I underwent emergency surgery to replace the aortic valve (Medtronic open pivot mechanical valve) and have the aneurysm repaired with a dacron graft. There are 2 broad categories of heart valve substitutes that can be used to replace the human aortic valve: mechanical valves or bioprosthetic (tissue) valves. In fact, like most people, the 25-year-old had never heard the term before. I am wondering if you know anything about these drugs and how they can impact aortic growth? Last few weeks Im getting chest pain on left side (very rarely on right side) while running and doing push ups. Also twice a week I try to do 40-minute workouts like planks, pushups and so on (with my bodyweight). coarctation of aorta. I was shocked. Any advice would be greatly appreciated. For the last 7-8 years I didnt do too much sport (kids, family). Your doctors will be in the best position to offer advice because they will be most familiar with your case. Frankly Im worrying quite a bit about thisand I feel like its causing additional chest pain and shoulder pain. This is an area where second opinions may be helpful in sorting out whats safe. Perhaps other readers will comment. For most athletes with only mild enlargement of the aorta and no problems with the aortic valve, there should be no activity restrictions. However, I absolutely love being competitive at running, and dont want to jeopardize that either. The Ross procedure borrows your sons pulmonary valve and uses it to replace his aortic valve and aorta. Thank you for the follow-up! Bicuspid Aortic Valve Although bicuspid aortic valves can occur . Best to continue to work towards identifying cause(s) and getting any needed treatment. As chemist mostly works in a lab not in the field. O'Donnell suffered a heart attack in 2012, and wrote about her experience on her blog. After an MRI, Ive been diagnosed with BAV and mild aortic coarctation. Most people require treatment once symptoms develop. I had a Medtronic Freestyle valve fitted in May 2002, did exactly as directed regarding exercise etc. The truth is that there is not much scientific information about what happens to such athletes if they do return to endurance sports. The pertinent questions for your cardiologist is whether there is any stenosis (narrowing) or regurgitation (leakage) of the aortic valve and whether the size (diameter) of the nearby aorta is normal. The other theory is that there is a structural problem that leaves the aortic wall weak. A bicuspid aortic valve only has two of these leaflets. I continued playing hockey routinely until I was in my late twenties. While the defective valve may be easy to see, the defect also causes changes in the tissues of the aorta and the heart. Aortic Stenosis Consensus guidelines suggest that (athlete) patients with BAV and moderate enlargement of the ascending aorta should curtail their strenuous static (eg, weight-lifting) and endurance sporting activities because of the risk of aortic rupture or dissection. Last week I visited a doctor and here are the changes for the last year (before|after): I was only diagnosed with BAV after a routine examination and only because my company has increased in size above a threshold at which all employees are supposed to be subjected to this examination (weird law in Belgium). I had my BAV replaced in Feb. 2005 (porcine tissue) with a Dacron repair of the ascending aorta. Baldwin Publishing, Inc. strongly suggests that you use this information in consultation with your doctor or other health professional. Hi Larry Ive a BAV with the fusion being between my right coronary and non-coronary leaflets. In Jan 2016 My son was seen by the cardiologist and had some changes on his echo and the cardiologist said hey had mild progression of the aortic regurgitation( moderate to severe) with preserved LV function. Dwayne E. Russell Im in Philly today but Im from Central NY. He left it pretty vague. I am wondering because I know that weighlifting with bav isnt so good I feel terrible because i lov weightlifting and I have build a body that is so difficult for a 18 years old. Pop Medicine > Celebrity Diagnosis . Now, five months after surgery Im gradually returning to sport with 5km runs and kettlebell routine, push ups and pull ups (still feeling pressure in breast bone) no heavy lifting. I had a cardio version to correct the AFIB. I have recently had CT scan and MRI scan, following some chest pain experienced on track while doing marathon training. "Until then, stay close.. I dont know why this formed as I have had the problem valve replaced many years ago. Please refer to this article if not: I wouldnt put you in the position of giving me your opinion in a public in forum but just let me know if based on the following, you think Im crazy or not. Thanks in advance. I am concerned about removing the coronary arteries and re attaching them again etc. I am 6ft 3 . Together, you should be able to settle on what sports activities will be safe based on those facts. There is a readable section related to BAV. I realize that appointment availability for medical specialistsin your case, the pediatric cardiologistcan be tight. I certainly know of athletes who return to all forms of endurance sport as well as weight-lifting after operations like yours. It seems to be a very interesting option for those who have aortic dilatation due to Marfan or BAV (which is my case). Either way I often think my cardiologist looks at me as if Im nuts and that my current 175 miles a week training should be thought of as beyond expectations post open heart surgery. And he never had any symptoms and played competitive soccer since he was 6. It has a male predominance and often occurs in multiple members of the same family, suggesting that it may have an autosomal dominant inheritance, perhaps with variable penetrance. 1,3,4,15 It can lead to chronic heart failure and increase the risk of acute aor-tic syndromes and sudden cardiac death.15 Michelena et al16 studied 212 cases of asymp tomatic bicuspid . 2020 Update: Arnold Gets An Aortic Valve Re-Replacement! March 15, 2023. I have also been advised that running intervals at over 80% max heart rate would not be sensible. Will I need meds? Okay to wait? Historically, a heart murmur was the most common reason affected individuals were identified. Thank you very much for writing such a thorough and well informed article. Search Heart Hospitals Robin Williams - Aortic Valve Replacement & Mitral Valve Repair. I would like to thank you very much for providing me with your thoughts. Bicuspid aortic valve is a heart problem present at birth. Is this true that you wont be symptomatic with only mild AR? what recommend me? The doctors tell me I will be able to run again at a level near to what Im accustomed to (50-60 miles per week) but are reluctant at this point to specifically tell me the limitations and restrictions Im to endure. In your experience how long are we talking before I have to have surgery and do beta blockers really help in prolonging the need for surgery. mod-severe regurgitation For me, its about gender equality. Typically, the aortic valve has three cusps (tricuspid aortic valve), but some people are born with an aortic valve that has two cusps (bicuspid aortic valve). The potential downside relates to durability. Call 911. Ive been told by my cardiologist that they think I should probably avoid competitive rowing and weight lifting. Do you have any info or recommendations about this? I am a 60 yo female who has been active my whole life. He would be devastated to never be able to play again. On Monday the 13th, I had my annual echo. Dear Dr. Creswell, He seen our family doctor that week who confirmed the murmur. I have no symptoms that I would notice, e.g. I have also spoken with Boston Childrens Hospital who have been very helpful and enlightening. In fact, one young man died 5 years after operation (from other non related causes) and the study on his aorta tissue revealed that the device helped it to heal, presenting a healthy histology. Have been told to keep away from exercises that strain me, ie heavy weights. Onside rations would be needed for hose with Marfans syndrome or other diseases of the aorta. Schwarzenegger was born with a condition known as bicuspid aortic valve, in which the heart's main artery, the aorta, has only two cusps instead of three.If untreated, it can lead to blocked blood . Bicuspid aortic valve (having only two leaflets rather than the normal three) happens in about 1% to 2% of the population and is more common among men. Advances in treatment have allowed many babies with known congenital heart disease to survive well into adulthoodand many people who have congenital heart disease go on to live long, productive lives. The cardiologist told us at that appointment that we needed to start considering surgery to repair his valve. triangle chokes, other blood chokes) could be putting pressure on my heart and cause my aorta diameter to increase? Im 53. We see his pediatric cardiologist every 6 months. I took it up 7 years ago. I have had scans and echos for as long as I can remember and have never been on medication nor has this condition stopped me from doing anything I have wanted. which seems to suggest that he has returned successfully to the sport. Can you direct us to ANY research on the effect of endurance sports on AVR patients? To quickly review, individuals with BAV have an aortic valve with 2 unequalinstead of the usual 3 equal sizedleaflets. I feel like 95% of other people my doc sees are just happy to get back to their normal life which doesnt include pushing their bodies to extreme limits. For example, his spurt in enlargement happens to coincide with his spurt in growth. A different set of. He told me to carry on as normal and to take 300mg Irbesartan per day. Im a 30 yr old male, training 5 times a week rowing and strength training. He is certainly expert in the area of drug therapy to reduce the rate of aortic enlargement. There are simply no reports that describe the experience of athletes returning to ECer ise (or training) after aortic dissection. Thank you for taking the time to respond to my post. To no surprise, people are worried about me running tomorrow. Thank you so much for your reply. Rose underwent the procedure last week, and said he would be going home to rest for a couple of weeks before returning in March. Males are about twice as . Four necropsy series5, 6, 8, 20 provide the only basis we have for estimating the incidence of bicuspid aortic valve in the adult population, as diagnosis by auscultation is insufficiently accurate and no relevant echocardiographic study has been published. The exact cause of aortic enlargement in patients is not known. That said, guidelines from the 36th Bethesda Conference suggest that BAV, without enlargement of the nearby aorta or problems with the aortic valve, shouldnt preclude any sports activities.including weight lifting. Dr. Creswell, Is it like keyhole surgery? In late March, Schwarzenegger was heavily involved in a chess tournament with his donkey Lulu. Bicuspid aortic valve. Athletes with BAV who have no stenosis or regurgitation of the aortic valve AND have no enlargement of the nearby aorta may participate fully in their sports. And any valve substitute (with valve replacement) is clearly not as efficienteven if the substitute is better than a diseased valve. "Thanks to the team at the Cleveland Clinic, I have a new aortic valve to go along with my new pulmonary valve from my last surgery," he wrote. If echo shows a normal size, thats probably okay. Today at my hospital, we do most 1st time aortic valve replacements for aortic stenosis (narrowing) this way and have started using TAVR for patients with previous AVR using tissue valves who need re-replacement. Or its the result of the cumulative effect of the aortic and mitral valve leakage? Im highly considering this option, after 4 months of research and appointments with doctors. Holding breath during lifts valsalva). That is to say, I did up until two months ago. My last CT scan in November showed a change from 4.3 (May) to 4.5 (November) however I was only given these results yesterday. For those with moderate aortic stenosis, the guidelines suggest restricting activities. But, while doing my cardio stress test they discovered that I have a Bicuspid Aortic Valve. I would very much appreciate your opinion weather he can continue his regular football training or should stop it. This blog helped me a lot in my panic days, it put me at ease when I was worrying to much, just to see and to know your enemy and to realize that you are not alone is great help. To much info to much detail so much information and advice. If I had to choose a valve for AVR, Id choose a tissue valve. Many heart conditions can be controlled or repaired once theyre diagnosed. Down side: must take blood thinners to prevent blood clots from forming on mechanical valve. 7373 Perkins Rd Thank you for best websit. In addition, the Left ventrical has slowly increased over this same time period from 5.87 to 6.6 cm. Sadly, we dont have a crystal ball, though to know what the future holds for any particular individual. Advice here will be based on opinion rather than accumulated evidence in large numbers of children with BAV. and my valve is working quite well (mild aortic regurgitation). While I recovered from surgery just fine, my return to my normal activity levels has been hampered by recurring arrhythmias, muscle atrophy during recovery, medication,and general inability to exert myself like I could prior to surgery. This procedure has the particular benefit that no artificial valve (with the disadvantages described above) needs to be used. This valve repair option is one that might best be pursued at a center that specializes in this problem. What is a TAVR? Barb. Its not around incision, its mainly middle of left side. Im a 33 yro female, diagnosed with BAV. Hes gained 25 pds . My cardiologist has advised me to avoid high impact activities such as weight lifting and endurance training. I have recently found out that I have aortic regurgitation will soon be needing surgery. Finally some solid information about exercise and life post AVR, thank you very much for that. The timing is my choice.. According to reports (and my new cardiologist), this congenital variation . Guidelines specifically for athletes come from the Proceedings of the 36th Bethesda Conference in 2005. CT or MRI may be more accurate. I just want to know what things I will see change so that I dont look past the change in my valve and miss my window to get the valve replaced. All Rights Reserved. Could you express your opinion on this issue? Enlargement of the left ventricle can be an indication that the heart suffers from the aortic regurgitation, even if the regurgitation doesnt produce symptoms like shortness of breath. The typical symptoms are fatigue or shortness of breath, particularly with exertion. Advertisement. The doctor looked at the results and told me to limit physical activity (running), because it can lead to heart failure in future. We saw cardio in April again and my sons symptoms are the same and no progression on the aortic regurgitation. This was caused by an aneurysm in the ascending aorta (root) that measured over 6 centimeters). I was diagnosed age 4 and am now 35. Can you clarify what may not be true please? Bicuspid aortic valve with Marfan and other HTAD when the ascending aorta is dilated >45 mm. If youre uncertain about any advice youve received about exercise, you might try to seek a second opinion that may provide some extra confidence about exercise. I mean, when competing, my average heart rate is close to 159 and my max HR is around 170. I am a marathoner with BAV and no other cardiac issues. There is a risk of sudden death in individuals with BAV, probably related most to aortic stenosis or aortic dissection/rupture. On April 16, 1997, Arnold Schwarzenegger underwent elective heart surgery to replace a defective, congenital aortic heart valve. Hi Sean, The best source of recommendations about safety of various forms of exercise will come from your doctor(s) who are familiar with all the particulars of your circumstance. It functions as a one-way valve, opening and closing with each heartbeat, which keeps the blood flowing in the correct direction. Did the heart have to work harder to compensate? I have wife and two small boys, I wanna live to see my grandchildren. My son was diagnosed with BAV, by chance, when he was 7. I have ramped up my walking to 30 minutes, keeping my heart rate under 100 bpm. All rights reserved. They said that everything is working fine except that I have a slightly enlarged aorta and the very beginnings of an aortic aneurism which most likely occurred PRIOR to surgery as a result of the pressure over the years and my old BAV. Should I increase amount of weight? I otherwise feel very healthy, other than (I think) normal slowing down that comes with age. However, this is not always the case. Benefits: long-term durability. I am perfectly happy to stick to the 10km max distance for races, but my key concern is that if I do run some faster training sessions then I might have a sudden death. Bicuspid aortic value ppg 24 mmhg Are there any things I can do now to help minimize my risk? As a consequence, these individuals develop earlier calcification of the valve leaflets, leading to narrowing, or stenosis. In March 2018 he underwent emergency surgery to have this replacement valve replaced. It is very difficult to find information regarding the athlete and BAV. Frequency of congenitally bicuspid aortic valves in patients 80 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation.Am J Cardiol. Arnold Schwarzenegger opted against a mechanical valve replacement and chose a tissue valve because he felt a mechanical valve might limit his physical activity and capacity to exercise. Get your act together, Columbus! I cant think like a nurse where hey is concerned. At issue are the potential long-term effects of repeated episodes of high heart rate and high blood pressure that accompany intense exercise. Many people in your situation will eventually need operation for replacement of the valve or the aorta, but wed need a crystal ball to know about the future. I cant imagine life without activity, but Im not fool to risk my life, not any more anyway :). I found a cardiologist with whom Im quite happy with. I take BP medication namely Amlodopine & Ramipril which has lowered my BP. I am a 36 yo male who was first diagnosed with BAV at the age of 17. Like you, I have been frustrated by the lack of experience and information that the cardiology community has for folks like us, although it is encouraging to read everyones posts here and see that we are not alone. Thanks for sharing your experience, Randy. If so, how quickly? Your surgeon will be in a good position to understand the exact details of operation that might be relevant when deciding whats safe.. Elite triathletes and heart problems In the simplest terms, a bicuspid aortic valve can be a serious heart valve disorder in which the valve only has two leaflets, or flaps, that control blood flow through the heart. Or is the real risk related to further deterioration of the heart in the longer term that would be picked up by 6 monthly monitoring, which may indicate the need for surgery but not an immediate risk of dying suddenly? Thanks for sharing. So far, none of the people that had the operation suffered any dissection. Likewise, if I did a 60kg bench press I could easier than say an 18 year old girl started at the gym tried that, they would have to strain beyond belief. Bobbie. Im 32 years old and back in 09 I discovered I have a BAV. I know that heart surgery can be scary.but I also know that for the vast majority of patients with these conditions, surgery goes well and the outcomes are good. While my surgeon said that I can do whatever normal healthy person would do my cardiologist gave me some restrictions basically not to raise my HR over 120. Normal function of cardiac valves Sheer brutality and trauma caused Myasthenia Gravis. Apparently I also have a mildly enlarged IVC as well as mildly enlarged left and right atria. Its a lot harder in the UK to see your cardiologist so you cant get the answers quickly. is my lack of top end performance indicative of someone with BAV & aortic coarctation? The surgery was a full success, and the valve is closing really well now. I have normal aortic size, mildly dilated aortic sinus (39 cm), and trace aortic regurg. Heart disease and stroke are the number one killers of women, Streisand, 74, told PEOPLE about why she helped found the organization. "Schwarzenegger's pulmonic valve was successfully replaced.". They ruled out Marfans syndrome because his aorta was dilating. As youve mentioned, sometimes it can be useful to visit a cardiologist who has an interest in athletes and their heart problems. I believe that many Cardiologist are not as experienced regarding how to advise high-performing athletes (even older ones like us). I wouldnt hesitate to register your concern with your sons doctor about waiting a few weeks. The readers here would love to hear back from you as you work through this. I get the fact that lifting excessively can cause a spike in blood pressure, but only under certain conditions (i.e. Be specific. Youre right, though. And, of course, aortic stenosis can affect ones native aortic valve or a prosthetic valve substitute. My doctor says i use losartan for decrease my blood presure. The ST junction and ascending aorta are mildly dilated max 35mm. Bicuspid aortic valve (BAV) is a genetic condition that causes the aortic valve to have two leaflets instead of three. Weve known the risks and my daughter has done well to avoid scrapping for the ball etc. Reply. Kimberly was born with an abnormal valve, but didn't begin to develop symptoms until her 40s. Stories of Bicuspid Aortic Valve. For athletes with mechanical heart valves, the most important consideration is usually about potential bodily injury while taking blood thinning medications. On Aug 30, 2017 I passed out at the gym and subsequently airlifted due a large abscess and valve dehisence and underwent another operation and now have a homograft. Im hoping you can help with some guidance. The aortic valve allows oxygen-rich blood to flow from the heart to the aorta. My cardiologist (London Heart Hospital) gave me green light to moderate sport activities (no marathon and weight lifting). Consensus guidelines suggest restricting activities in athletes with BAV and aortic diameter >4.0 cm. I look forward to hearing from you. A few hours after helping the woman, she began to experience chest aches, soreness in both arms, nausea and clammy skin. Monica Lewinsky: 25 Randoms on the 25th Anniversary of the Bill Clinton Calamity. To list down the names of celebrities including entertainers, musicians, politicians, TV personalities, sports figures, etc. I understand its strenuous activity but if Im for example bench pressing it will get harder for me to put it up at the 8th rep.. She says now it is stable and I dont have to see her for 2 years. I have regular checks, 12 to 18 months, and until about 3 years ago was told that it was hard to tell that Id had a replacement valve, it now shows slight stiffening. i.e. Dr. Larry, very helpful content. Arnold Schwarzenegger was born with a bicuspid aortic valve, in which the aortic valve has only two leaflets, instead of the typical three. Thank you so much for all of this insightful information. Questions currently remain about how long such repairs will last and whether patients might require re-operation at some point in the future. Those with symptoms are usually identified (BECAUSE of those symptoms) in the first year or two of life. Im 52 years old and had surgery 2.5 years ago to repair an ascending aortic aneurysm (5.8 cm) and aortic tissue valve replacement. "Weve gotten a lot closer and weve learned each other on a whole different, deeper level, she told PEOPLE in 2015. He is on meds to slow it down. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window). Latifah has taken on her mom's caregiving duties, along with relatives and a nurse, whenever she is on the east coast. Im a 30 year old male who is currently living in Asia with family. So you know, this is not uncommon for heart valve surgery patients. A repaired valve may not be as efficient as the native, healthy valve. However, I always performed poorly when it came to the top end fitness tests e.g. BAV only has mild regurgitation. Search for heart hospitals that specialize in heart valve treatment. Before 2 years my aorta was 37mm . transcatheter aortic valve replacement (TAVR), Mick Jagger's Heart Valve Surgery: Top 5 Facts. I had my AVR almost one year ago. I have no proof this may be causing my less than stellar performance or if perhaps I should have more patience. My exercise is limited to 30 minutes of moderate carido, with no weights. Miley Cyrus - Singer & Actress - Tachycardia. 4.2cm dilated aortic root Ive got my results from my recent echo and a lot of normals on there but main things were regurgitation and stenosis were mild with the aorta measuring about 33mm. I would prefer not to stop. I am healthy, strong, and active. Dr. Larry, thank you very much for your blog! We live at 6,500 ft (elevation) so Im not sure if its affecting my blood pressure when doing normal things. Could the changes in my LV be the result of the physiological, not the pathological change? Im really wondering at what point should I look into flying back to Thailand or Hong Kong to get re-checked. (liver cysts noted). While I do expect to have a replacement done later in life, the repair was the best decision I could have made. Also, my next appointment is, unfortunately the week after my next marathon (which I will be pacing and not racing). Thanks for sharing your sons story. The tragic event's silver lining was that it caused Latifah, 46, and her mother, 67, to bond. A bicuspid aortic valve is a congenital condition, meaning that people are born with two rather than the normal three cusps on their aortic valve. Do you think the jiu-jitsu (e.g. You might keep in mind that trans-catheter aortic valve replacement (TAVR) can be used to re-replace the aortic valve. Whether 130 beats per minute is a good cut-off truly isnt known. Jones' goal with the AHA is to help women "actively put themselves on the track to heart health."
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