Many heart conditions can be controlled or repaired once theyre diagnosed. We go back in 3 months for another echo. We expect the current generation tissue valve to last at least 12-15 years before problems. This has been true as long as I can remember in all sports I seem to have to put a lot more in to get the same out as others. Only two cusps, commissures and sinuses are seen in the less common "pure" bicuspid aortic valve subtype. Many athletes with bicuspid aortic valve (BAV) may continue to participate in their sports.provided there are no other problems, either with the aortic valve or nearby aorta. I have question about your opinion about aortic valve regurgitation (no BAV) They are also predisposed to enlargement of the ascending aorta, the large blood vessel that carries blood flow away from the heart. 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.. In the blog post, I talked about the circumstances when operation is needed.as well as when sports are generally safe. He was just diagnosed with functional BAV due to partial stuck together of two leaflets (out of three, as far as I understand, they are equal). I wouldnt be happy just running I want to be the best that I can be at it. 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. Bicuspid aortic valves can accumulate calcium deposits more easily than tricuspid aortic valves. Aortic valve stenosis: Your aortic valve narrows, reducing blood flow through it. Not only the degree of aortic regurgitation, but also the degree of enlargement of the nearby aorta, should be taken into consideration when settling on limits for exercise. with valve area of 1.4 cm2 and aorta of 4.1 cms We dont have a crystal ball, though. Index to blog posts and online articles, Filed Under: Heart problems Tagged With: aorta, aortic aneurysm, arotic valve, bicuspid aortic valve, congenital heart disease, heart, heart surgery. there was a tiny strand of tissue on the septal aspect of the muscular LOVT (LCOT Vmax 2.1m/sec;20mmHg peak gradient. She was originally under the impression she felt the way she did simply because she was exhausted. Follow up for development of these functional lesions is indicated. "I had been doing some work around the house working with a heavy ladder, he told PEOPLE of his activity in the days leading up to his heart attack. Thank you so much for your clear explanations. We use surveillance (you mention every 6 months) because usually problems with progressive enlargement of the aorta or with the valve itself can be picked up before there is any lasting harm. Normally, your aortic valve has three cusps that regulate blood flow from your heart to your aorta. Best to continue to work towards identifying cause(s) and getting any needed treatment. After 5 years of amateur competitive rowing, I had no problems keeping up with my peers whilst training at lower intensities. 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 . Normal function of cardiac valves Baldwin Publishing, Inc. strongly suggests that you use this information in consultation with your doctor or other health professional. Since my initial post i decided to call another pediatric cardiology hospital in our state, University of Michigan Pediatric Cardiology. The increased stroke volume and cardiac output may cause . Also he told me I can lift weights and do other activities. They are located between the atria and corresponding ventricle. Current guidelines suggest no restrictions on activity for athletes with BAV who have no stenosis/regurgitation and who have a normal sized aorta. I hadnt heard about the technique previously. I believe that many Cardiologist are not as experienced regarding how to advise high-performing athletes (even older ones like us). And any valve substitute (with valve replacement) is clearly not as efficienteven if the substitute is better than a diseased valve. Sadly, we dont have a crystal ball, though to know what the future holds for any particular individual. Theo Wargo/Getty. As a result, the valve doesn't function perfectly. View HelpingHeartsCharitys profile on Facebook, View @HelpingHeartsMDs profile on Twitter, View HelpingHeartsCharityMDs profile on Instagram. Onside rations would be needed for hose with Marfans syndrome or other diseases of the aorta. Now I take brisk walks and run on the treadmill only occasionally. Anything you can offer up here would be very much appreciated. 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. The incidence of bicuspid aortic valve and complications. Those with symptoms are usually identified (BECAUSE of those symptoms) in the first year or two of life. Im a 42 year old male and have been a highly competitive distance runner since high school. Thats always the concern with new techniques with limited follow-up data. No changes in regurgitation status (aortic regurgitation LVOT 19%); Hi Dr. Creswell. I have recently found out that I have aortic regurgitation will soon be needing surgery. 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. Im aware that those days are past, but to abandon every activity seems like a prison sentence What is safe side threshold? Both are important in deciding if and when operation is needed. I would think that, ordinarily, a homograft would heal up along a similar timeline to other types of valve/aortic root replacement. For healthy individuals who have BAV with no other heart or aortic problems, follow-up imaging with echocardiogram and/or CT could probably be undertaken annually, or perhaps less often once stability is ensured. The doc says the big risk is due to the blood thinners. Perhaps your primary care doctor or cardiologist could help you find another specialist in your area who could help with thatlook over all of the pertinent information and share an opinion about whats safe. In my practice, we often do such second opinions (about all sorts of issues) and I have found that athlete patients usually value the information that comes from such visits. "The 1997 heart valve replacement was never meant to be permanent," stated Daniel Ketchell, a spokesman for Arnold. thanks for sharing all this interesting info. is my lack of top end performance indicative of someone with BAV & aortic coarctation? 2) According to your explanation I rather not do cycling sports, but can I have low intensity sport like cycling or swimming twice a week for 90 minutes each, or 3 times for 60 minutes? All aorta is normal, valvula normal funkcion only sinus valsava 35-37mm. Thanks very much. The other theory is that there is a structural problem that leaves the aortic wall weak. The issues related to repeat aortic valve surgery, with or without replacement of the aorta, are complicated. Bicuspid aortic disease occurs when a defect is present in the valve that opens and shuts to allow blood flow from the heart through the aorta. My cardiologist gave me green light for everything except strenuous exercise (used to train for ironman and similar challenges). Thank you very much for writing such a thorough and well informed article. She's currently spreading the word about the AHA's partnership with CVS' MinuteClinics for free heart health screenings every Thursday in February. Periodic re-evaluation with echocardiogram and/or CT scanning is used for most patients in this circumstance. Most people require treatment once symptoms develop. Surgery. Im less certain about how BAV, coarctation, and history of VSD repair might impact ones current top-end performance. I get sporatic tingling in my left hand and footand every so often in my left cheek bone. This was during a 12 week intense training block where my resting heart rate got as low as 42 bpm. Unanswered questions include: Can a bioprosthetic valve wear out more quickly than expected? At the USC Cardiovascular Thoracic Institute, we are dedicated to improving the statistics concerning cardiovascular and thoracic disease such as those once faced by the governor, said Starnes, who also serves as executive director of the Institute. At approximately three months I became very ill and was diagnosed with prosthetic valve endocarditis. My questions are I was just curious if there any way to know if my valve is affecting my times at all? Please refer to this article if not: https://academic.oup.com/ejcts/article/50/3/400/2197426. Thank you so much! Thank you for the follow-up! Hi Dr Creswell, Who Qualifies for TAVR. 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. Get on with it. The congenital bicuspid aortic valve (BAV) condition is a valvulo-aortopathy with substantial heterogeneity in its clinical expressions, associated disorders, complications, and prognosis. If reoperation is needed in your case, this would be something to discuss. Those figures are funny to me because before I was doing three or four times more intense training beside my job (air force pilot). Although the vast majority in each group (97%) underwent TAVI via the transfemoral approach, bicuspid patients were less likely to receive conscious sedation (57% vs 62%) and more likely to be treated with the largest 29-mm valve size . Moderately dilated aortic root (max 46mm), mild ascending aortic dilatation. "Weve gotten a lot closer and weve learned each other on a whole different, deeper level, she told PEOPLE in 2015. Thanks for sharing the article about the PEARS technique. I would like to know more about your recovery timeline since you are so much further out from surgery than I amfor instance; how long before you could do long rides again; when could you do tempo efforts; start high heart rate intervals; and finally race again? In general, we recommend no weight lifting in patients with BAV if the aortic diameter is greater than 4.0 cm. Required fields are marked *. Im 32 years old and didnt expect at all that my aorta would dilate. During the Ross Procedure, the aortic valve is removed. Randyyour situation has many similarities to mine; I would be very interested in sharing experiences. Thank you,dr Creswell, Also suggested taking low dose of beta-blockers although I have been told the effectiveness has not been proven. Hi Dr. Creswell. Okay to wait? Im not surprised that youve received a conservative recommendation about exercise. Aortic valve repair is sometimes possible. I was also advised that it is really the static weight-lifting that could pose a problem. Dr Creswell, While i appreciate you are not my cardiologist and we`ve never met is there anything generic out there that i can look at to gain an idea. My Dr. gave me the all clear to go back to my exercise routines. I wouldnt hesitate to register your concern with your sons doctor about waiting a few weeks. Great to hear that youre doing cross country running. In short, is it too early for me to start talking to a surgeon to identify available options? I got checked out by my GP who detected a murmur then had all the other heart related tests and was diagnosed with BAV with stenosis and regurgitation. On Ocotber 23, 2020, we learned that Arnold Schwarzenegger had a third heart valve procedure, a re-replacement of his aortic valve replacement. Some good points there, Craig. Questions currently remain about how long such repairs will last and whether patients might require re-operation at some point in the future. The incidence of normally functioning bicuspid aortic valves is 0.6% to 0.9%.5 . We have decided to wait and watch. Very often, follow-up CT scans and echocardiograms are needed every 6-12 months to keep track. I used to run a lot. About a year ago a pulmonologist discovered a grade 2/6 heart murmur during a workup for a sleep study. Thus far shes had only minor bruising (shes 6ft and has a solid build). Thanks for sharing an update. Im hoping you can help with some guidance. It is very informative. Approximately 1%-2% of the population are born with an aortic valve that only has two cusps. We live at 6,500 ft (elevation) so Im not sure if its affecting my blood pressure when doing normal things. I have a few questions because I was instructed not to lift more than 10 lbs and that I could resume surfing in a year. Aortic dilatation is a common feature of BAV with a prevalence ranging from 20 to 84% , due to differences in assessment techniques, study population, aortic size thresholds, and heterogeneous nature of the . Thanks for the enlightening article. 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. Post 2 years and Ive yet to get back to my high level of racing fitness and wanted to see what should be expected. 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The only question I have is in regards to having my children screened. I have 4 children and a great wife. So you know, this is not uncommon for heart valve surgery patients. Hi Larry, when I discussed this with my Dr. he reassured me that its not my heart causing it. I was wondering if you could give your opinion on my scenario. From afar, I dont have much to add. Hi Dr Creswell, I think its reasonable to think of things this way. The abnormal anatomy of the bicuspid aortic valve is complex, and a classification schema of 3 anatomical types has been proposed by Sievers and Schmidtke. Medical therapy may be useful to slow or halt the progression of aortic valve disease and aortic enlargement by reducing the blood pressure and the blood pressure across the aortic valve. 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. Guidelines suggest that athletes with BAV, normal size aorta, and no more than mild aortic regurgitation or stenosis can participate in all sports, without restriction.provided that they do not have an inherited connective tissue disorder like Marfan's's syndrome. ODonnell, now 54, said her heart attack began after she helped an enormous woman struggling to get out of her car in a parking lot. Make no mistake, though. Several contemporary elite triathletes have BAV and Ive written about their stories in: Examples from other sports would include Arnold Schwarzenegger, among others. Review of the clinical records of 152 patients aged 20 years and older found to have a bicuspid aortic valve at autopsy revealed aortic stenosis in only 28 percent. All they said is dont really do weight where you can feel the strain in your neck ?!? Aside from the problems with aortic valve stenosis or regurgitation or with enlargement of the aorta, individuals with BAV can also suddenly develop the problem of aortic dissection. Do you think the jiu-jitsu (e.g. Bicuspid aortic valve (BAV) disease does not usually cause symptoms. Aortic valve replacement is recommended for nearly all patients with severe valve stenosis (valve opening less than 1.0 cm2), Aortic valve replacement is recommended for patients with severe valve regurgitation if there are symptoms due to the regurgitation (eg, shortness of breath with exertion) or evidence that the heart is suffering because of the regurgitation (enlargement of the left ventricle), Repair or replacement of the beginning portion of the aorta is recommended if there is enlargement of the aorta to greater than 5.0 cm. Finally, athletes are not spared. No aortic root dialation. Last echo measurements LDid 6.3cm z-score 2.4, LVIDs 4.1 cm z-score 2.0, LVPWd 1.2cm z-score 1.9, asc aorta Diam 4.0 cm z-score 5.8. Alternatively, bicuspid aortic valve symptoms can appear during the first twenty years of life. Thanks in advance. "I had to make lifestyle and diet changes, she said. I get the fact that lifting excessively can cause a spike in blood pressure, but only under certain conditions (i.e. There, Lucci learned that she had a 90 percent blockage in the main artery of her heart and a 70 percent blockage in another, and needed emergency surgery. All Rights Reserved. "Heart disease is the number one killer of all Americans, the number one killer of African-Americans and the number one killer of women, so I shouldve been put on notice since Im three-for-three. My father has struggled with heart disease since he was 50, and I lost him [in 2008].. Thank you for your assistance in this matter. Throughout the years he has played football and basketball. Answers to your questions. Bicuspid aortic valve is associated with abnormalities in the coronary artery anatomy in about 2% of patients, including anomalous origins of the coronary arteries and upwardly displaced coronary ostia. Ed Helms - Actor - Undisclosed CHD. These techniques are most applicable to situations in which there is regurgitation, rather than stenosis, of the valve and when there is also enlargement of the aorta. Dietz?) In addition to this public search, we scanned our proprietary research database of over 1 million sources and were unable to find any specific research reports that address your goals. His story is typical. Im a 29yo CrossFit addicted man who just found out I have BAV while applying for the defence force here in Australia. BAV is present at birth (congenital). Would this constitute as too much in your opinion ? You would never know meeting these celebrities that they had a CHD. Robin Williams - Aortic Valve Replacement & Mitral Valve Repair. In my early 40s I thought that I was getting out of breath more than I should and eventually began to feel weak or nervous during a game, but only on Sunday. It would be great to know what happens to groups of patients after AVR and aortic replacement that have returned to their various sports. However, many people will develop complications from their BAV and may need surgery in their lifetimeeither to repair or replace the aortic valve, the thoracic aorta or both. Some people with bicuspid aortic valve will have symptoms in early childhood. Its a hard thing to describe to my cardiologist that my legs and HR are not cooperating when the pace picks up. That post is a starting point for todays discussion. Dear Dr. Creswell, There are simply no reports that describe the experience of athletes returning to ECer ise (or training) after aortic dissection. I had an echo because of a scuba diving accident and was discovered to have a BAV (no PFO). 2k erg test. I know that there can be complication with Dacron graft or even aorta aneurysm building up but Ill stay on positive side since I have no tissue disorder and its highly unlikely that with properly working aortic valve I would develop another one in that short period of time. The confusing thing I hear is some cardiologists telling BAV people not to life over x lbs. Perhaps meeting with a heart surgeon now, even if operation is not yet needed, might provide a forum for discussion about the options for surgery, the technical issues, and recovery. My son was diagnosed with BAV, by chance, when he was 7. eventually was told everything was ok. Over the past 3 years, my endurance has declined significantly, and now I cannot run a lap on the treadmill without some walking; however, my numbers from the semi-annual utrasound have not changed much. As youve mentioned, sometimes it can be useful to visit a cardiologist who has an interest in athletes and their heart problems. To me, cardiologists are not sports people and air on being absolutely over cautious. March 10, 2016 at 1:50 pm. I know I will need it replaced. Have tried to get a personal trainer that specialises in all things heart related here in the UK but there don`t seem to be any around despite searching. Now I wanted to start again (also due to the 8kg I accumulated in the meanwhile:( ) and I discovered that I can barely run 5K in 30 min and I generally find it very difficult to run. My sinus of valsalva is at 4.8 and my BAV is functional (discrete regurgitation). She advised us we should start to consider surgery but would follow up with us again in 3 months. He seen our family doctor that week who confirmed the murmur. They included a web link to the European medical guidelines. My heart rate some time is 100. So I saw an incredible surgeon and we are going for the Ross Procedure in Feb. Now that we know the type of surgery does this improve my chances or one day returning the CrossFit addicted life I miss? I do think that this condition can weigh heavily on patients minds, though, and in your case perhaps particularly so because of the experience of your mother. Anyway, talk to a surgeon who understands quality of life means. But Bob, you confirm that it does for you; and unfortunately I see same for me although 25 years younger. 2) He can lead a normal life & can continue his training with regular echocardiography control (once in a year). Bicuspid aortic valve refers to a spectrum of deformed aortic valves with two functional leaflets or cusps which are often unequal in size. 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. I used to do quite some running 10 years ago (still at amateur level), I was doing lots of 10k and 20k and even I managed a marathon in 3h:26min (but at that time I didnt know about the BAV). Zdenko . I would prefer not to stop. My performance as a cyclistgiven my ageputs me in the elite category, although with the stenosis I am experiencing a definite decline in performance. Looking forward to hearing your thoughts. To continue to live this amazing life so full of challenges and friends, including so many of you in the audience, I have chosen to replace the valve with a new one. If you wont we can share experiences about healing and progress, its pretty much same situation. The doctor said she would see if she could talk about his case with the surgical panel but she said even if he did have surgery he couldnt have a career in sports??? This content can also be viewed on the site it originates from. My son is a baseball player, so that is good. My problem is with cardiologists stating do not lift anything over 50lbs. I was training for 11th marathon at the time (over the past 13 years). Males are affected 3:1 compared to females.

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