Do you opration? Dear Dr Creswell you seem to be such a kind cardiac surgeon to make yourself available in answering questions. Follow up for development of these functional lesions is indicated. Starnes implanted a healthy human tissue valve and said at the time, This will not limit Arnold Schwarzenegger in any way when he recovers.. Me, i`m nearly 43, male and have BAV. 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? I had to take time off gym, when I returned I only did light weights and only walking on the 4x a wk and the same issues where still there. Thanking you in advance, Thank you very much for your answer. Hello Dr. Creswell, 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. Dr. Larry, thank you very much for your blog! Okay, thats greatbut I left feeling uncomfortable with the diagnosis. Consult your doctor to see if there are any restrictions that would be specific to your case. Thanks! Hi Dr Creswell, A CT scan made the diagnosis. Thanks for sharing your sons story with BAV. Would this constitute as too much in your opinion ? And, if so, how did things go? The fusion (sticking together) of the valve leaflets causes abnormal valve opening and closing. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. Celebrities With Heart Disease - Celebrity Heart Health Survivors. My son at 11 months was diagnosed with BAV. On March 30, 2018, we learned that Arnold Schwarzengger required a second heart surgery. 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. No aneurysm. I would encourage you to have further discussion with your doctor(s) about EXACTLY what forms of exercise are safe. Also hypertension in both arms. Its awesome to see you are diligent at responding to people also. I had a David Tirone Operation a couple of weeks ago to repair a BAV with aortic dilatation (49mm), and a small leakage. My cardiologist is not concerned. 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. Sory but I dont speak very vell english. Get your act together, Columbus! But if you have a bicuspid aortic valve, you only have two cusps. My son will be 16 next month. Aortic Stenosis Abstract. I used to run a lot. There was only a 0.2 cm increase in the previous 7 years (so from age 21 to 28). I dont believe this has been well studied. The other theory is that there is a structural problem that leaves the aortic wall weak. Is it like keyhole surgery? Their experiences have been variable, and perhaps for a variety of reasons. Would this have any affect on any of the results of the tests I have done (Echo, EKG, Chest Xray)? For most athletes with only mild enlargement of the aorta and no problems with the aortic valve, there should be no activity restrictions. I otherwise feel very healthy, other than (I think) normal slowing down that comes with age. I have 5 children, so I dont want to drop dead and leave my poor wife with them all to look after on her own. PS: I noticed that the option Notify me of follow-up comments by email doesnt seem to work. I met an old guy once after a run and he described me very well his running experience; he said when I accelerate, Im the only one to know. BAV is the most prevalent congenital heart defect, but can go undetected for years - even into adulthood. Can you clarify what may not be true please? His cardiologist said, i am sure he can play a full game with new issues but I have to go with new guidelines and indirectly left it up to me to make the decision which moved him to mild /moderate and put right at the Borderline. Bicuspid Aortic Valve: Symptoms, Diagnosis & Treatment, Biological Tissue Valves: Pig, Cow, Horse & Human, The Patient's Guide To Heart Valve Surgery. I cant lift over 40lbs and I cant continue my work as a tradesman as it requires lifting over the 40lb mark. Looking forward to hearing your thoughts. 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. Only two cusps, commissures and sinuses are seen in the less common "pure" bicuspid aortic valve subtype. I would defer to Dr. Dietz since youve already contacted him. Well, as it happens, the Cleveland Clinic has been recently rated the top heart hospital in the nation, and the number two hospital overall. Bicuspid aortic valve (BAV) disease does not usually cause symptoms. Ive a BAV with the fusion being between my right coronary and non-coronary leaflets. In your experience, can patients with BAV go a lifetime without having AVR? Does the BAV with aortic dilatation and small leakage prevent the blood to flow less efficiently? however I have been getting pain (on the left side of my breast) and chest pain due to lack of oxygen. What a great resource! And, of course, aortic stenosis can affect ones native aortic valve or a prosthetic valve substitute. In practice, the indications for aortic valve replacement for severe aortic stenosis or severe aortic regurgitation are straightforward and uncontroversial. Good to hear that youre making a good recovery from your second operation. 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. Regarding the PEARS, the main concern is about the possibility that the aorta dissects even in a controlled measure (lets say 4.5cm). I have a 15 year old son with a BAV, Aortic stenosis, Noderate regurgitation and dilatation of his ascending aorta. 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. Film star, former California governor, and seven time winner of the Mr. Olympia title Arnold Schwarzenegger published positive images to his social media platforms on Friday as he recovered from heart surgery. Can you please shed some light on this is the sport performance supposed to gradually diminish (seems to go to zero for me) before the operation is needed? celebrities including musicians, actors, TV personalities, politicians, entertainers, and sports figures, etc. I have moderate to severe regurgitation and the heart is enlarged as far as I understood. As I have aged I have upped the reps to 15 or more and two or three sets max, sometimes doing a set or two of 5 reps with heavier weights. Then, Arnold's pulmonary valve was switched to the aortic position. triangle chokes, other blood chokes) could be putting pressure on my heart and cause my aorta diameter to increase? I was diagnosed with BAV about four years ago now by fluke whilst looking into my high blood pressure (I was only 24 at the time so I underwent a lot of testing due to my age and HBP the conclusion was it is hereditary, with many members of my family with HBP). His whirlwind romance with Katherine Schwarzenegger has resulted in a rather large ring on her finger. Is a CT or MRI absolutely necessary for measuring the aortic diameter? So for that first month, we usually advise no driving, lifting, pulling, pushing, reaching, etc. The bicuspid aortic valve opens and closes abnormally, and can result in leaking of the valve. 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. Business, Economics, and Finance. Interesting situation Sean Miller. Lastly, Id say that BAV alonewithout leakage or narrowing of the aortic valve, and without enlargement of the nearby aortawould not preclude sports activities of any sort. Many of us are not familiar with the many types and facets of the martial arts. I have some issues with a dull pain right below my left breast that seems to come more often with a poor dietbut just doesnt seem like it could me esophagus related? Replacement? 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). If youre questioning the recommendations youve received, perhaps a second opinion might be helpful. Do you think the jiu-jitsu (e.g. No LA, RA, RV, chamber dilation Your sons doctors are undoubtedly experts at pediatric patients. There are just so many causes of shortness of breath, lightheadedness, and chest pain.even besides the heart-related causes. I have recently found out that I have aortic regurgitation will soon be needing surgery. After that, most patients can gradually return to activities that put stress on the sternum and upper extremities. Any advice would be greatly appreciated. Yes, as the patient grows, so will the aorta.and eventually you get to the traditional >40 mm cutoff where activity restrictions are advised. An early indicator of BAV is a heart murmur, which is an abnormal sound caused by the turbulent . That said I have a resting HR of ~40 (always have). Bicuspid aortic valve (BAV) and congenital aortic stenosis are two types of heart defects that may be present at birth. Rose underwent the procedure last week, and said he would be going home to rest for a couple of weeks before returning in March. A repaired valve may not be as efficient as the native, healthy valve. The problem is I have developed an aneurysm on my ascending aorta of 44mm. I am big for my age . 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 . His BAV is causing very little back flow. 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. Together, you should be able to settle on what sports activities will be safe based on those facts. I do not do any kind of sport and I want to have healthy life at make sure my situation not getting worse and I weight 90 kg. He wasnt real worried about me and I have regurgitation (mild) and (mild) aortic root dilation.. Do u think it would be OK to lift weights and if so maybe u could give me a better understanding. Easy bicycling might work, but I suspect that running wont be workable with that cap. In some cases, bicuspid aortic valve causes another condition called aortic valve stenosis. 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? Lack of breath? EKG and echocardiogram were done showing BAVD. Most probably not pericarditis cause I had it once so I know that pain type, but again, maybe its some other type. I would just like to share my experience of having a Aortic Valve replacement. Dr. Larry, very helpful content. Options for operation I would think that, ordinarily, a homograft would heal up along a similar timeline to other types of valve/aortic root replacement. It may cope adequately for a few years if the person leads a sedentary life, but the longer crucial surgery is delayed, the more damage there will be to . I was just curious if there any way to know if my valve is affecting my times at all? 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. My son is a baseball player, so that is good. Hello dear doctor. Unfortunately, I really cant point you to such studies. what recommend me? Required fields are marked *. there was a tiny strand of tissue on the septal aspect of the muscular LOVT (LCOT Vmax 2.1m/sec;20mmHg peak gradient. 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. I have severe aortic stenosis with no signs or symptoms. These operations can sometimes enjoy the benefits of each of the operations you mentioned.and avoid done of the down sides. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV . First, a disclaimer.My practice is devoted to adult patients. Since Im not close to good medical care, are their specific things that I will start to notice if my heart valve is causing a problem? Consensus guidelines are developed to be broadly applicable, but the guidelines may not be applicable in a given athlete patients circumstance. Latifah has taken on her mom's caregiving duties, along with relatives and a nurse, whenever she is on the east coast. Hi Larry, thanks for doing this website, I wish there were more like it. Join Vanity Fair to receive full access to VF.com and the complete online archive now. Its very helpful for people with heart problems. When first diagnosed with BAV I just nodded and smiled it was only the following day that reality hit home and I thought of all of the questions that I would have liked to have asked the cardiologist! Im doing cardio as they said thats fine and I was lifting free weights tonight of 10kg. Can BAV cause sudden death incidents in otherwise healthy 40 year old males? What Is Bicuspid Aortic Valve Disease? When the aorta is enlarged in the setting of BAV, there are a couple possibilities: the valve needs to be replacedor it doesnt: Valve repair. The doc states that basketball is a contact sport in her medical books and we would need to consult with another doctor to possibly get approval. Bicuspid aortic valve with Marfan and other HTAD when the ascending aorta is dilated >45 mm. Males are about twice as . The Ross procedure borrows your sons pulmonary valve and uses it to replace his aortic valve and aorta. Bicuspid aortic valve (BAV) disease is the most common congenital heart defect, as it affects 1.3% of the adult general population . Here are some celebrities that experienced severe heart valve defects and had to have either heart valve replacement and heart valve repair surgery. E. G. I could bench 50lbs with no need to strain and hold my breath, which wouldnt result in a massive spike in blood pressure, but if I tried to bicep curl 50lbs it would do. Anyway, his aorta was growing at a rate of 2 mm per year (he was growing faster:).and they put him on 100 mg Losartan. Mild/moderate regurgitation. Before 2 years my aorta was 37mm . Its weird because sometimes when Im resting I can feel a little weird fluttering.. 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. Bicuspid aortic valve is a common congenital anomaly but does not cause functional problems unless aortic valve stenosis, aortic valve regurgitation, aortic root dilatation, or dissection or infective endocarditis occurs. I suspect (and hope) you will say that the latest recommendations say no restrictions for someone like me but I havent seen yoga specifically mentioned. Some people with bicuspid aortic valve will have symptoms in early childhood. I have almost everyday all day shortness of breath which follows with chest pain and discomfort. And, of course, its important to monitor over time the function of the prosthetic aortic valve and the size of the aorta. March 10, 2016 at 1:50 pm. Im 39 also diagnosed with BAV when I was 31. It is quite frustrating, Im running with some guys that have a hard time believing that I run a marathon. The aortic root is moderately dilated (max 46mm sinus to opposite commissure but you can measure 48off axis). As I train triathlon I check my heart every year and there is small back flow (the same last 5 years). Also, due to a bout of DVT and elevated d-dimers Im on Warfarin for life. I am now in no mans land of not needing immediate surgery (per the pressure number in left ventricle) and not being able to run more than 30 min. Thank you for your ideas and I apologize for my gramma errors (English is not my first language). Ive done so much research and there are lots of young people who have went on to play sports and lead normal lifes. The surgery was a full success, and the valve is closing really well now. Thanks for the infoI really appreciate what you,have to say. Open heart surgery is sometimes the best option, but it is not always the only option. Since he had to stop playing.. depression has set in. At issue are the potential long-term effects of repeated episodes of high heart rate and high blood pressure that accompany intense exercise. What he did say is there are no signs of stenosis, and my heart looks very strong. i.e. Adam has been featured by the American Heart Association and Medical News Today. 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.. If untreated, it can lead to blocked blood flow. I was diagnosed with BAV, with regurgitation, no stenosis, at age 63. In patients needing valve replacement because of stenosis or regurgitation, the aorta should be repaired or replaced if the aortic diameter exceeds 4.5 cm. Since then I completed several 10k races and one half-marathon. swimming? Early after operation, and for perhaps the first month, we typically limit activities that place stress on the shoulders and sternum. Normal LV diastolic function. More difficult questions relate to what are acceptable sports/exercise if operation is not (yet) needed. Does lifting weights up to 100 pounds and being cleared for push-ups, pull-ups, all cardio, etc., sound reasonable? 1. when I discussed this with my Dr. he reassured me that its not my heart causing it. It usually consists of three flaps of tissue what are called valve cusps. After the scans, ultrasounds, stress tests and TOE, I was diagnosed with BAV with no Stenosis, no Aortopathy and no evidence of Coarct and normal LV size and function. For those with moderate aortic stenosis, the guidelines suggest restricting activities. The false lumen extending into the abdominal aorta was left since the point of origin in the ascending aorta was repaired. Depending upon the size of the prosthetic valve, there is so e built-in obstruction to blood flow that is e aggregated during exercise. Functionally bicuspid aortic valve (type 1). It is very frustrating as my doctor would prefer to see me live the rest of my life with restrctions and have the aneurysm stabilized rather than take a chance on surgery and possibly returning to my normal lifestyle. The issues of when, how, what sports are safe, etc. Im 33 from UK and have known about my BAV since I was around 18. And he never had any symptoms and played competitive soccer since he was 6. 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 Marfanss syndrome. Im not sure I have all the answers from afar. I see my cardiologist the end of May. "I had to make lifestyle and diet changes, she said. I had my BAV replaced in Feb. 2005 (porcine tissue) with a Dacron repair of the ascending aorta. You already have a cardiologist looking after you. Ive been told by my cardiologist that they think I should probably avoid competitive rowing and weight lifting. I have BAV with an ascended aorta and heart murmur. John Ritter - Actor - passed away due to undiagnosed CHD at age 55. This is such an interesting blog, I wish I had known of it sooner. Good to hear that youre doing well. 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. Symptoms of bicuspid aortic valve disease most commonly develop in middle age in people with a history of a childhood heart murmur. Best to continue to work towards identifying cause(s) and getting any needed treatment. I would not want yo distinguish between the various forms of static exercise that you mention. What should I do ? In late March, Schwarzenegger was heavily involved in a chess tournament with his donkey Lulu. My primary question relates to sports. I too am looking for information on effects to performance since I am a Masters racing cyclist with 25 years of racing/riding long events. I dont doubt there is variability in recovery among athletes who have operation for AVR and aortic replacement. 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. Best for athletes like you to have a discussion with their doctor(s) and settle on a defined, mutually acceptable course of action about which sports activities are safe. I can imagine it might be difficult to make arrangements when you live in one country and your doctor(s) work in another. Mild aortic valve disease without symptoms may only require frequent health checkups. Very helpful. Will surgery mean I can do more or less training? Thats the reason we try to place the largest possible substitute valve in patients who need replacement. I was concerned about his cough last weekend so I was assessing his lungs with my stethoscope when I heard a very pronounced diastolic murmur at his 3rd ICS. He sees his cardiologist every year. Could you express your opinion on this issue? Always best to heed the advice of your doctor(s) who will be in the best position to offer advice about safe forms of exercise. Ive thought that the next visit to the pediatrician would be a good opportunity to discuss the issue. This makes the aortic valve a tricuspid valve. I ran a 1/2 marathon 4 months after my surgery and have been since training for the Philly FULL marathon, which is tomorrow. Im keeping my heart rate below 150, 160 at most but just for short period of time. You didnt mention your age, but obviously youd hope that whatever operation is performed.lasts a lifetime. After an echo and an MRI with and without contrast, I found out that I have a BAV with mild aortic and pulmonic valve regurgitation. With the blood thinning needed for a mechanical valve, serious bleeding may occur with injuries. Sounds like youre on the right track by getting things evaluated. Unfortunately his cardiologist took that from him so he focused his energy and talent on basketball. One situation that seems particularly ripe for differences of opinion is that of the athlete with BAV, no significant stenosis or regurgitation, but with an aortic diameter of 4.5 to 5.0 cm. Seven months ago I had emergency AVR due to a BAV that was severely compromised by endocarditis. The use of a less invasive transcatheter therapy in this . Because it was just a cardiologist, not a sports cardiologist or physiotherapist. I feel as though Im recovering well and, having no other conditions or comorbidities, rapidly. Im a 29yo CrossFit addicted man who just found out I have BAV while applying for the defence force here in Australia. Thank you very much for writing such a thorough and well informed article. no tiredness, no dizziness, etc. A bicuspid aortic valve is a congenital heart defect that affects the one-way valve between your heart and your aorta, known as the aortic valve. My family is pressuring me to quit strenuous cycling but I am thinking that switching to longer rides at lower heart rates would not accelerate valve wear or otherwise be bad for me. My cardiologist (whom I trust) said to keep working out like I always have (good news for me). The value of CT/MRI comes when a millimeter or two makes a difference in treatment, restrictions, surgery, etc. In addition to the European guidelines, there is also an American set of guidelines published in the Proceedings of the 36th Bethesda Conference. Routine endocarditis prophylaxis is . 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. That would include weightlifting. 3 In the most common type (type 1), there is a fusion line between the left and right coronary cusps, which extends a variable distance from the commissure (the point of attachment of the . To the extent that any operation fixes the stenosis or regurgitation, we might expect better efficiency from the heart. I am a 36 yo male who was first diagnosed with BAV at the age of 17. My doctor says i use losartan for decrease my blood presure. Its really not strenuous, maybe 10 km/h and not more that 10 push ups at once. Do we have a choice with him only being 15??? But neither of these procedures are durable for the long-term. Hector V. Ive never heard about a mechanical aortic valve becoming loose because of high HR. I have wife and two small boys, I wanna live to see my grandchildren. Ever since undergoing open heart surgery in 2010 for her surprise diagnosis of heart disease, Jones has worked as a national ambassador for the American . Im not aware of studies explicitly about athletes after Ross procedure for BAV. I would really like for people to not have to experience what I had to experience, she continued. Practice Essentials. The typical symptoms are fatigue or shortness of breath, particularly with exertion. Just still unsure however if my bioprosthetic valve affects my cross country running times. Thanks, His cardiologist said he cant play. From your reading, or even just here at the blog, youll know that its not an unusual story. I wouldnt be happy just running I want to be the best that I can be at it. My consultant informed me that, because of my age, I would have a mechanical valve fitted which meant that I would be on warfarin for life and therefor not be able to play football. What should i do? His doctor said his heart look very healthy and no other issues. I had a ventricle septum defect patched up shortly after birth with no further follow up and a full recovery. Dietz?) Thanks very much. This year (her junior year) her Cardio doc is saying that she cant in good conscious clear her for basketball (the sport my daughter LOVES). There are certainly individuals with BAV who never have trouble down the line. 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. We briefly talked about the Ross procedure vs mechanical valve replacement. Aorta diameter (34 mm|34 mm); Weve known the risks and my daughter has done well to avoid scrapping for the ball etc. The most common type was type 1 (1 raphe with the raphe positioned between the right and left coronary sinuses (75%), while the second most common type was also type 1 . No thrombus, vegetation were noted Im a 33 yro female, diagnosed with BAV. Baton Rouge, Louisiana 70808. 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. Its also clear-cut that patients with significant enlargement of the aorta to greater than 5.0 cm need operation for replacement of the aorta. . Is this true that you wont be symptomatic with only mild AR? Dr. Larry, I do appreciate your insightful article very much. Im really wondering at what point should I look into flying back to Thailand or Hong Kong to get re-checked. Thank you so much for all of this insightful information. Enlarged ascending aorta 42-43 mm I think hes amazed by what I have described for my workouts of 65+ mile rides several times a week. I am a marathoner with BAV and no other cardiac issues. The valve may also become stiff due to calcium deposits on the leaflets over time. Historically, a heart murmur was the most common reason affected individuals were identified. 1. 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 . Could the changes in my LV be the result of the physiological, not the pathological change? Thank you for your expert opinion. Its a hard thing to describe to my cardiologist that my legs and HR are not cooperating when the pace picks up. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Cond Nast. Sometimes patients with mechanical aortic valves report that they lose a bit of their top-end athletic performance. While she ended up being okay, she advised other women to be more cautious. Ive done the Philly a Marathon a coup,e times and know that its a terrific event. It seems to be a very interesting option for those who have aortic dilatation due to Marfan or BAV (which is my case). Exercise and sports are usually safe if there is mild aortic root enlargement but no other heart or vascular problems.