They all cause a small bit of obstruction to blood flow as it leaves the heart. Perhaps the best course of action might be to start off very conservative with exercise, as you are doing, with periodic assessment of the aortic valve and aorta with echo and CT. You might then gradually increase the activity and monitor for any bad signs with the periodic echos and CTs. He had a mild BAV and was told that he can play with no restriction. In March 2019, media outlets hailed two new studies on transcatheter aortic valve replacement (TAVR) as potentially signaling the beginning of the end of open heart surgery for aortic stenosis. 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. The HAART 200 is an innovative device that helps in the repair of BAV, allowing patients to avoid aortic valve replacement. Hi Larry, Is the biggest risk (from numbness) a over-calcified valve which would cause lack of blood flow? Bicuspid aortic valve is a type of abnormality of the aortic valve. Thats the main reason for choosing a tissue valve in my case. I have only trivial aortic regurgitation. Im am in stres ?! Have you heard about the PEARS procedure? Unfortunately his cardiologist took that from him so he focused his energy and talent on basketball. CT or MRI may be more accurate. My cardiologist gave me green light for everything except strenuous exercise (used to train for ironman and similar challenges). At the age of 12, she had a procedure to widen her valve as her heart condition continued to have an impact. Given my age and activity level, do you think it would be beneficial, or even prudent, to explore a valve repair surgery as you described above? Vanity Fair may earn a portion of sales from products that are purchased through our site as part of our Affiliate Partnerships with retailers. 1. When you start seeing changes with regurgitation does it progress quickly? Ive recently joined the gym to get fit an toned up but I cant get a clear answer from the cardiologist of what weights I cant actually do at the gym. Looking through the reader comments here at the blog and reflecting on the athlete inquiries Ive received, I thought Id cover some of the major issues. Between one and two percent of all people have this defect, and it affects more men than women. I was to the understanding that the aneurysms caused in bav patients was due to the problematic bav valve causing uneven blood flow to cause uneven pressure on the aorta. My cardiologist has advised me to avoid high impact activities such as weight lifting and endurance training. On Monday the 13th, I had my annual echo. Do you think the weights Im doing at the moment seem OK with those results ? Finally, many patients are able to return to their sports after successful operation. November Cover Star Gal Gadot Is in a League of Her Own A First Look at Diana and Margaret Thatcher in The Crown Season Four Celebs Roast Trump in Rhyme for John Lithgows Trumpty Dumpty Book Brace Yourself for George Clooneys Apocalyptic Movie The Midnight Sky The Best Shows and Movies Streaming This October Inside Netflixs Latest Binge-able Escape, Emily in Paris The Crowns Young Stars on Prince Charles and Princess Di From the Archive: How Hollywood Sharks, Mafia Kingpins, and Cinematic Geniuses Shaped The Godfather Not a subscriber? 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 was hoping that if the ultrasound numbers dont change much, the endurance will not decrease significantly. The value of CT/MRI comes when a millimeter or two makes a difference in treatment, restrictions, surgery, etc. I would pose these questions to your doctor(s) since they are most familiar with the details of your situation. People can live normal lives with Congenital Heart Defects. To no surprise, people are worried about me running tomorrow. For athletes who return to sport after AVR and aortic replacement, its important to settle on whats safe with your doctor(s) ahead of time. Many thanks. We were to see them in 3 months. In 1997, Dr. Starnes led a team of three surgeons who replaced the aortic valve in then-actor Arnold Schwarzeneggers heart. I would encourage you to have further discussion with your doctor(s) about EXACTLY what forms of exercise are safe. He is very athletic. The increased stroke volume and cardiac output may cause . I understand that we are only beginning to learn about the use of ARBs in patients who DO NOT have connective tissue disorders like Marfans syndrome. The false lumen extending into the abdominal aorta was left since the point of origin in the ascending aorta was repaired. Thoughts. Thats always the concern with new techniques with limited follow-up data. Fox News anchor Bret Baier has a . 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. 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. Last i took him for the check up and everything is still the same but they said now the guidelines has changed and he is on the borderline of Mild to Moderate which will move him to restricted activities. 3. In 1997, Schwarzenegger underwent heart valve surgery to correct his heart defect. Unanswered questions include: Can a bioprosthetic valve wear out more quickly than expected? ), What do you think? Also he told me I can lift weights and do other activities. EKG and echocardiogram were done showing BAVD. 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 . Congenital heart issues affect approximately 40,000 people born each year in the U.S. and are one of the most common types of birth defects. Consensus guidelines suggest that athletes with mild aortic regurgitation and no other heart problems can participate fully in their sports. Maybe thats not surprising, given that Im a heart surgeon and that many individuals with BAV need operation at some point. 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. I had AVR exactly 1 year ago to the date. Athletes in this circumstance should collect opinions from their doctor(s) and make very careful considerations before returning to exercise. Post 2 years and Ive yet to get back to my high level of racing fitness and wanted to see what should be expected. I would really like for people to not have to experience what I had to experience, she continued. I have no proof this may be causing my less than stellar performance or if perhaps I should have more patience. 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. Kimberly was born with an abnormal valve, but didn't begin to develop symptoms until her 40s. Bicuspid aortic value ppg 24 mmhg First, a disclaimer.My practice is devoted to adult patients. 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. Log in, September 26, 2013 By Larry Creswell, MD 155 Comments. Keep us posted! He is certainly expert in the area of drug therapy to reduce the rate of aortic enlargement. 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. Prescriptions for safe exercise will need to be carefully tailored to your particulars. I am healthy, strong, and active. I used to do HIIT and moderate to heavy weight 5 days a week before my physical complications. 2. There is recent interest and experience with aortic valve repairinstead of replacementfor patients with BAV. How severe are the problems? Is operation needed? They all underwent aortic valve replacement. 2k erg test. The valve may also become stiff due to calcium deposits on the leaflets over time. I would very much appreciate your opinion weather he can continue his regular football training or should stop it. There is a readable section related to BAV. There are simply no reports that describe the experience of athletes returning to ECer ise (or training) after aortic dissection. It functions as a one-way valve, opening and closing with each heartbeat, which keeps the blood flowing in the correct direction. The aortic valve allows oxygen-rich blood to flow from the heart to the aorta. Be specific. I believe that many Cardiologist are not as experienced regarding how to advise high-performing athletes (even older ones like us). I was running 9 to 10 minute miles. Aortic valve stenosis: Your aortic valve narrows, reducing blood flow through it. With so many similar stories, do you know why there is not more statistical data or studies done with regards to sports and BAV and changes in aortic diameter? Make no mistake, though. Catch up on the years best movies, whether in theaters or now streaming at home. Onside rations would be needed for hose with Marfans syndrome or other diseases of the aorta. Easy bicycling might work, but I suspect that running wont be workable with that cap. They are located between the ventricles and their corresponding artery, and . There is a risk of sudden death in individuals with BAV, probably related most to aortic stenosis or aortic dissection/rupture. To me, you know your own body and what you can manage whilst straining as little as possible. My name became public 25 years ago this week. Search Heart Hospitals I am young with many years ahead, I dont want to accept this just yet when I know theyre is possibilty of repair. She is afraid, I can understand that. At approximately three months I became very ill and was diagnosed with prosthetic valve endocarditis. The aortic valve prevents blood from flowing back into the left ventricle of the heart. I have been factual with him and told him worst case scenario is he is done with both and have pushed him to see the positives of exploring other things to do. I want to continue weightlifting .. what is your opinion about this ? Normal LV diastolic function. The actress, 44, found out she had a leaky valve in 2002. No pulmonary hypertension 27yr old male. Several famous people were reported to have had bicuspid valves: former first Lady Barbara Bush, the comedian Robin Williams, and California Governator Arnold Schwarzenegger. Thanks for sharing your sons story. 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. Thank you for your expert opinion. The issue of how much (& what types of) exercise after surgery is difficult because we dont have good studies (& evidence) upon which to base recommendations. I think its reasonable to think of things this way. Im keeping my heart rate below 150, 160 at most but just for short period of time. Have completed an excercise stress test and signed off as ok on reaching level 13. I just thought it was muscle strain., My body cleared the blockage itself, said the game show host, who credited the aspirin he was taking for what he thought was simple muscle pain. I feel fantastic and have already been walking the streets of Cleveland enjoying your amazing statues. Its now 8 months after surgery and Im pretty much back in my every day life, was even granted to attend my pilot medical tests which are due in 2 weeks. I had a ventricle septum defect patched up shortly after birth with no further follow up and a full recovery. Surgeon Q&A: What is TAVR Valve-in-Valve? First, Id encourage you to follow your doctors advice. I have been doing this for the last 5-6 years now and am hopeful it can continue. All they said is dont really do weight where you can feel the strain in your neck ?!? Yes, I am aware of the work by Dr. Dietz. I am 6ft 3 . Today, echocardiography (ultrasound) for screening or diagnostic purposes for some other heart problem is the most common way that BAV is detected. Our only tool to keep track of aortic enlargement is repeated measurements with CT or echo. 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. With aortic root 39mm. Any person in my family there was no problem with the heart. I see Im not alone. No operation to replace/repair the aortic valve and yo replace the ascending aorta is minimally invasive. Thats just a marketing gimmick. They may also disrupt the normal flow of blood through the heart. Can you direct us to ANY research on the effect of endurance sports on AVR patients? My questions are: can my root dilation remain stable? Finally, athletes are not spared. Barb. And my doctor do not give me responsive and exact answer to my questions regarding sports. Since my initial post i decided to call another pediatric cardiology hospital in our state, University of Michigan Pediatric Cardiology. It makes the heart work harder than it should. 1, 2 Much of the data relating to its complications derive from necropsy studies since reliable . He also has minimal leakage at the valve aorta. My mother passed away last May following her second AVR. Im not sure how those two problems would be related. no tiredness, no dizziness, etc. Robbie Benson - Actor/Director - Bicuspid Aortic Valve. "Women are the natural caregivers; we take care of everyone else under the sun," she says. Thanks for the very insightful post, and for taking the time to reply to everyone here. The valve will become healed (scarred) into the surrounding heart tissues with the passage of time. Hello dear doctor. Often times, especially for patients with tissue heart valve replacement devices, the valve simply wears out. I feel as though Im recovering well and, having no other conditions or comorbidities, rapidly. I dont want to do any damage or compromise my homograft as the last surgery was a very difficult recovery. In some cases a particular arrhythmia that is responsible for your feelings of palpitations or light-headedness could be identified.and options for treatment could be presented. Does the (unreplaced) aorta enlarge over time? My son is a baseball player, so that is good. The notion is to reduce the number of cycles of heart beat x high blood pressure. Thanks. 6 weeks later Im still experiencing symptoms that (in the back of my mind) have me thinking about the BV issue. Im a 51 year old male who had aortic repair (5.8 cm) and bovine valve replacement AVR surgery 2 years ago. Follow up for development of these functional lesions is indicated. Im not surprised that youve received a conservative recommendation about exercise. The procedure has the potential to bring the aorta to 4.3/4.4 and avoid further enlargement. Those with symptoms are usually identified (BECAUSE of those symptoms) in the first year or two of life. Specifically, Im wondering about inversions like forearm stand, head stand, and hand stand. 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. March 15, 2023. Glad Ive found this website! A lot of people have it, she told Access Hollywood in 2009. 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. We have contacted the Cleveland Clinic to learn more and will report back soon. The doctor allows me to do moderate sport defined by her like not 20k each day; 20k per week should be fine. We just dont know. I had a good childhood being very active in sports and physical activity, I had just had to watch out for contact due to warfarin. Do you opration? Maybe you can help me with some questions. Before 2 years my aorta was 37mm . I was training for a marathon when I was 62 years old and diagnosed with BAV with severe regurgitation. My daughter (16 y/o) has a St Jude mechanical mitral valve (adult size valve even though she has had it for 7 years). Can you tell me what is to much, are push ups or pull ups heavy lifting, is 3 time per week 5 km running with 10-12 km/h pace to much? Considering the results of my stress test and TOE, do you think it could be my heart and should I seek 2nd opinion. This is such an interesting blog, I wish I had known of it sooner. I have: Hi . While I no longer due very strenuous activities, I still play softball, golf, kayak, ski, and do play hockey every now and again. Its not around incision, its mainly middle of left side. She learned she needed an aortic valve replacement in 2009 and underwent open heart surgery, receiving a mechanical valve to replace her damaged aortic valve. Thanks for sharing your experience, Randy. Therefore, people . I would not want yo distinguish between the various forms of static exercise that you mention. My son is 16 years old and his story is very similar to many I read on your blog. Kim Kardashian Doja Cat Iggy Azalea Anya Taylor-Joy Jamie Lee Curtis Natalie Portman Henry Cavill Millie Bobby Brown Tom Hiddleston Keanu Reeves. I do not know aorta measurements. As I train triathlon I check my heart every year and there is small back flow (the same last 5 years). I take bisoprolol (low dose) and my pressure is currently normal . 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? We have decided to wait and watch. Yes, there are certainly patients with BAV who never need operation. Then, a Dacron fabric tube can be used to reconstruct the aorta, in a so-called valve-sparing aortic root replacement. After that, most patients can gradually return to activities that put stress on the sternum and upper extremities. What Is Bicuspid Aortic Valve Disease? Arrhythmias may sometimes manifest many years after surgical repair of congenital heart defects. The BAV is monitored annually, the doctor told me that Im currently in the grey zone but stable since I started the monitoring. Ordinarily, athlete patients with mild degrees of valve regurgitation can continue to participate in their sports. Congenital heart issues affect approximately 40,000 people born each year in the U.S. and are one of the most common types of birth defects. i.e. This can be very frustrating to athletes who are used to being more active. Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1-2% of the population. ( I was much worse though). As I mentioned in previous comment my recovery is going great. The video is just 1 min 42 sec long. Thus far shes had only minor bruising (shes 6ft and has a solid build). It will probably take a visit with a surgeon (who has all of the pertinent details) to outline the possibilities for you. Then, Arnold's pulmonary valve was switched to the aortic position. A bicuspid aortic valve only has two of these leaflets. "Until then, stay close.. There was only a 0.2 cm increase in the previous 7 years (so from age 21 to 28). Aortic stenosis will limit athletic performance at the top end. Thanks! His only complaint or change is shortness of breath with stairs. . 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. 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. Apparently I also have a mildly enlarged IVC as well as mildly enlarged left and right atria. I seen my cardiologist yesterday and this is the first year in 4 years that the aneurysm hasnt grown a mm. A cadaver if valve is then used to replace his pulmonary valve. Probably a bicuspid aortic valve but there are many other possibilities Reply Thank you for answering these questions. 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. I had a Bentall with mechanical valve done in Feb 2017. The tragic event's silver lining was that it caused Latifah, 46, and her mother, 67, to bond. Lastly, a human donor valve was inserted into the pulmonary valve position. 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. 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. But if you have a bicuspid aortic valve, you only have two cusps. I am a competitive cyclist, neither the Cardio or my Doctor said I should not be racing bikes anymore, does that sound reasonable to you, my doc did say to monitor the aortic root size yearly. I love running. when I discussed this with my Dr. he reassured me that its not my heart causing it. I am playing basketball I am doing 100m and 200m and swimming . 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). My mom [and aunt] passed away [in their 60s from heart disease], and my dad had a heart attack when I was around 10 and he had a triple bypass, the actress told PEOPLE. 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. Data from these studies supported the U.S. Food and Drug Administration's approval of TAVR for low-risk individuals - replacing a narrowed aortic valve through a small incision in a procedure . This almost seems like an off the shelf answer and Id therefore be really keen to find out your thoughts? Theres no reason to not be CPR certified.. I have a call in to his doctor but what do you think? In short, I consider myself to be a high level athlete. The typical symptoms are fatigue or shortness of breath, particularly with exertion. Open heart surgery is sometimes the best option, but it is not always the only option. my age is 20 right now Only your cardiologist and heart surgeon will be in a position to make those considerations. Having a congenital heart defect means you are born with a problem with the hearts structure. Ive thought that the next visit to the pediatrician would be a good opportunity to discuss the issue. In addition to running, I also perform moderate to high intensity resistance (weight) training 5-6 times per week. Again, this is a topic that is not yet well-researched. 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. Holding breath during lifts valsalva). (I'm a 17 year old female)After a heart echocardiogram yesterday we found out I have a bicuspid aortic valve, I originally went in to the cardiologist for extreme fatigue, constant racing heart (avg around 130bpm resting), palpitations, spells where I almost faint, feet swelling and turning purple, etc . The GOPs failure to get the 118th Congress going shows how the performative nature of todays Trumpified party is making it incapable of governing. Perhaps the doctor could contact the specialist and request an earlier appointment, if that made sense. These Famous People Survived Congenital Heart IssuesYou Can, Too, On-Site CLIA Certified Laboratory Services, Click here for COVID-19 & Vaccine Information, Actor, body builder and former California Governor, After winning three Super Bowls with the New England Patriots, linebacker. Frankly Im worrying quite a bit about thisand I feel like its causing additional chest pain and shoulder pain. In practice, the indications for aortic valve replacement for severe aortic stenosis or severe aortic regurgitation are straightforward and uncontroversial. Do you think the jiu-jitsu (e.g. Surgery. There are many causes of light-headedness and chest discomfort that are not related to the heart. Athletes with mechanical or bioprosthetic heart valves may participate in low and moderate intensity sports, Athletes who are taking blood-thinning medications should avoid sports where bodily injury, with potentially life-threatening bleeding, might occur. 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. Dr. Larry, I do appreciate your insightful article very much. Thank you so much for your reply. Routine endocarditis prophylaxis is . You are correct that we worry about the influence of such activities on the enlarged aorta in those with BAV. Perhaps you could organize such a visit for a 2nd opinion regarding safe levels of exercise? In addition, the Left ventrical has slowly increased over this same time period from 5.87 to 6.6 cm. The heart has a difficult time coping with extra demands of exercise. Currently, it is estimated that about 5% of those with bicuspid aortic valve disease will experience aortic dissection. Males are about twice as . Thank you! I have moderate to severe regurgitation and the heart is enlarged as far as I understood. Would you recommend taking beta-blockers at this stage? There are a multitude of patient-specific circumstances that must be considered when deciding if and when operation is needed. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Dr. Larry Creswell on athletes and heart health. 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. Great to hear that youre doing cross country running. My cardiologist (whom I trust) said to keep working out like I always have (good news for me). "Were saying to put the focus back on you and make a date with your heart.". I hadnt heard about the technique previously. Im 53. There can be issues with aches and pains even months after operation that still relate to healing. I have been given no restriction to date in any physical exercise as my valve is in decent condition. Last week I visited a doctor and here are the changes for the last year (before|after): Also, my next appointment is, unfortunately the week after my next marathon (which I will be pacing and not racing). Is a CT or MRI absolutely necessary for measuring the aortic diameter? What a great resource! . 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. He has stenosis and moderate regurgitation. And now my aortic root is 42 mm. I suspect it had been leaking for a long time, as I felt no different; however, my recovery from long runs took longer than in the past (old age?). Measurements of aortic diameter can be made with echocardiogram. In general, we recommend no weight lifting in patients with BAV if the aortic diameter is greater than 4.0 cm. Most probably not pericarditis cause I had it once so I know that pain type, but again, maybe its some other type. I see in this blog that Dr. C noted: Compared to our own native valve, all of the available prosthetic substitutes have a small degree of aortic stenosis built in, unfortunately. what would your advice be for training & competing? The issues related to repeat aortic valve surgery, with or without replacement of the aorta, are complicated. There are certainly athletes whove returned to their sports after valve (and aorta) repair/replacement. Hi Larry, thanks for doing this website, I wish there were more like it. It is very difficult to find information regarding the athlete and BAV. swimming? Less than one month ago Schwarzenegger was (virtually) hosting the Austrian World Summit of the Schwarzenegger Climate Initiative, which introduced speakers like Prince Charles, Jane Goodall, and Pakistani Prime Minister Imran Khan. Related posts: Now, fully healed thanks to two stents in her arteries, Lucci is spreading the word. All severe aortic stenosis patients who are experiencing symptoms should ask for a TAVR evaluation. Exercise and sports are usually safe if there is mild aortic root enlargement but no other heart or vascular problems. 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. (Or do I just need to train even harder??). Last few weeks Im getting chest pain on left side (very rarely on right side) while running and doing push ups. A bicuspid aortic valve (BAV) is the most common congenital heart defect, occurring in approximately 1%-2% of the general population. Ordinarily, race walking is considered to be in the same category of activity as long-distance running. I think hes amazed by what I have described for my workouts of 65+ mile rides several times a week. Thanks for the enlightening article. To much info to much detail so much information and advice. The potential downside relates to durability.