We have decided to wait and watch. Can you advise and or recommend a specialist? My questions are: I dont have any ayptoms. Early after operation, and for perhaps the first month, we typically limit activities that place stress on the shoulders and sternum. She advised us we should start to consider surgery but would follow up with us again in 3 months. A total of 25,556 newborns (51% male; mean age, 12 days) underwent echocardiography. Im not sure how those two problems would be related. We just saw them in January. My questions are Thank you for your assistance in this matter. Negative Stress Echocardiography Aortic enlargement in patients whove had valve replacement for BAV can be a vexing problem. The CVTI was created under the leadership of Dr. Vaughn Starnes, chair of the Department of Cardiothoracic Surgery and surgeon-in-chief at the Keck Medicine of USC. There is a risk of sudden death in individuals with BAV, probably related most to aortic stenosis or aortic dissection/rupture. 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. It makes the heart work harder than it should. enlarged LV = 350ml 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. My son was also complaining of shortness of breath with stairs mild and feels tired more easily. Bicuspid aortic value ppg 24 mmhg Thank you for your time. 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. Women are 50 percent more likely to be given a wrong diagnosis after a heart attack and are at a greater risk of dying within a year of a heart attack than men. Dr. Larry, very helpful content. Consensus guidelines suggest restricting activities in athletes with BAV and aortic diameter >4.0 cm. There are four valves of the heart, which are divided into two categories: Atrioventricular valves: The tricuspid valve and mitral (bicuspid) valve. We are wondering is there a science to knowing when he should have the surgery? I love running. http://www.24hourgym.us. 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? I cant do that justice here. Please refer to this article if not: https://academic.oup.com/ejcts/article/50/3/400/2197426. While the defective valve may be easy to see, the defect also causes changes in the tissues of the aorta and the heart. The bicuspid aortic valve opens and closes abnormally, and can result in leaking of the valve. September 13, 2017 1:00 PM. I like to thank you in advance for reviewing my question and also, thank you for such a great blog. Check out Anthony DiLemmes blog, Anthonys Heart Valve Replacement Saga. It sounds like youve gotten conventional advice regarding sports where there is a risk of bodily injury. The potential downside relates to durability. 2. I have no proof this may be causing my less than stellar performance or if perhaps I should have more patience. 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? He is very athletic. Enjoy! My cardiologist has advised that while marathon running is out, shorter runs (up to 6-8 miles) and pilates are both fine for now. But Bob, you confirm that it does for you; and unfortunately I see same for me although 25 years younger. Is that so, or can it be measured by the echocardiogram as well? Bicuspid Aortic Valve with trivial AR. Males are affected 3:1 compared to females. Bicuspid Aortic Valve To revist this article, visit My Profile, then View saved stories. Im doing cardio as they said thats fine and I was lifting free weights tonight of 10kg. So, my question then is really, what should I look out for? A 2019 report suggests that bicuspid aortic valve disease is the most common congenital heart valve problem, affecting between 0.5 and 2 percent of the general population. 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. Unfortunately, I really cant point you to such studies. 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. People can live normal lives with Congenital Heart Defects. I was running 9 to 10 minute miles. To much info to much detail so much information and advice. No stenosis or regurgitation, aorta 27 mm at the time. Yes, there are many athlete patients whove had operation for BAV/aortic replacement and returned to a variety of sports. My question here is what is the damage I can cause to my heart, mechanical valve, if I keep my heart rate at hi intensity levels? Bicuspid aortic valve: A bicuspid aortic valve only has two leaflets, increasing the risk of circulatory problems and heart conditions. With the blood thinning needed for a mechanical valve, serious bleeding may occur with injuries. Dr. Larry, thank you very much for your blog! I have 6 years to go to retirement at the very least. Hi dr. However, my problem is that if I can train at this pace then I can still run but I certainly cant compete! It usually consists of three flaps of tissue what are called valve cusps. Does lifting weights up to 100 pounds and being cleared for push-ups, pull-ups, all cardio, etc., sound reasonable? Hi all, How much exercise is too much for someone with a functional BAV? Just still unsure however if my bioprosthetic valve affects my cross country running times. Up until this time shes played volleyball, basketball and has even run track in elementary. But like a lot of women, I thought that heart disease was an old white guys disease," the former talk show, 56, host tells PEOPLE. Historically, a heart murmur was the most common reason affected individuals were identified. Specifically, Im wondering about inversions like forearm stand, head stand, and hand stand. Ad Choices, Blood molecules as they exit the left ventricle: I'll be back., The 42 Best Romantic Comedies of All Time, The 25 Best Shows on Netflix to Watch Right Now. Between one and two percent of all people have this defect, and it affects more men than women. I would really like to know if I can (or shouldnt) push myself as hard as I used to. To me, cardiologists are not sports people and air on being absolutely over cautious. Im a 51 year old male who had aortic repair (5.8 cm) and bovine valve replacement AVR surgery 2 years ago. Thank you so much! We dont have a crystal ball, though. I want to continue weightlifting .. what is your opinion about this ? Sounds like youre on the right track with your upcoming visit with a specialist. Here is a link to a diagram that categorizes sports according to their dynamic and static components: http://www.athletesheart.org/wp-content/uploads/2013/12/Classification-of-Sports-300217.png. Thank you very much for writing such a thorough and well informed article. As a consequence, these individuals develop earlier calcification of the valve leaflets, leading to narrowing, or stenosis. Hi, Further to this most recent discussion point I was advised that isometric exercises, such as planks and other pilates type activities, as I understand them, are perfectly safe with BAV. Very helpful. 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. these conditions occur mostly during my exercises at the gym and Im left very lightheaded and shortness of breathe. Hi . Thanks for sharing an update. For many patients, I recommend no heavy lifting (>10 pounds) for the first month after conventional heart surgery. The congenital bicuspid aortic valve (BAV) condition is a valvulo-aortopathy with substantial heterogeneity in its clinical expressions, associated disorders, complications, and prognosis. The only prudent course is to have periodic follow-up imaging to keep track of size/growth. Normally, your aortic valve has three cusps that regulate blood flow from your heart to your aorta. But if you have a bicuspid aortic valve, you only have two cusps. It doesnt help that I am a nurse. Finding this site is such a relief / source of hope for me thanks so much Dr. Larry!. Diagnosed last year while looking at something else. He also has minimal leakage at the valve aorta. Most people require treatment once symptoms develop. Thanks so much for all this info! I am an having trouble seeing the difference in the ross procedure and the bioprospthetic valve replacement as far as benefits go? While I no longer due very strenuous activities, I still play softball, golf, kayak, ski, and do play hockey every now and again. Anyway, I just wanted to say I found this article particularly informative. Okay, thats greatbut I left feeling uncomfortable with the diagnosis. The incidence of normally functioning bicuspid aortic valves is 0.6% to 0.9%.5 . Before that, I had never seen a cardiologist ever. 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. Males are about twice as . I was born with a BAV and but I didnt notice performance issues until the Summer of 2016, so I brought myself to the doctor. Aortic Stenosis I am a 60 yo female who has been active my whole life. Those with symptoms are usually identified (BECAUSE of those symptoms) in the first year or two of life. I dont know why this formed as I have had the problem valve replaced many years ago. Now I take brisk walks and run on the treadmill only occasionally. Ascending aorta is normal and so the rest. Im 33 and I do jiu-jitsu. I have a St. Judes Bovine valve now. Bicuspid aortic valve. 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 . My son will seek a repair when his conditions deteriorate. They may also disrupt the normal flow of blood through the heart. They call this type of heart attack the Widow Maker," she wrote. Hi Sean, Like you point out, its always wise to be vigilant after surgery for things that might be amiss.and get checked out. Ive a BAV with the fusion being between my right coronary and non-coronary leaflets. Your advice is always invaluable and most appreciated. I was training for 11th marathon at the time (over the past 13 years). Hi Dr. Creswell. Youve got the right idea, though. After the first month, patients are generally allowed to return gradually to all of their previous activities. Aortic valve regurgitation: Blood leaks back into your left ventricle instead of only flowing into your aorta. This is the only measurement that has gone down . 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. Is it possible that the valve will get loose? In fact, in some people they can go undiagnosed for years. I like to practice MTB and running competitively in local races. Less 100mmhg. Because BAV may be an inherited condition, Athletes with BAV, no significant valve stenosis or regurgitation, and an aortic diameterless than 4.0 cm can participate fully in their sport(s), Athletes with BAV and enlargement of the aorta to between 4.0 and 4.5 cm can participate safely in only low and moderate intensity sports (this would. Sounds like youre on the right track by getting things evaluated. I have wife and two small boys, I wanna live to see my grandchildren. This is an unfortunate situation for the athlete patient because the consensus guidelines do not yet recommend operation, yet advise against strenuous sports activities. 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. The guidelines were developed by an expert panel based on the scientific information available at that time: The issue has not been studied very well, but one recent study suggests that continued participation in sports for periods of up to 5 years does not change the natural history and progression of BAV. I did cardio training 3 times a week and weight training twice a week for 60 years. 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. What does heavy weights mean? My cardiologist has advised me to avoid high impact activities such as weight lifting and endurance training. My surgeon basically said, Lets get you back to living your life. Cardiologists always say take it easy. Our only tool to keep track of aortic enlargement is repeated measurements with CT or echo. That said, the recommendations dont address WHEN that screening should occur. It sounds like youre off to a good start with your recovery. Details of my condition: Sometimes my cardiologist says there is minimal change and he thinks my aorta had slightly enlarged by 1-2mm. 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. No enlargement of aorta or any other problems. Additional types of patients who should ask for a TAVR evaluation include: Bicuspid aortic valve patients who are experiencing symptoms. I would think that moderate would be a good term for 8-12 rep range, pullups (unassisted), and pushups. Barb. Although bicuspid aortic valves can occur . I am a 28yr old male, and Ive just found out about my BAV. 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. I would really like for people to not have to experience what I had to experience, she continued. Rest pulse (70 bpm|50 bpm) Needless to say, the diagnosis was quite overwhelming. It would be great to know what happens to groups of patients after AVR and aortic replacement that have returned to their various sports. If he is a candidate for valve replacement are these sports he could ever return to In the best case scenario? Editorial Review: Andrea Cohen, Editorial Director, Baldwin Publishing, Inc. The doc says the big risk is due to the blood thinners. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been systematically determined.Objective To determine the frequency and predictors of cardiac outcomes in a. Crossref Medline Google Scholar. 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. Bicuspid aortic valve (BAV) disease does not usually cause symptoms. 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. Obviously, I underwent emergency surgery to replace the aortic valve (Medtronic open pivot mechanical valve) and have the aneurysm repaired with a dacron graft. My cardiologist Said to not lift heavy weights. Left Ventricular Mass (LV mass/BSA 93g/m2| 114 g/m2, Septal thickness 0.93 cm|1.0-1.1 cm, Posterior wall thickness 0.93 cm|1.0 cm). However, his ascending aorta has been enlarging: 11/27/13 31 mm (echo), 6/10/15 39 mm (echo), 7/8/16 41 mm MRI). 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. I will do whatever I can to make sure my mom is comfortable and has whatever she needs, she said. From afar, its hard to know what might be responsible for your symptoms. Considering the results of my stress test and TOE, do you think it could be my heart and should I seek 2nd opinion. 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 . 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. It is very informative. The typical symptoms are fatigue or shortness of breath, particularly with exertion. 3. 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. They all cause a small bit of obstruction to blood flow as it leaves the heart. What a great resource! Is operation needed? Is this a possible explanation? Thank you to every doc and nurse on my team!". Thats important to keep in mind. Finally, many patients are able to return to their sports after successful operation. Im not sure I have all the answers from afar. Frankly Im worrying quite a bit about thisand I feel like its causing additional chest pain and shoulder pain. Bicuspid aortic valves can accumulate calcium deposits more easily than tricuspid aortic valves. I currently run 40 -50km a week and do two 2 hour intensive yoga sessions a week. My question is if my weight&lack of training or my BAV is the cause of difficulty in running. However, I always performed poorly when it came to the top end fitness tests e.g. Thats an issue to pursue with your sons doctor(s). In large-scale pre-participation cardiac screening programs for young, competitive athletes, BAV is one of the most commonly identified abnormalities. Consensus guidelines are developed to be broadly applicable, but the guidelines may not be applicable in a given athlete patients circumstance. Susp. Do you recommend any particular diet, exercise, vitamins,etc.? Kim Kardashian Doja Cat Iggy Azalea Anya Taylor-Joy Jamie Lee Curtis Natalie Portman Henry Cavill Millie Bobby Brown Tom Hiddleston Keanu Reeves. no symptoms yet please help. I would not want yo distinguish between the various forms of static exercise that you mention. The aortic valve lies between the heart and the aorta, the main artery . For these individuals, provided there is no other relevant heart disease, it may be appropriate to have follow-up echocardiogram and/or CT scanning every 2 years. Patients need operation if there is severe stenosis or regurgitation of the aortic valve.or if the nearby aorta becomes moderately enlarged. Randyyour situation has many similarities to mine; I would be very interested in sharing experiences. What have I observed and learned in the quarter century since? However, this is not always the case. (Have you heard of the studies by Dr. One doctor to told me just to control it and train as I like but the other one said that with those hearts parameters I will have only 1-2% to have operation in the future but if I will continue to do triathlon for sure I will have to have one. Lack of breath? His story is typical. 2012; 109:1632-1636. The Institute is a unique collaboration of cardiothoracic and vascular surgeons, cardiologists, pulmonologists and basic scientists all working together without the boundaries of departments or specialties. We see his pediatric cardiologist every 6 months. My cardiologist gave me green light for everything except strenuous exercise (used to train for ironman and similar challenges). my son has BAV he was born with. 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. http://games.crossfit.com/athlete/39565 Although bicuspid aortic valve is typically asymp tomatic at fi rst, it is commonly associ-ated with progressive valvulopathy and tho-racic aortic disease. My resting pulse is 55 and BP 115/82. Body contact sports may pose some danger to athlete patients who take blood thinners. 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.
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