Dilated Aorta with bicuspid Aortic Valve

[ZStuck]

Hello, I am 31 years old, I am 6ft tall and 285 lbs. I have a bicuspid aortic valve and my aorta is dilated to 5.0 as of last November. I have high blood pressure and I am on Lisinopril to control it. My cardiologist says that I can wait to 6.0 cm. Is that correct. Everything I have read says that number is lower when you have a bicuspid valve. My measurement the year before that was 4.6 cm, so it is getting worse.  Is it better to have this corrected earlier rather than later. Thanks for your time.


This discussion is related to aortic aneurism and/or dilation aorta?.

[ZStuck]

Thank you again, this has been really helpful, I am glad that I joined this site.

[skydnsr]

I meant to say, "as far as I know," not "as I know."

[skydnsr]

For what it's worth, I have had aortic valve replacement and aneurysm repair and have never been given any restrictions on walking.  I've never heard of any other aortic valve patients being limited on walking, either -- at least not reasonable walking or walking to tolerance.  (People can take anything to an extreme.  I'm not talking about walking 20 miles a day.  That would be extreme.)   And as I know, it is okay to lift light weights and go for reps, rather than trying to "max out."  

But my native valve was regurgitant and not stenotic.  If you are stenotic, then there might be different restrictions.  For instance, with stenosis, not only do you not want to lift heavy weights, I wouldn't think it would be safe to do certain types of strenuous aerobic exercise, either.  I've heard that even a treadmill test can be dangerous with advanced aortic valve disease, especially if the valve is stenotic.  

Some of this exercise limitation stuff was never an issue with me, personally, because I'm not terribly active.  For an athlete, even a a recreational athlete like yourself, there might be more significant limitations than for someone like me who isn't trying to push any limits.  I would say, keep seeking information like you are doing now.  

The guiding principle for exercising with aortic disease is to keep yourself in as good overall condition as you can, but don't stress the weakened tissue of the aorta, and don't overload your aortic valve's capacity to do its job.  Your own specific limitations are going to have to be determined by sound medical advice and also by your own common sense and general awareness.

[kenkeith]

QUOTE: "There is an apocryphal story about a cardiologist who bragged that he had successfully kept one of his valve patients off the surgeon's table for 10 years, by means of careful medical management.  And the surgeon's reponse was, "Yes, but then I had to replace two valves, instead of one."

There is a renowned surgeon for valves associated with Mayo Clinic who is on record saying the biggest problem he sees is the patient has waited too long!  The danger of waiting too long presents a risk of heart muscle damage, the heart chamber enlarging and reduced cardiac output.  A valve operation under those circumstances increases the risk of any
operation, and the heart may never again pump normally or completely recover.

Ask your doctor, it may in your best interest to modifying or limiting exercise. Those with severe heart valve disease need to avoid strenuous activities altogether.

"Safe Exercises
Mild exercises that do not severely increase your heart or breathing rate are recommended. For example, you can take leisurely walks. You could participate in gentle yoga. Also, tai chi and stretching are safe.
Unsafe Exercises
Highly aerobic exercises like cycling, running, or kickboxing should be avoided. Competitive sports are not recommended. Additionally, weightlifting is out. Lifting light weights is better. Any exercise that accelerates breathing or fatigues you, is not recommended".

I have for the past 6 years, participate in treadmill exercise for a half an hour 3 times a week at a pace that doesn't shorten my breath, cause fatigue, and with weights more repetititions with lighter weigths.

Take care, and thanks for your question.

[ZStuck]

Thanks, so the lifting is a bad idea, but is it okay to jog or walk still. The valsalva maneuver was interesting. Always appreciate info on my condition.

[skydnsr]

Okay, good luck.  I think you are approaching the problem in the right way.  I do agree with kenkeith about the heavy lifting, too.  The Valsalva maneuver (google it), where you are straining hard, is what stresses the aorta.  

[ZStuck]

Thank you both, very helpful. I am going to get a second opinion. I was never even limited with my weightlifting. Even after telling him that I do lift very heavy occasionally and that I get lightheaded at times. I dont want something to be overlooked because my cardiologist has gotten "Comfortable" with my case, or because he is trying to keep me off the surgery table. If there is a disection of the aorta while weightlifting, it isnt like I can run to the hospital and have them fix it. Kind of a scary thought.  Thanks again!

[skydnsr]

There is an apocryphal story about a cardiologist who bragged that he had successfully kept one of his valve patients off the surgeon's table for 10 years, by means of careful medical management.  And the surgeon's reponse was, "Yes, but then I had to replace two valves, instead of one."

This story illustrates the stereotype about cardiologists vs. surgeons.  Oftentimes you do get a different opinion about the timing of valve replacement from members of the two specialties.  Then it's up to you to decide.  But then, the cardiologist's opinion might change, once he hears that the surgeon wants to operate.

[kenkeith]

Lifting heavy weights may not be a very good idea; in fact it counterindicated for BAC.  For more information  http://www.medhelp.org/posts/Heart-Disease/question-about-bicuspid-aortic-valve/show/867002.

[skydnsr]

You can consult a surgeon at any time.  With a 5.0 aneurysm, you would not be out of line to request that your cardiologist go ahead and refer you.  If the surgeon also says wait, then fine.  The worst that can happen is that you got to talk to a surgeon, you got to ask him whatever questions you want to ask, and you got to assess your comfort level with him as a candidate to do the job when the time comes.  Many surgeons will operate at 5.0.  

[ZStuck]

Thank you, the symptoms that I have had are shortness of breath, and occasional light headedness if I am lifting weights. I have chest pains once in a while but most of the time I think they are muskuloskeletal. but I have also had my heart race before and feels like it is pounding really hard.

[kenkeith]

The question when to operate requires a surgical opinion.  You are in the size category and size progression when surgical intervention is considered.  If you don't have symptoms, there may be an advantage to wait.  Take care.