Hi xantho,
These are all important questions and I can understand your concerns about restricting your sons activity.
The family history may indicate the presence of a genetic mechanism for aortic dilation. In addition to Marfan syndrome there are other conditions which are broadly classified as 'aortopathies', and include familial thoracic aortic aneurysms & Loeys-Dietz syndrome, among others. A review with a clinical geneticist can be very helpful in exploring this possibility and would be important for both diagnostic and prognostic reasons (i.e. being able to predict the likelihood of future events and thresholds for intervention). It can also be important for future family planning.
Cardiologists take progressive increases in aortic dimensions very seriously because of the risk of death due to aortic dissection. Another complication of increasing aortic size is leakiness of the aortic valve (aortic regurgitation) which can impact ventricular function. Weight lifting results in periodic increases in pressure in the aorta and there is a potential risk of aortic dissection. There are no large studies to support this statement but there are anecdotal reports / case studies, and therefore cardiologists educate patients about this potential risk. A progressive increase in aortic size would be a reason to switch from heavy weight lifting to a program in which lower weights are lifted but with greater repetitions (15 minimum) with a focus on avoiding breath-holding and heavy jerk and lift type actions.
The most relevant article for your question is that by Babaee Bigi in the American Journal of Cardiology 2007. In that study 100 male high intensity (weight lifting) athletes were compared with normal 'controls'. There was evidence of increasing aortic root size with increases in strength training. Note that patients with aortopathies were excluded from this study. Whether Marfans patients and others with aortopathies have further accleration of their aortic root size was not addressed in this study.
Try googling Babaee Bigi American Journal of Cardiology 2007 to view this article. There will be links to other relevant studies also.
I hope this information is useful. There are also physicians and surgeons with a special interest in aortic disorders that may provide individual assessment and advice to your son. If interested, try copying and pasting this link into your web browser:
http://my.clevelandclinic.org/heart/departments-centers/aorta-center.aspx
Take care and good luck
Thank you for your reply. It answered some of my questions and gave us some other things to consider, for example a visit with a clinical geneticist. I'll look up that article reference. Currently we are trying to line up a 2nd opinion specifically about the recommended no activity for 6 months while on the beta blocker. Thanks too, for the link for my son.
Also, I found the doctor's letter regarding my father's enlarged aortic root, discovered on an ECHO when he was 60 in the late 1980s. The measurement was 4.7 cm. At that time he was experiencing atrial fibrillation. I will ask if it has been measured since then. He continued swimming, gardening, and walking after this discovery. Both my sister and I were screened at the advice of the doctor and our roots are normal.
Hi Xantho,
Given case reports of (1) aortic dissection in patients with aortic dilation and (2) evidence for progressive enlargement of the aorta in athletes who participate in high-intensity weight lifting, I would not recommend that he continue with this activity.
Whether he needs to stop all forms of exercise is unclear and I agree that some alternative form of exercise is important. Based upon the information provided I see no reason why he could not switch to swimming, running, cycling or rowing. Perhaps there is some additional information I am not aware of but in any case I agree that a second opinion regarding exercise may be helpful.
Another thought I had for your case was to contact the National Marfan Support Group. This group also provides advice to non-Marfan patients with other forms of aortic disease. Here is the link: http://www.marfan.org/marfan/2307/About-the-NMF
Take care and good luck.