Aortic Stenosis and Bicuspid Aortic Valve

I operated on a young man (in his early 30’s) a couple weeks ago for aortic valve replacement. It reminded me that valvular heart disease is not limited to older folks. This particular patient wasn’t an athlete, but I have a cycling acquaintance here in Jackson who also needed aortic valve replacement in his 30’s.

The aortic valve is the valve that lets blood flow out of the heart, from the left ventricle (the heart’s main pumping chamber) into the aorta (the large blood vessel that carries blood to the rest of the body). Ordinarily, this valve has 3 leaflets that are arranged to produce a pattern much like the Mercedes Benz emblem, if you look at the valve from above. With each heartbeat, the leaflets open nearly completely, allowing for unobstructed blood flow out of the heart.

There are 2 main problems that happen with heart valves….the valve can leak or it can become obstructed. Today, we’re going to focus on narrowing of the aortic valve, that produces obstruction to blood flow, and this is a condition that we call aortic stenosis. We’ll leave the leaking valves to another day.

There are several causes of aortic stenosis, but, by far, the most common cause is age-related calcific degeneration of the valve. That is, over years and years, calcium deposits build up in the valve leaflets, making them immobile. The leaflets eventually become so stiff that they do not open properly….and produce obstruction to blood flow exiting the heart. Aortic stenosis is usually a problem for patients who are in their 60’s, 70’s, or even older. Because the problem develops gradually over many years, patients sometimes don’t notice the effects, but the 3 primary symptoms are: 1) shortness of breath with exertion; 2) chest pain; and 3) syncope (blacking out).

Patients come to medical attention because of one or more of the hallmark symptoms or occasionally because a physician hears a heart murmur. There is a characteristic sound, or murmur, associated with aortic stenosis and your physician can hear this murmur in a very particular location on the chest—just to the right of the sternum, above the level of the nipples. An echocardiogram (ultrasound) is used to make detailed pictures of the heart valves and can be used to quantify the degree of stenosis, or obstruction, as mild, moderate, severe, or critical.

Aortic stenosis is a serious medical problem. Patients with severe or critical aortic stenosis require valve replacement. There is no other treatment (ie, medicines) that can correct the problem. For patients with breathing difficulties because of their aortic stenosis, the average life-expectancy is less than 2 years without valve replacement. Major heart surgery is needed to replace the valve with a mechanical (eg, carbon fiber and metal) or tissue (eg, the aortic valve “borrowed” from a pig) valve.

But like I mentioned above, aortic stenosis can sometimes be encountered in a much younger patient….sometimes as young as in the 20’s. And this is often due to a congenital abnormality of the aortic valve in which there are only 2—and not the standard 3—leaflets. This occurs in 1-2% of the general population. For some reason, this arrangement predisposes the individual to earlier calcification and stenosis of the valve as well as leaking of the valve. This is relevant to the athlete because problems are likely to develop during the very active portion of a typical athlete’s active lifetime.

The second important consideration in patients with bicuspid aortic valve is that they are much more likely to develop enlargement (aneurysm) of the beginning portion of the aorta, as it leaves the heart. Over time, the aorta can enlarge from its typical diameter of less than 3 cm to 5 cm or more, the aorta and the aortic valve should be replaced….again, with major heart surgery

Professional triathlete, Torbjorn Sindballe, was recently in the news when he retired from competition because of bicuspid aortic valve and mild aortic enlargement.
Decisions about continued participation for patients with these conditions will need to be individualized, but should only be made after careful consideration of the risks involved. Athletes with mild to moderate aortic stenosis, and who don’t have symptoms, probably can participate fully in athletic activities. Those with severe aortic stenosis should refrain from strenuous activity as treatment plans are made with their physicians. Athletes with bicuspid aortic valve and enlargement of the aorta should refrain from strenuous activity.
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Comments

  1. says

    Hi I was just looking up blog topics about aortic stenosis, and ran across yours. My youngest daughter was born with severe aortic stenosis (as well as a coarctation which was diagnosed and repaired at 4 months old). She’s undergone a heart cath twice, the first time was to improve her stenosis. She now has mild-moderate stenosis, and her cardiologist says at some point she will have to have open heart surgery with a valve replacement. We don’t know when.

    Anyhow, I never hoped to read aortic stenosis and athelete in the same blog. I don’t know what the future holds for my girl.

    I just wanted to say that I enjoyed reading your blog. Thank you.

  2. says

    Thank you for this great info….and the simplicity in which it was given. I was diagnosed with mitral vale prolapse as a toddler and have it checked yearly (in my mid 30’s now). I also have a cousin who has been diagnosed with the same disorder but his has changed a bit in the past 2 years and he now has stenosis and is preparing to have the valve replaced. I was very athletic during my school days and never had any issues. Should I be worried as I get older? Appreciate your article!

  3. says

    Mis-Wen,

    Thanks for your kind comment.

    It sounds like you’re on the right track. Important to continue to keep an eye on the mitral valve prolapse (like you’re already doing). Many people with mitral valve prolapse have little or no problems with exercise.

  4. says

    Hi,

    My son was just diagnosed with BAV with mild (2.6 cm) dilation of the ascending aorta, he is 7 years old. I am terrified for him. What is the progression of this disease? Life expectancy? Can he still play baseball?
    Help…I have an appointment with a pediatric cardiologist, but, I need some answers now!

    Kelly

  5. says

    David,

    Thanks for your comment. Apologies for my delay in responding.

    It sounds like you are on the right track. A pediatric cardiologist is the right kind of doctor to be looking after your son. The pediatric cardiologist, after visiting with your son, examining him, and reviewing his s-rays or ultrasound images, will be in a position to offer advice about monitoring the condition and limitations, if any, on rigorous physical activity.

    The progression of the disease is probably highly variable. Many people with BAV live for decades and have no trouble at all. Others have progressive narrowing of the valve at an early age and require valve replacement. It would also be difficult to predict the progression of the mild aortic enlargement. Careful measurements made from repeat x-rays or ultrasound studies will allow your doctor to monitor the situation and be aware of any enlargement. This is important because operation is sometimes needed if the enlargement becomes severe or if the enlargement causes problems with the normal workings of the aortic valve.

    Hope that helps. And best of luck.

  6. says

    Hi Dr. Creswell
    I am 53 years old and very active. my main sport is Olympic Weightlifting. I had a Snatch of 92 kg and a clean and jerk of 121 kg. in November of 2009. In December my doctor had me evaluated because of a murmur he detected. After a complete workup of my heart i was told i had a bicuspid aortic heart valve and that the aortic valve was enlarged to 4.3 cm. My cardiologist told me I cannot do weightlifting any more or my aortic valve might enlarge too much and eventually blow. I have not had any symptoms at all. I love sport and love to train. i enjoy vigorous exercise and want to continue to compete. I would love to continue lifting. Am I in danger? Who can help me with a training routine or clear parameters to follow to continue an active sports lifestyle at my age. i feel i am very fit and i am not interested in slowing down. I am 6ft 6inches and 260lbs. I have been involved in sport all my life. Thanks for your help. Mike Walters a good friend and physical therapist recommended you.

  7. says

    Hello Dr Creswell,

    I present similar to Michael above – 6’9″, 270lb (no Marfens), BAV with severe insufficiency but no obvious health issues. Two questions pls

    – where can BAV patients find low cardio exercises for weight control and strength? There is a real lack of info on this topic.
    – why is it difficult for doctors to estimate expected valve size in large patients? My doctors have had difficulty determining how enlarged my valve is, and both doctors are well respected in their fields.

    Thanks
    Iain

  8. says

    Dear Dr. Creswell: I’m 59, and had a congenital BAV replaced sith a pig valve about 12 days ago, along with my ascending aorta. The BAV opening was about 1/4 of a normal aortic valve, when they removed it, and the ascending aorta was at 4.7 cm. My father died of an unexpected heart attack when he was 58, so I was very lucky to have caught this when my doctor detected a mummur about 2.5 months ago. Before then, and even leading up to the surgery, I’ve always been a big exercise person, running, biking, swimming, working out, etc.

    Here’s my question: my heart rate normally is and has been for long time around 45-50 (blood pressure usually 110/65). It goes toward the low end of the range if I’m very consistent with my running, etc., and towards the high end if I’m not; but it stays pretty much in that range.

    Since my operation (May 18), I’ve been experiencing atrial fibrillation off and on, and my surgeon and cardiologist have me on a 200mg daily dose of amiodarone, a 20mg daily dose of Lipitor, 12.5mg of Metoprolol (taken twice a day), and the usual temporary post-op doses of lasix and potassium. I was able to avoid taking Coumadin, compromising with my cardiologist on a daily dose of 325mg enteric aspirin (I’ve been using the 81mg dose successfully for years to thin blood).

    I have a feeling my heart is being medicated to beat at 60 beats per minute (see metoprolol and amiodarone, above), and it really wants to go back to 45-50. As I’m relaxing just before sleep is when I tend to go into atrial fibrillation, if it’s going to happen at all.

    I wonder if these meds are actually causing rather than resolving the problem. Remember, my heart is in perfect health in every other way, excect for the BAV and aortic aneurism.

    My solution to controlling the atrial fibrillation is to exercise a bit more, and it really seems to stabilize things (although we’ll see what happens tonight at bedtime).

    Should I just be patient with all these meds? They are all temporary; but some are pretty heavy-duty (especially amiodarone, Lipitor, and metroprolol). Or should I get with my cardiologist (I just saw him Thursday) again, and review them, given the reemergence of the AF). I honestly don’t think that most folks are used to dealing with atrial fibrillation after BAV in an otherwise healthy heart, so I’m eager to hear your insights!

  9. says

    I am an athletic 47 year old male and recently diagnosed with aortic stenosis and a bicuspid aortic heart valve. I took the treadmill stress test of 4, 3 minute intervals and was breathing and feeling fine until level 4 at which time I had to stop about 1 minute into the interval due to extreme breathing problems. I was a very competitive soccer player until 24 and continue to be a very active athlete. Intense workouts of running, weightlifting, soccer and tennis are my cure for keeping chronic depression in check. It has been 4 weeks since my diagnosis and six months since I have had a hard, rigourous workout. My cardiologist does not recommend valve replacement yet as my symtoms are moderate, not severe.

    If I have surgery, is it possible for me to again participate in rigorous workouts?

  10. says

    Scottj,

    Good to hear from you. And a great question.

    Yes, athletes who have undergone aortic valve replacement can participate fully in their sport(s). Athletes who choose to have replacement with a mechanical valve (that requires life-long blood thinning) should avoid sports, though, where contact injuries are common. Athletes who choose to have replacement with a tissue valve don’t have that concern.

    Good luck.

    Larry

      • Larry Creswell, MD says

        Bowling is usually a low intensity activity that would be suitable for patients after heart valve replacement.

        Always wise to ask your doctor, though, about any plans for exercise after heart surgery.

  11. says

    Dr. Creswell. My husband, age 47 was a semi-pro cyclist. He had a new physician last year who detected a heart murmur and sent him for an echo which showed he had a BAV. He had a mildy dilated aorta – ascending aorta diamter was 3.9 cm. Trace mitral regugitation, mild aortic stenosis with moderate aortic insufficiency. He had left ventricular enlargement with normal systolic function and severe left atrial enlargement. He reported having no symptoms. He obtained 3 cardiologist opinions about whether or not he could continue his competitive cycling and he was given the ok. He had a repeat ehco in March 2010 which showed no changes from the original echo in June 2009. This June after finishing a race he collapsed and died from a sudden cardiac death. From what I understand he had venticular fibrillation. I’m curious if there is an increased risk for sudden cardiac death when you have a BAV? I know once you have symptoms from BAV you require a replacement. Being a competitive athlete I now wonder how one would know if you’re having symptoms versus the normal feeling one gets when you push yourself physically? My questions are 1) when you have a BAV are you at a greater risk than the general population for a sudden cardiac death? If so what’s the percentage. 2) If you do you symptoms from BAV is there an even higher risk for sudden cardiac death?

    Thank you for your time.

    Elle

  12. says

    Elle,

    Thank you so much for sharing your sad story here. My heart really goes out to you.

    You ask a couple important questions.

    We ordinarily follow patients with BAV and enlargement of the aorta because of: 1) the increasing risk of aortic rupture as the diameter of the aorta increases and 2) the likelihood that significant narrowing (stenosis) of the valve may occur early in life. I must say that I’m not aware of studies about the risk of sudden death due to arrhythmias in this patient group. But I wouldn’t be surprised if there was at least a small increase in that risk compared to completely healthy individuals.

    Your second question asks about symptoms and BAV. People with BAV develop symptoms when the valve becomes severely narrowed. Often years may go by with no symptoms, but we know that once symptoms (shortness of breath, chest pain, or blacking out) develop, that the life expectancy is severely diminished….and that’s why we recommend operation for replacement of the aortic valve at that point. Athletes who are “in tune” with their bodies, will often notice subtle changes in their shortness of breath with exertion….it will feel out of proportion to the effort. But these changes usually happen gradually and sometimes you have to reflect back to 6 months or a year previously for comparison to realize that something has changed.

    Hope that helps. And again, my condolences.

  13. says

    hello!
    i am 22year old chap! & i’ve got bicuspid aortic valve i consulted 3-4 great cardiologist here in bombay and two of em has told me not to do intense workout. i am a swimmer i’ve got swim meet next month and my father isnt allowing me to compete bcuz of the doctor consult..i never had chest pain or other heart symptoms i can swim whole day.
    neeed your consult now!

  14. says

    Vishal,

    Thanks for your email.

    I know that it can be frustrating to receive differing opinions from your physicians, but they will be in the best position to offer you good advice.

    That said, simply the presence of a bicuspid aortic valve should not preclude athletes from participating. It is the associated aortic stenosis (narrowing of the valve) or enlargement of the aorta that are the issues that might lead your physicians to recommend that you not participate.

    Larry Creswell

  15. says

    What a very interesting article. I hope you won’t mind my quizzing you. I’m 34, overweight but very physically active (6’1, 275 lbs, recently down from 320lbs), working out seven to ten times a week). I was diagnosed with mild asymptomatic aortic stenosis (defect of spetum causing partial blockage) in December. I find that when I have a spell of consistent training for about a month or so, I develop a pronounced and consistent arrythmia at rest and was wondering whether as the heart gets stronger there could be an added impact on heart function from the murmur?

    just curious

    Thanks
    Selwyn

  16. says

    Selwyn,

    Thanks for your comment.

    When aortic stenosis is due to thickening of the septum (rather than narrowing of the valve itself), any additional thickening of the heart muscle that might come from exercise may produce worse symptoms.

    I’m not sure what to make of your situation with arrhythmias–may or not be related to the aortic stenosis.

    Best course is to continue to be followed by your physician for this problem.

    Larry

  17. says

    Hi. I have a son who is a competitive swimmer. He was diagnosed with bav at age 1 and later diagnosed with mild to moderate aortic stenosis at age 11. Since age 11, if I am saying this correctly, his gradient has measured at 30 & has not changed. His cardiologist said he may still participate in comp. swimming.

    I am always worried about him that something may happen to him while he is training/competing etc. He trains 2 hrs/day & sometimes 4 hrs/day. I realize that his progress will come slower than most his age do to the added stress on his heart compared to his peers. Do you feel he will be able to continue swimming at this rate & possibly at the college level? His dr is going to do an exercise test in the Spring ’11 to check the stress load etc. on his heart.

  18. says

    I forgot to mention that my son, who is the competitive swimmer is now 15 yrs old. His condition is still the same today – mild/moderate aortic stenosis. Thanks!

  19. says

    Swimmon,

    Thanks for your comment and questions.

    I’m glad that your son is doing so well with his swimming.

    The combination of bicuspid aortic valve and moderate aortic stenosis is a difficult one for athletes. Most authorities would recommend no strenuous athletic activities in that situation, but others would be more lenient. It is possible to have additional testing to determine if such individuals are at increased risk of problems. You should talk carefully with your son’s physician about this.

    College athletic departments are very vigilant about problems like this. As your son considers various colleges, it would be wise to have early discussions with the school’s medical people about the issue of participation.

    Larry

  20. says

    Dr Creswell,

    Great website – it’s informative but, above all, it gives us athletes a hope that we don’t have to be armchair-bound even after valve replacement. I’m not missing a good rainy, cold bike ride for some stupid heart problem!

    I have a sport-related question that none of my cardiologists can satisfactorily answer. We (those of us with aortic valve disease) are told to look out for symptoms of fatigue, dizziness, shortness of breath, light-headedness, etc. But I don’t know how to distinguish our natural reactions to sport and a ‘symptom’. I do Ironman events once or twice a year and I’d say I’ve had all of those symptoms, but so too do my friends who don’t have AVD. We’ve all called each other after a tough long bike and run, confessing we’d fallen asleep in the bath only to wake an hour or two later! I’ve hammered myself so hard in the run-up to the World Championships that I’d freely admit I’ve come close to fainting (I’ve certainly fallen off my bike from it), but so too have my training buddies.

    Is there any way you could write a piece to help us distinguish ‘exercise intolerance’ from normal hard training? Is ‘exercise intolerance’ going faint 5 hours into an Ironman, or is it can’t jog for 5 minutes? My cardiologist has suggested looking for a deterioration in performance, but I’m 44, so wouldn’t I expect to see that anyway?

    I’d much appreciate it.

    PS My job has a regulatory restriction that prevents me from working if I have symptomatic aortic valve disease – in other words, my whole career would come to an end when I report a symptom. My cardiologist knows this and says I should be sure before I report it. As an athlete, I just don’t know how to be sure!

  21. says

    Not far now–

    Thanks for your comment. This topic seems to draw more comments and email than any other. I enjoyed your story more than any other comment or email I got this week!

    You raise several important issues.

    First, the discovery of cardiovascular problems may be a double-edged sword, as you point out. Once discovered, a problem can be treated. Unfortunately, there may also be implications related to one’s job and one’s insurability (health insurance, life insurance, disability insurance). It sounds like you’re knowledgable about this issue, which is good.

    Second, I appreciate your comment that perhaps I’ve offered hope. I hope so! Most cardiovascular problems that affect athletes are treatable–and should be treated. Most affected athletes can return to their sports with some reassurance that problems are “taken care of.” My worry is that many men in their 20’s through 50’s don’t like to see the doctor about potential problems. This is a mistake–and it can be a costly mistake.

    I don’t think I’ve written much here at the blog about aortic regurgitation (leaking aortic valve)….and your comment is here in the section dealing with aortic stenosis/bicuspid aortic valve….so I’ll make the assumption that your problem is some degree of aortic stenosis.

    Significant aortic stenosis doesn’t develop overnight. It develops gradually over years….perhaps decades for most people, as calcium and other materials collect and build up in the leaflets of the valve. The opening of the valve doesn’t become suddenly narrowed; instead, narrowing develops over many years. The symptoms that you mention (and the classic symptoms are shortness of breath, chest pain, and syncope [blacking out]) don’t usually manifest until there is substantial narrowing of the valve opening. Once symptoms develop, conventional wisdom suggests that treatment (valve replacement) is warranted before some catastrophic event.

    As a heart surgeon, I usually see patients for only a “moment in time”–that brief period from immediately before operation (once a diagnosis of severe aortic stenosis is made) until a few months after operation. But it’s very remarkable what happens during that period. Even patients who were only mildly symptomatic tell me that they feel MUCH better immediately after operation–that they didn’t appreciate how limited they had actually become (because symptoms crept up gradually).

    Athletes seem to be very “in tune” with their bodies and seem to notice even small changes in performance. You’re right to note that, at some point as we age, there will be a decrement in our performance related solely to age. But I suspect that a vigilant athlete might well be able to tease out the added effect of worsening aortic stenosis.

    Of the things you mentioned, light-headedness that occurs DURING exercise would be very worrisome. When light-headedness occurs at other times, there are many possible explanations.

    Again, thanks for sharing your observations. As I said, this is a topic with a lot of interest among the readers here at the blog.

  22. says

    Dr Creswell,

    My son was born with aortic stenosis with valve insufficiency. We weren’t aware of it until a few hours after birth when he was rushed to St Pete’s Children’s Hospital. When he arrived there they rushed him into surgery and performed an angioplasty on him to fix the valve. For a long time he was in blood thinners and blood pressure medicine, but now he is off most of those.

    He is 8 years old. Other than a very neat murmur you would never know anything was wrong with him. He goes to UNC Chapel Hill to see Dr Cotton once a year. They are planning on doing the Ross Procedure on him when he gets older. As of right now they are trying to wait as long as possible before they actually doing surgery. I’ve done some research and from what I understand The Ross Procedure is an open heart surgery. I’m a medical assistant and phlebotomy tech but still some of this worries me.

    I was wondering if you knew what the mortality rate is for a teenager getting this sort of surgery done. How long does a surgery, if things go well and ‘by the book’, like this usually take? How long is recovery? Will he be in alot of pain?

    Thank you so much for everything and I think your blog is great.

    Jackie, MA, PBT

  23. says

    Dr. Creswell,
    My boyfriend who is 28 years old and has bicuspid aortic valve and received a pig valve replacement about 2 years ago, constantly gets lightheaded and feels like he is going to pass out. This happens quite frequently and he seems to think it only happens when he needs to eat, but I’ve noticed that it happens whether he has just eaten or not. I wanted to know if this is a common post surgery side effect?
    Another concern I have is that he still gets a sharp shooting pain on his left side which he has had both before and after surgery. It has never been able to be picked up on an EKG, or halter monitor. Is this something to be concerned about?

  24. says

    I am a 28 year old male who does smoke but rarely drinks if ever.

    Lately I have been getting chest pains that come and go almost in the middle of my chest, sometimes it moves around under the rib area mostly left sided, around the first rib underneath and moves as far as the side of my chest and lower, this has been the case for 2 weeks now and it happens random, i also sometimes i get a stiff neck with the pains from the chest or without, from my jaw down to my neck .. also on the left side of my body or behind my neck, I can breath normal so no problems there. Also i workout regularly and i am in really good shape. I did find out i have a BAV two years ago and was not put on any restrictions. My blood pressure is good and heart rate stays with in range when training and rest. I can pin point soreness on ribs and chest area. So i think this is musculoskeletal related.

  25. says

    Jackie,

    Thanks for your comment. My apologies for a slow reply.

    I think you understand things correctly….the Ross procedure is an “open heart” operation in which the patient’s pulmonary valve is removed and used to replace the patient’s aortic valve. A donated human pulmonary valve (allograft) is then used to replace the patient’s own pulmonary valve.

    You ask a few specific questions about the procedure:
    1. The mortality rate is usually <2%.
    2. The operation takes several hours to perform.
    3. Most young patients who have the Ross Procedure will be out of bed the next day and be able to go home in a few days.
    4. Pain is variable for patients. Sometimes young patients are the most bothered by pain. Your son’s surgeons and other doctors would work hard to find the right type and amount of pain medication(s) to help with this problem. This “problem” is usually not a big problem.

    Hope that all helps. Best of luck!

  26. says

    I have a 12 year old son who also happens to be a very talented athlete. Last year, his cardiologist cleared him to play football. However, due to the strenous nature of the sport, his aortic stenosis got worse and he now faces an aortic root dilitation (4.5cm)(his gradient went from 35 peak/16 mean to 65 peak/35 mean). Boston is mentioning a cardiac cath and valvuloplasty to treat his condition in hopes of returning him to competitive football. I would like to know the statistics, if available, of athletes with this condition and this procedure successfully returning to this type of sport.

    Teresa

  27. says

    JON,

    Hard for me to be the doctor from afar.

    Chest pains are never normal, though. There may be a musculoskeletal cause, but I’d suggest that you return to your cardiology doctor to make certain there’s not a heart-related cause.

    Larry

  28. says

    Teresa,

    Thanks for sharing your son’s story.

    Unfortunately, there aren’t readily available statistics about young patients returning to their sports after the operation you describe. De visions about continued participation must therefore be individualized for the particular patient. Your son’s cardiologist and cardiac surgeon will be in a good position to help you weigh the pros and cons of continued participation.

    Maybe you could return here and update our readers about your son’s progress.

    Larry Creswell

  29. says

    Aloha from Hawaii. Of the many things that I am, 50 year old pediatrician, husband, father, coach etc….I am nearly 2 years post Aortic Valve Replacement surgery that was urgently performed due to severe aortic insufficency-dilated aortic root-unusual dysrhythmias secondary to grossly dilated left ventricle. I am( was ) a multiple time Triathlon All-American, Ironman World Championship contender x 4 etc. Now, nearly two years after AVR ( aortic valve replacement ) with a porcine valve I can run but despite proper training I run nearly 2 minutes a mile slower than pre-surgery and it feels like I am working hard/uncomfortable when I run even slowly. Two days ago I had a modified stress echocardigram that shows 36 mm HG gradient across the valve at rest and 64mm right after full exertion. I have the largest procine valve made in place but the symptoms and data are looking like I am flow/pressure across the valve limited and this is causing me to be so limited in my capacity for running/biking etc at anywhere close to pre-AVR. There is some concern that I may have some post AVR pulmonary hypertension as well.

    My questions are many but for the blog, is there anything other than cardiac cath to further understand what my flow/pressures are and then the usual ” live with it and be less active” and could my pulmonary hypertension be result of the elevated pressure gradient across the aortic valve as it applies back pressure to the pulmonary vasculature..if so is there risk of progressive damage that could cause further limitations to my activity/life? Most Cardiologist/cardio-thorasic surgons see ultra-distance athletes as physiologic odd-balls and seem to feel un-comfortable trying to match the clinical information that they know verus what we odd-calls present with. Mahalo for your understanding and help.

  30. says

    Dr. Creswell

    Thanks for the response. Cameron had a stress test last week and apparently his heart is very “accomodating” to the stress of exercise (no st changes, no arrhythmia, no drop in bp). He did become very tachy quite quickly which was of a mild concern but he returned to baseline quickly. Dr. Lapuk is encouraging us to see Dr. Paul Thompson who apparently is quite versed in athletes with heart abnormalities. Dr. Lapuk did sign him off for baseball, which is obviously coming very soon. We will see what Dr. Thompson has to say and I would love to keep everyone posted. BTW, Cameron, while only 12, is 5’11” 190lbs so we are talking an adult size individual.

    Take care

    Teresa

  31. says

    Eddie,

    Apologies for a slow reply. I’ve been in Tucson doing some cycling….and I took a few days off from being “connected.”

    For the readers here, Eddie has asked several important questions about the consequences of having aortic valve replacement. In many cases, an artificial heart valve does not function as well as our native valve….and this can cause problems like Eddie describes.

    For Eddie….I’d be happy to talk with you about the issues you raise, but perhaps we could do that offline, if you’d like. If so, drop me a line at lcreswell@umc.edu with your contact info and I’ll give you a call or continue the discussion by email.

  32. says

    Dr. Creswell,

    My son was diagnosed with aortic stenosis just after birth…a detectable heart murmur was heard, and further investigation revealed the stenosis. He had followup visits with his cardiologist every 6-9 months, and remained stable for many years with a gradient always somewhere in the upper 30s. At the age of 6, he was allowed to start running, but was not to exceed 6 miles distance at any one time.

    At the age of 8, at a routine checkup, it was found that the gradient had increased, and another echo was scheduled for a few months later, at which time, the gradient had once again increased…to around 50 or so. Brandon was ordered to stop running immediately, and surgery for a balloon valvuloplasty was scheduled for a few months later, in February of 2009.

    The surgery was a success, with the gradient reduced to just below 20 and only minor regurgitation. Brandon was allowed to begin running again 30 days after surgery, and after a checkup a few months later showed a gradient in the low-mid 20s, was given no restrictions whatsoever on his running, and told he could wait 12 months between echos.

    His latest echo in May 2010 showed no change, with a gradient still in the 20s, and he also had an exercise stress test for the first time, which was 100% normal. Brandon asked him if he could even run a half marathon, and the cardiologist said that was perfectly fine. He ran the half marathon in December in under 2 hours…pretty impressive for a 10 year old with AS…and also completed a trail 25K race just a couple weeks ago.

    Track season will be starting soon, so the distance he runs will be decreasing, but the intensity will be increasing. He’ll be running the 3000 meter, 1500 meter, and 800 meter this track season. The cardiologist doesn’t seem too concerned, but I’m always a bit nervous, and especially so the past week or so reading about the 3 young teenagers who have collapsed and died from apparent heart conditions. Does checkups every 12 months seem adequate for someone as active in running as my son? Is it correct that a gradient that low poses virtually no risks?

    Thanks for listening to my story, and for any input you may have to offer!

  33. says

    Dr. Creswell

    Just to keep you posted…Cameron went to see Paul Thompson the other day and he cleared him for football. Paul said that the Bethesda guidlines are very restrictive and he sees no reason why Cameron can not play. He did mention to Cameron that he should start looking for a new sport but for now, football is OK. Of course Cameron also plays baseball so we are concentrating on that this spring. Hope you are well and enjoy the spring.

    Teresa

  34. says

    Mark,

    Sorry to be slow to reply. I enjoyed reading the story about your son’s aortic stenosis and his success with running.

    Yearly re-assessment doesn’t seem unreasonable to me. Your son’s doctor(s) will be in the best possible position to recommend a follow-up interval, though. You may find that there is no more problem with the aortic valve for many years to come. I’ll keep my fingers crossed.

    Wish your son good luck with his track career.

    Larry

  35. says

    Dr. Creswell,

    Thanks for the response! Brandon just had his annual visit last week and everything still looks good! Hopefully it stays that way for awhile.

    Mark

  36. says

    Hi Dr, very awesome blogspot you have, and have enjoyed following your posters!,

    My body is 29 years old and I have a bicuspid aortic valve… they said it’s bicuspid but no stenosis etc… currently
    Does this mean I can exercise normally?, I couldn’t get a clear answer. I mean just 3 or 4 mile run a day.

    The next thing I want to ask, if I place my right hand just below my left nipple, and breath in very deeply, I can ‘feel’ bubbles, for about 1.5 seconds, like a flowing of hundreds of bubbles,
    I would call it a flutter of bubbles, I can’t explain it any other way, do you know what this is?

    thankyou very

    Prahlad.

  37. says

    Hi Dr Creswell,

    My boyfriend who is 31 has BAV with thoracic aortic aneurysm of 4.7 and also mid aortic stenosis. This doc say surgery is not currently needed. But he has had him to get checked every year. My boyfriend is a bit overweight and is exercising to reduce weight. He swims and bikes. He also enjoys surfing. I am concerned, is it ok for him to do all this? Also is goes to hot tubs often. Is it safe for him?

  38. says

    Dr. Creswell,

    Interesting article. I ‘m a 37 yo male recreational runner and marathoner. I was dx’ed with BAV 12 years ago and have had no change in my baseline echo since that time and no symptoms.

    I am in Birmingham, AL and my cardiologist recently retired. Can you recommend someone to me who also has an interest/sensativity towards endurance athletes?

    jpattillo@nwkt.com
    Jim Pattillo

  39. says

    Gundiya,

    The conventional recommendation for athletes with BAV and moderate dilation of the aorta is to avoid strenuous exercise. It’s very important for your boyfriend and his cardiologist to be very clear about allowable exercise levels.

    I’m not certain about the potential risk of the hot tub. As a general rule, we don’t like the heart rate to be elevated in patients with aortic aneurysm….& the hot water can sometimes do that.

    Larry

  40. says

    Jim,

    In Birmingham, I’d suggest the Pediatric Cardiology group at UAB. The have a program for adults with congenital heart disease. You’d be in expert hands.

    An alternative would be to ask your primary doctor (if you have one) who he/she could recommend….& work with.

    Larry

  41. says

    I have a question? My son at the age of 19 had part of his aorta replaced and had to replace his bicuspid valve with a cow valve. As a worried mom that I am, this was just 6months ago but remember the doctor saying ‘hes good to go! He will have a normal life’. We know he will always have to be under the doctors care, the cow valve last 10-15 yrs, but I saw his life a long and good one. But yesterday my son said to me “Mom, you know Im going to only live till 60, with this heart and all”. Then he went on to say he is okay with this…. it just made me sick to my stomach that he thinks this way… I looked up the life expectancy but couldnt find anything. He has had some dizzy spells that the doctors are addressing right now, changing meds, doing a 48hour monitor on him but other than that he is doing great. Question, what is the life expectancy of someone so young? He must be getting information somewhere or maybe the stress of all of this is getting to him.

  42. says

    Dear Dr Creswell I am 22 years old and was diagnosed with BAV at 15 years old however the doctors did not mention this to me or my family it was mentioned on some papers they sent to my local GP (general practioner) I live in london I have had several echoes in the past 5 years that showed no significant heart issues just a Bicuspid aortic valve my latest one was 6 months ago. I wanted to ask you how long do bicuspid valves last and when will I need replacement surgery I have heard several claims e.g mid 30s or 40s and sometimes 50s I also suffer from a sensation of skipped heartbeats I am not sure if they are related to BAV but they really scare as it feels like my heart stops for a moment and restarts with a large thump

    Best wishes Bilal

  43. says

    Billu,

    Sounds like you’re doing well.

    For any single individual with bicuspid aortic valve (BAV), we’d need a crystal ball to know how things will unfold.

    Many patients with BAV never have problems with their valve. Others will develop narrowing (stenosis) at an early age. We don’t know how to predict who.

    Best advice is to continue to see the doctor for periodic exams (listening for developing heart murmur) and echocardiogram to look for stenosis.

    Larry

  44. says

    Dear Dr Creswell sorry to pester you again but I have heard some promising new in BAV replacement surgery I think its more of A UK thing than US but I am sure you have heard of TAVI (trans catheter aortic valve implantation ) do you think this new procedure will realistically replace open heart surgery soon Dr Iqbal a prominent British heart surgeon believes that within 10 years TAVI will be used for even low risk patients compared to only high risk candidates currently I just wanted a heart surgeons thoughts into this TAVI breakthrough as I am restricted to discussions with cardiologists only and rarely have the opportunity to discuss things with cardiac surgeons like yourself

    Thank you once again for taking time out to speak to patients I hope you will keep this blog running for many years to come 🙂

  45. says

    Billy,

    No problem. Apologies for my slow reply.

    I think you’re right. Technology continues to improve and experience continues to grow with TAVI. I don’t doubt that this procedure will come to be used increasingly in lower risk patients with time.

    At the moment, the procedure is only for patients with significant aortic stenosis–and not for patients with regurgitation or enlargement of the aortic root.

    Please feel free to email if tou’d like to continue our discussion.

    Larry

  46. says

    Hello, my name is Shawn. I am 42 and during a recent physical, my doctor found a murmur. I had an echo last week and was told that I have a BAV. I’m scheduled for a CAT Scan in a few days to determine the serverity of my condition. I have been an athelete my whole life…4 yr varstiy cross country, 34 years of soccer, triathlons and have been racing mountain bikes for the last four years. A couple of years ago I noticed an occasional flutter or twinge in my chest, but it doesn’t necessarilly happen under exersion. Other than the aforementioned, I don’t have any of the typical symptoms. Also, my speed and endurance have been increasing year after year, and I don’t know what to make of it all! Are there any major concers, and is it fairly common for people with this condition to continue to participate in sports at a competetive level? I’m part of a new race team and am scheduled for 5-6 races this summer varying from 20 to 100 mi. The first one is in a couple of weeks! I just hope I’m told that I can still participate!

    Any thoughts?

    Thanks,
    Shawn

  47. says

    Shawn,

    Thanks for commenting. Apologies for a slow reply.

    By now, you’ve probably had the CT scan.

    Yes, many athletes with BAV can participate fully in their sport(s). That’s usually okay so long as the aortic valve doesn’t have more than mild stenosis (narrowing) or regurgitation (leaking) and the beginning portion (root) of the aorta is normal in size.

    For athletes with BAV, it is important to settle on a course of periodic follow-up imaging (eg, echocardiogram, CT scan) to monitor the valve and aorta. It’s important to catch problems early.

    Best of luck. Feel free to comment again or email if there’s anything I can do to help.

    Larry

  48. says

    Dr. Creswell,

    I am trying to determine the cause of some baffling symptoms. I am 51 and have a BAV (diagnosed in 1967) with mild stenosis first exhibited last Sept. I can no longer run more than 1/2 mile without chest tightness, breath shortness, burning windpipe and nearly fainting. My heart rate does not get to
    140bpm during these episodes. I can immediately jump on an exercise bike after each running episode and ride for 30 minutes hard with no symptoms and getting my heart rate to 160 bpm within 5 minutes. In the past five weeks I have also gone on 5 bike rides of 40-70 miles with no symptoms. Since November I have been treated for Exercise Induced Asthma (EIA) with temporary symptom relief from Albuterol and QVAR but symptoms always return. My pulmonologist now discounts EIA due to run/bike dichotomy. I am at my wits end and would appreciate your insight.

    Tim Taylor

  49. says

    Hi,

    When you write: “Those with severe aortic stenosis should refrain from strenuous activity as treatment plans are made with their physicians.”

    What is your definition of strenuous?

    My husband is 53 and has a BAV with asymptomatic moderate/severe aortic stenosis. He plays basketball, snowboards and goes hiking.

    Would you consider those strenuous activities? He does no weight lifting and no endurance sports.

    Also, when do you think TAVIs could be an option for low risk younger people? (I understand that they are only being done on the high risk elderly population at present).

    Thanks.

    Kathy

  50. says

    Kathy,

    Good questions.

    1. Patients with moderate AS might safely do activities like golf or bowling. Those with severe AS should refrain from even those activities. Basketball and downhill skiing (or snowboarding) might be done safely if patients have mild AS.

    2. TAVI will certainly become available for patients at lower operative risk. That said, patients with BAV have the additional consideration of the condition of the aorta which can become enlarged with time. There’s certainly little information available about the use of TAVI in relatively young patients with BAV.

    Larry

  51. says

    Dr. Creswell,
    My grandson is 2.5 years old and was diagnosed last year for BAV during a pre-surgical check up to have tubes inserted in his ears. This past weekend while playing outside (it was hot) for about 10-15 mintues, I noticed that his face and ears became extremely red (not from the sun) and his cheeks were a little swollen. At first I thought he could have an allergy (he was playing near clover) but I also wondered if this could happen with BAV. I made sure he had some water and I settled him down and he seemed fine the rest of the afternoon. I am just looking for information about things to watch for in kids with BAV.

    Thanks for you article and for your insight.

  52. says

    Hi Larry

    I am based in England and have a 9 year old daughter who was diagnosed with a bicuspid aortic heart valve 2 years ago she also has triva to mild stenosis with mild narrowing and mild leak. She was told that she can live normally but would not be able to compete at major level when she is older (that being olympics etc) only she is turning into an amazing little athlete becoming very good at tennis and has been selected to take parts in a schools aquathon in 2 days. I am just getting a little nervous that something might happen, it is a 100m swim which isn’t a problem for her her can swim length after length but afterwards they run to get their trainers on and have to do a lap of a field which is up hill then down. Just becoming slightly anxious as she really enjoys sports but what are the limitations? When she had her 1st annual review last year they were please as none of the conditions had changed and said they thought she would now get to early adulthood before needing a valve replacement.

    I look forward to your comments. Thank you

    Lisa

  53. says

    Lisa,

    Thanks for sharing the story of your daughter’s condition. It’s always fun to see kids embrace athletics.

    It sounds like you’re being thoughtful. The issue with BAV is the degree of narrowing (stenosis) of the valve itself and the degree of enlargement of the aorta nearby. Your daughter’s doctors will be monitoring these issues over time and will be able to offer recommendations about safe levels of exercise. Ordinarily, when there is little or no stenosis or aortic enlargement, athletes can continue to participate.

    Larry

  54. says

    Elvira,

    Apologies for a slow reply.

    I’m not sure that BAV would explain your grandson’s recent experience, but sometimes there’s more to the story than meets the eye.

    As you may already know, it’s important over time to monitor BAV patients for the degree of aortic stenosis (narrowing) and the size of the nearby aorta.

    If you haven’t already done so, it would probably be prudent to talk with your grandson’s doctors about the recent event.

    Larry

  55. says

    Hello Dr.
    My 18 yr old son was diagnosed with a bicuspid aortic valve at age 5. From that time we were told there were no restrictions on him as an athlete. He trained in soccer and is a competitive scholarshiped athlete now at a Div 1 college. Unfortunately the College and his cardiologists disagree as to his clearance. His adult cardiologist and pediatric cardiologist and a cardiac surgeon have all cleared him to play. The schools athletic trainer, team dr and referring cardiologist have pulled him from the sport.
    His echos from 18 months ago and 6 months ago all show 4.1 to 4.2 aortic artery dilatation. Mild regurgitation, no stenosis. The school followed up with an echo in April (3 months ago) and say it is at 4.5cm now. The increase is why they have pulled him.
    Subsequent CAT scan in May for the surgeon show the dilatation at 4.2cm at the largest and most slides at 4.0 or less. No root involvement. An MRI in July confirmed a 4.2 and less.
    One surgeon says he is cleared to play with only restrictions of heavy weight lifting and isometric exercises. Another surgeon is hesitant to clear him and we are still waiting his response for further course of action.
    The University is not willing to clear him, they are willing to release him and other schools have made offers for him to play. We are trying to decide what course of action we should persue. While many say the 4.2-4.5 is too early for surgery, others say that since he will most likely need surgery in a few years, we could get surgery early so he can recuperate and rehab and possibly return to competitive DI soccer. TIme is of the essence with NCAA guidelines as he has started school ad now has only 5 yrs to complete 4 yrs of competitive play. He could take this year to have repair surgery and return in a year.
    What is the likelyhood he could return to the rigourous training schedule of a college soccer player after aortic artery repair? He wants to persue a full college career and possibly a professional career. It has been suggested he would be a candidate for valve sparing surgery since his valve has very mild regurgitation.

  56. says

    Hello Dr.
    My 18 yr old son was diagnosed with a bicuspid aortic valve at age 5. From that time we were told there were no restrictions on him as an athlete. He trained in soccer and is a competitive scholarshiped athlete now at a Div 1 college. Unfortunately the College and his cardiologists disagree as to his clearance. His adult cardiologist and pediatric cardiologist and a cardiac surgeon have all cleared him to play. The schools athletic trainer, team dr and referring cardiologist have pulled him from the sport.
    His echos from 18 months ago and 6 months ago all show 4.1 to 4.2 aortic artery dilatation. Mild regurgitation, no stenosis. The school followed up with an echo in April (3 months ago) and say it is at 4.5cm now. The increase is why they have pulled him.
    Subsequent CAT scan in May for the surgeon show the dilatation at 4.2cm at the largest and most slides at 4.0 or less. No root involvement. An MRI in July confirmed a 4.2 and less.
    One surgeon says he is cleared to play with only restrictions of heavy weight lifting and isometric exercises. Another surgeon is hesitant to clear him and we are still waiting his response for further course of action.
    The University is not willing to clear him, they are willing to release him and other schools have made offers for him to play. We are trying to decide what course of action we should persue. While many say the 4.2-4.5 is too early for surgery, others say that since he will most likely need surgery in a few years, we could get surgery early so he can recuperate and rehab and possibly return to competitive DI soccer. TIme is of the essence with NCAA guidelines as he has started school ad now has only 5 yrs to complete 4 yrs of competitive play. He could take this year to have repair surgery and return in a year.
    What is the likelyhood he could return to the rigourous training schedule of a college soccer player after aortic artery repair? He wants to persue a full college career and possibly a professional career. It has been suggested he would be a candidate for valve sparing surgery since his valve has very mild regurgitation.

  57. says

    Dr
    My son is 18 and was diagnosed with bicuspid valve at 5 yrs old. He is an elite level soccer player (Division 1 scholarship, national team) and recently has been pulled from participation by the Iniversity. His aortic artery has dilated to 4.2 (as indicated by CAT scan and MRI and previous echos showed 4.5) It has been indicated that he has a mild regurgitation but no root involvemet.

    Is it generally thought to restrict competition, or at what point do they generally pul from highly competitive levels. He has offeres to transfer to different colleges, and his own cardiologist has cleared him to play, but the University cardiologist has said no, not at the College D1 level.

    His father passed away suddenly at 50 of what was assumed was heart attack. I have no autopsy results to show any different or relation to the bicuspid valve but a nephew on his side had aortic valve and artery replacement at age 30 two years ago. So there may be familial relation.

    Is there a possibility of repairing the valve, and artery so he can resume sports. He has trained all his life, competed at the highest levels and hopes to become a professional and has been scouted as such.
    Thank you
    Andrea Smith

  58. says

    My son is almost 17, was diagnosed with a Bicuspid Aortic Valve at age 5. At age 13, it was noticed that the valve was leaking, at a mild rate. He is an athlete and runs for his sport, as he can’t be a catcher in base ball any longer, or lift weights, or play football. He runs constantly, at least 5 miles a day, but normally 10. The other day, at a track meet, he ran the mile, and afterward he had chest pain. I was not present but he said that the pain was both dull and sharp, tightening, and his heart rate was low, which seemed odd to him. His team mates said that he was pale, and he said that he felt like he was going to pass out. He said that he had the BAD pain for about an hour, and the rest of the night, he had mild pain. Can anyone give me some advice? It is a weekend right now, so I am waiting to call his Pediatric Cardiologist tomorrow morning to see what she says. Any ideas, or comments appreciated!!

  59. says

    I’m a 63year old male who in 2000 had a aortic allograft due to a biscupid aortic valve. For 15years prior I had competed in triathlons and marathons including 8 Ironman races in Australia and Hawai’i.
    After the valve replacment I continued in my ultradistance competitions including a 7 day running race through the Sahara Desert and a 600kilometer mountain bike race across the Simpson Desert, Australia as well as many other long distance runs and multi-day treks.
    My valve is showing no sign of deterioration after 12+years much to the surprise and satisfaction of my cardiologist as other human valves from the same ‘era’ have all since failed. There is some mild regurgitation which has remained stable. I have an annual echocardiogram.

    I am very keen to hear from other ultradistance athletes who have had an Aortic Valve Replavement and who are still competing/training

  60. Carl says

    Dear Dr Creswell,

    I just wanted to thank you and commend you on the single greatest resource I have seen on this subject. I am a 40 year old male from the u.k, born with bav. My childhood was governed by my birth defect and I was made to feel quite inferior as a child through not be able to participate in certain sports, and generally being wrapped in cotton wool by my parents. The results soon triggered a long battle with mental health issues including, depression and anxiety. After minor procedures in my teens ie valvuloplasty I had a bovine replacement 5 years ago. After buying myself a 2nd hand mtb and doing a 7 mile circuit, I invested in a road bike and now cycle at least 200 miles a week, achieved 10,000 miles in 2013 and climbed every single hill in the peek district, Derbyshire, u.k I am addicted to cycling. I wear a hr monitor and do constantly push myself to achieve more power and cycle faster, I feel amazing, mentally and physically and yet I now hear the same thing. “You must slow down, you must decrease time on the bike” my 6 month ultra sounds results are not changing and yet my docs refuse to support my quest to compete, which of course I am complianted it just feels like I’m back being that little boy with so many can’ts and don’ts… Sorry to waffle on, again thanks for this great resource not sure I’ve got a question just thought I’d share. 🙂

    • Larry Creswell, MD says

      Thanks for sharing your story. Many athletes are able to participate after surgery to fix problems with BAV and/or aortic enlargement. I’d encourage you to continue to work with your doctors of monitoring things and settling, together, on what’s safe in your specific situation.

  61. Carlos says

    Hi,
    Came across your website (and probably the only resource for athletes on bav) and it made me feel 100% better. Also wanted to share my story. I’m a 40 year old male. Have been bodybuilding/training 4x/week since I was 17 – but play competitive hockey, soccer and most other sports to a high degree as well. Relevant or not, body is my temple and I keep it looking like a million bucks.
    Just 3 years ago, a heart murmer ended up doctors realizing I had bav. My doctor said to reduce the lifting a bit. But I was not leaking that much – so I changed my workouts to higher reps. Just this year, they said there is nothing to worry about (size of ventricules haven’t changed much?), but leaking has become severe – and she preferred that I do not lift at all. (but it was said almost as a joke, as she thought that I would do it anyways). I began to freak out a bit, because like others lifting weights is my love, my cure of anxiety, possible depression and just an artistic side of how to carve my body.
    My last question for her (my dr) was actually, “Will I die if I continue to lift, even a little? And how soon?” The answer was no, just surgery will come faster.
    Just wanted to say to other “athletes” or workout lovers like me, you’re not the only one. But the real question is, what next?

  62. Jonathan Fowler says

    I am 32 years old and I was diagnosed with Aortic Stenosis W/BAV at 2 years old…I think. In 2012 I did my first triathlon. I have sense done a Half Ironman and many other 10k, half marathon races. I do not currently experaince any symptoms. I had a cardiologist a couple years ago tell me that he found no indications that I had Aortic Stenosis anymore. But a couple weeks ago my new DR told me that I do. This has caused anxiety because I LOVE training. Should I consult with my DR again and go ahead and have the replacement so that I can get back to my training? Or, just train easy and wait?

    • Larry Creswell, MD says

      I’d encourage you to work with your doctors to get things sorted out, not only with whatever evaluation/treatment is needed but also with recommendations about the safety of exercise.

  63. digiro says

    I am an avid surfer. In fact I base my lifestyle around it. It is my life. I am 52 and have just been diagnosed with aortic stenosis. I have always been extremely fit and have taken care of my body through diet and exercise. I believe that this year on my yearly 2 month “surf safari” to Costa Rica I was in probably the best physical shape of my life for surfing. My question is which procedure would be best for me….. organic or mechanical procedure to let me continue to live my lifestyle and life. Before this I believed I could surf into my 80’s. I still show no signs of being tired after surfing, running, weight training or experience dizziness except on a few occasions which I thought were normal and explained by dehydration , hunger, stress from work or a combo of them. The dizziness does not occur that often, but in retrospect I am thinking it may be because of my condition. I cannot imagine life without my one passion…..surfing.

    • Larry Creswell, MD says

      You ask about the relative advantages and disadvantages of mechanical and bioprosthetic (tissue) valve substitutes.

      Mechanical valves are designed to last forever. They have the disadvantage, though, that blood-thinning medication is needed to prevent blood clots from forming on the valve and causing problems like stroke. A small number of patients each year will have problems like stroke….or problems with significant bleeding because of the blood thinning. Bodily injuries (that can occur in many sports) can be made more serious or even life-threatening because of the blood-thinning medication.

      Bioprosthetic valves have the advantage that blood-thinning medications are usually not needed over the long term. Thet have the disadvantage, though, that they do not last forever. The valves can “wear out” and need re-replacement.

      Those are the general considerations. You’ll need to have a discussion with your doctor(s) to settle on the best choice in your particular circumstance.

  64. says

    I am turning 68 this month. I am a very active athlete: I do triathlon and very aggressive mogul skiing. I usually train about 8 hours per week in the winter and 11 hours a week in the summer. I do four or five triathlons each year, usually two Olys and three sprints. I’ve done one half-iron. I was diagnosed with BAV about four years ago, after my PCP had my murmur worked up. Over the past few years my BAV and aortic stenosis gradually worsened, and I became more cautious with the intensity of my workouts. I gave up my plans to do an Iron. In the fall of 2013 my cardiologist recommended I not run in a 15K and instead encouraged me to promptly have the valve replaced. In December 2013 I had a porcine valve implant, which went very smoothly. I was back to work in a week and resumed treadmill running and indoor biking in January and mogul skiing in February. My high blood pressure disappeared (I’d been taking medication for this for four years), and the only medicine I take now is Simvastatin, 40 mg.

    During the two years prior to my surgery I noticed I was having more and more trouble with my swimming. It was as if I couldn’t get my breath cycle down properly, and I struggled in the water. I concluded that this was due to a combination of problems with the coldness of the water the effects of the BAV and aortic stenosis.

    When I had the surgery my surgeon told me it might take up to a year for my heart to become totally normal, that “it had to learn that it was healthy.” This doesn’t seem to be much of a problem with my biking and running, and I feel comfortable pushing my self so that my heart rate is up to the 160’s when climbing an intense hill. Once I get started I feel fine, and I can push myself comfortably without fear and with no problems of any kind.

    But, I have problems every time I climb the stairs at work. I feel exhausted from climbing one story and have to pause and wait to feel OK. This has gradually gotten a bit better but it seem to be a slow pace of improvement. I have the same problem at home – unless I have been working out, in which case its not at all noticeable. Yesterday I started my run by running up a small but steep little hill, it couldn’t have been more than a twenty foot climb, like a set of steps, and my heart rate went up to maybe 110, but I felt really exhausted. I ran for about 6 minutes and then returned to the same little hill and climbed it with no problem at all. I then ran 6 miles and felt fine.

    The same thing happens with swimming: its like my heart has trouble catching up to what I am asking it to do. I am starting to do a trudgen stroke instead of my usual freestyle as the trudgen allows me to breath more often, which makes me both more comfortable and less anxious. My coach recommends I run before getting in the water, which works well in general, but before a race I am often stuck waiting in my wet-suit for an extended period before my wave goes in the water. My question is: will my heart return to normal over time, so I will no longer feel physically challenged by walking up stairs or the first 50 to 100 meters of swimming?

    • Larry Creswell, MD says

      I’d encourage you to continue the dialog with your doctor(s) about your symptoms with exercise. From afar, I don’t have particular advice other than that.

      More generally, I can comment about aortic stenosis, though. After operation to replace the aortic valve (and relieve the obstruction to blood flow), the heart usually needs to do less work. It is now pumping blood through a (much) larger opening. Over a period of time, from weeks to months, the thickness of the heart muscle may decrease as a result. Even if the artificial valve is not as efficient as the normal human aortic valve, the situation is much, much better physiologically for the heart.

  65. Amrit says

    Hello Doctor,
    Thanks for so much information on AVR.

    I am 27 year old boy from India. I had undergone aortic valve replacement in Jan 2014 with a mechanical valve and I am on blood thinners (WARF). I have been a very active person all throughout my life though not a athlete or a sportsman. I use to go to gym before my operation to keep my weight & posture in check. My cardiologist has told me not to lift weights and my family has taken it so seriously that they do not allow me to even lift my shopping bags. I believe there will be many instances when I won’t be having anyone to lift my bags, what will I do then?

    I just want to know if is it so dangerous to lift anything. I gain weight easily & I find going for walk very boring. Can I go to gym & if yes what necessary precautions should I take. I am having a normal life otherwise and it is much more comfortable as compared to the life before my operation.

    Also, I am taking the following medicines that my doctor have advised to take throughout my life
    1. Betaloc- 50: For controlling my heart beat and blood pressure, twice a day
    2. PAN- 40: for avoiding any ulcers due to blood thinners, twice a day
    3. WARF: 3 & 4 mg alternate day, once daily
    4. Ecosprin- 75 (Asprin): I was having side effects(itching) due to this so my doctor replaced it by Clopid- 75, once daily.

    I want to know if these medicines have any side-effects in the long run

    Thanks in advance
    Amrit

    • Larry Creswell, MD says

      Thanks for sharing your story, Amrit.

      Many athletes who’ve had AVR are able to be physically active and return to their sports. For those who are using anticoagulants because of a prosthetic valve, it is necessary to consider the risks of bodily injury, depending upon their particular sport. As you know, there can be a very real risk of harmful bleeding.

      I don’t know all the details of your situation, so I’m not in a good position to offer advice. I’d encourage you to work with your doctor(s) to determine what level of activity is safe for you….and realize that this is a conversation that can be repeated as circumstances change. If you are unhappy with one doctor’s advice, perhaps you could seek a second opinion. Regardless, though, I generally believe it is safest for patients with AVR to be honest with their doctors and to heed their advice.

  66. Anne says

    Hi Dr Creswell,

    I found your website after Anthony posted about it on the Valve Replacement forum.

    I had BAV, murmur first heard when I was 25 but I managed to get all the way to 60 before it needed replacing. I also do – well did and will do – serious weightlifting (even though I’m a middle aged woman). I only stopped weight lifting when I was referred for surgery and then I carried on with lighter weights until the day before.

    What interests me is that you say aortic valve replacement is done when symptoms develop. I live in the UK and I was told in no uncertain terms that replacement is done BEFORE symptoms develop, at a point just before they think symptoms will develop. I read the very sad message above from a woman whose husband died with BAV and it seemed to me that in the UK, judging from the severity of his stenosis, his valve would have been replaced as he wouldn’t have had to wait until symptoms develop. Sometimes I get annoyed that I had to go through major heart surgery when I was feeling so fit and well, because now, five months after surgery, I am less fit than I was before because of the nature of heart surgery. Doubtless in another five months I may be back to as fit as I was before surgery.

    Am enjoying reading your blog.

    Anne

  67. Mark Brown says

    (grateful for this site)
    I am a 56 yr. athletic Male with a BAV with moderate stenosis and sclerosis. I have had 2 episodes of a-fib and both times needed to be cardio- verted . I have not had a-fib in 2 years now due to less stress in my mind. My question is ; I sweat too much and have a difficult time staying hydrated. When I become dehydrated I get dizzy upon standing and it takes a few seconds to get going. When I’m hydrated I can run 2-3 miles , ride 12 miles without issue. Do you think my intolerance to dehydration is an indication of a more severely compromised valve . Thank you

    • Larry Creswell, MD says

      Athletes with known aortic stenosis should be very vigilant about light-headedness. It can be easy to attribute this to dehydration alone, but it can certainly be due to the heart valve.

      Specifically for your case, best to discuss with your doctor.

      • Mark says

        Dr. Creswell, I had an ablation done 10 months ago and I’m not the same person. No a-fib but lots of skipped beats now along with terrible neck and headaches. Last echo 5 days ago was done with abutamine and showed my AV less than 1cm. Is it possible that the valve became symptomatic because of the ablation? Headaches are brought on by excursion and last for days. Still recovering from a simple abutemine test as the 135 bpm upset the heart. Thanks

    • says

      Hey Mark,

      I wouldn’t describe myself as an athlete but I’m pretty decent on a bike and push the limits probably to much for a 40 year old b.a.v patient 6 years post bovine replacement. I’ve been told that I’m again on the verge of more surgery for a new (this time mechanical) valve. Here in the u.k it has been uncharacteristically hot/humid and I have been experience more episodes of dizziness upon standing. From experience I know one of the first symptoms of aortic stenosis is dizziness but obviously dehydration should be a concern for all. I’ve been told that by the measurements I should be experiencing more symptoms but the truth is the only symptoms right now are dizziness at rest, standing up or very moderate exercise i.e walking. I wear a h.r monitor on the bike and although trying to minimise the time I spend in the red, I still do and feel fitter than ever. Consultant would prefer me not to cycle to to the extremes I do but I’m addicted to cycling and pretty much need it to function. Surgery’s going to be a massive shock to the system and I know in going to struggle to cope with the rehab a lot more than the first time. Sorry for rambling, take care, Carl.

      • Mark Brown says

        Thank you both. Carl your experience is helpful and your courage is truly inspiring. When this decision is made I certainly want to be in then best health to promote a robust recovery.
        The references and advice given here has provided much understanding . The personal perspectives expressed here are not to be found any where else ( I did countless searches before finding athletesheart.com) and are a Godsend.

  68. Katy Buompensiero says

    My bicuspid aortic stenosis was just upgraded to moderate with mean gradient of 28 mmHg. I’m asymptomatic. I just finished my 11th half marathon, (fast walking 15-16 min mile). I do about 3 half-marathons a year and walk 20-30 miles per week. I’d like to continue for weight management/health. Do you think it’s safe to continue exercising at this level?

    • Larry Creswell, MD says

      According to the 36th Bethesda Conference guidelines, it’s best to restrict the activity of athletes with BAV and moderate aortic stenosis unless there has been careful stress testing to prove that exercise doesn’t produce troubles.

  69. Susan says

    My 18 year old boyfriend plays semi professional hockey. He has bicuspid valve and says at the end of his shift he is struggling to breath. Is that just something he needs to learn to live with or is it a dangerous situation. From what I know the condition is not severe and doesn’t require surgery at this time or anytime soon.

    Thanks.

    • Larry Creswell, MD says

      By itself, bicuspid aortic valve (BAV) does not affect the breathing.

      If there is associated narrowing of the valve (stenosis) or leakage (regurgitation), there may be breathing symptoms.

      Individuals with BAV and breathing problems should get checked out.

  70. Alan says

    Hi Dr Larry
    I am writing from Cape Town, South Africa.
    I had a aortic valve replacement (mech) last year 13/06/13. After the op started walking for exercise but after a few months started getting bored as I found it tedious. I played soccer to the age of 54 years (old farts side) and really enjoyed the exercise. I will be 58 in Jan 2015 and would like to know if I could train with the old guys . . . I will refrain from playing in matches as they are competitive, even at our ripe old ages.
    Please give me your recommendation.
    Best regards
    Alan

    • Larry Creswell, MD says

      For patients with mechanical valves who are taking anticoagulants, the consideration is the risk of injury.

      Be thoughtful especially about potential head injury.

      • Alan says

        Hi Dr Larry
        I am nervous about taking a hard knock (head area) as my Mom passed away due to falling and knocking her head while on wafarin.Would you object to soft training practices where there might be a few body and leg knocks but nothing on the head? Another question is are there any anti-inflammatory medications one can take that do not aggravate the use of wafarin?
        Thank you for the previous reply and just need to say it is very relieving to read your articles/letters. When one has had or needs to have a valve replacement it (I cannot explain with the right words) it is so nice to be able to read and/or communicate with someone of your stature.
        Thank you
        Alan

  71. Doug Kabat says

    I got a tissue valve when I had my BAV replaced at age 67. As an extremely active person (triathlete, expert bump skier) I thought this would give me the freedom to keep doing what I love – but I will face the likelihood of a valve replacement down the road. If I had been ten years younger I probably would have gotten the mechanical valve – it lasts forever – but it would have resulted in some restrictions. I’m not completely sure what I would have chosen, but I think Alan’s choice was probably wise, given his age.

    • Anne says

      I got a tissue valve at age 60 earlier this year. I’m very active, do weight lifting and tons of walking, so maybe not an athlete but certainly very much more active than the average person. I was really pleased to get a tissue valve (bovine pericardial aortic valve) as I wouldn’t want to take anti-coagulantes, and I have very sensitive hearing and would have hated the clicking noise. I understand that the tissue valve will last 20 years, maybe longer, and by then other methods like the TAVR will be perfected. Even if I have to have OHS again, techniques will get better and better as the years pass. On the valve replacement forum I’m on some people have found that cardiac surgeons as young as 50 say would choose tissue if they had to have surgery themselves.

    • Alan says

      Hi Doug
      My doctor didn’t offer the alternative and I assume this was due to my age and level of fitness. I must admit that at times it is a bit scary being on Wafarin and hearing about the side affects. One thing I am extremely grateful for is the progress that has taken place on valve replacement as my valve eventually led to heart failiure and then after six months of diaretics completely failed by tearing due to degeneration. If not for this progress I would not be writing this email today.

      • says

        Alan wrote to note he has struggles with a mechanical valve and Warfarin. This follows that up: I think all of us are lucky to live in a time when these kinds of cardiac problems can be addressed. I know triathletes who have mechanical valves, are taken Warfarin, and are happily competing. I think if you want to compete in triathlon its best, if you are taking Warfarin, to hold back a little in the water so you don’t get thrown around in the tumult of an aggressive start.

  72. Alice Long says

    What a great site. My 23 yr old son just had his Aortic Valve replaced. He is 6’4″ and skinny… 185 lbs He had a valvoplasticy at one month old to stretch his valve and was observed all his life. My question is this. How active can he be after his recovery? Since he is a large person will the valve wear out sooner? Please tell me the normal time for a pig valve to last in a large young man. After his surgery he had to go back in for an emergency surgery to stop some leaking a few hours after the first one.
    He has suffered well through this ordeal. It has been 4 weeks and he is taking it slow. It is hard to find reassurances on the web about how active he can be and how long the valve will last. Thank you for your site. I appreciate you taking the time to answer us. Have a great day!

    • Larry Creswell, MD says

      The best, most specific answers to your questions will come from your son’s doctor(s). They will be familiar with all his particulars.
      As you know, “pig valves,” or bioprosthetic valves in general, do not last forever. They wear out. In adult patients, we generally think about a 12-14 year lifespan for the latest generation valves, and then some patients will begin to experience difficulties such as regurgitation, or leakage. Patients with these valves need to be monitored periodically with echocardiogram to make assessments of how well the valve is “holding up.” I’m not aware of how the longevity of the bioprosthetic valves is related to patient size. It may not be.
      Most adult athlete patients can return to their athletic pursuits after aortic valve replacement. With a bioprosthetic valve, there isn’t the additional concern about blood thinning that is required with the mechanical valves. Everybody’s recovery is different, though, and how soon is probably very individual. Best to settle on a plan for return to sports activities with your son’s doctor(s).

  73. Mitch says

    What a wonderful, informative piece you have written here! I am 42 and had two surgeries to fix my bicuspid aortic valve in the space of a week at age 36. I may have just learned more from reading this than with all my conversations with the cardiologists and surgeons (I was in shock and didn’t really take anything in – it was inside a two week window that I had gone from nothing to a new doctor noticing a heart murmur which I was it even there for and unaware of – to waking up after my first open heart surgery).

    The first time the surgeon tried to correct it and then a few days later the other side prolapsed. He said he had never seen it before. I also had a sleeve placed inside my ascending aorta because it had swelled to over 5cm and was just about to blow. Then it would be curtains…

    I have returned to a normal life now and even run 3 or 4 times a week though have been told to lay off weights etc because of blood pressure issues. Anyway that’s me in a nutshell…

    Aside from wanting to tell you how much I enjoyed your article, I have emerged with a new problem – I have been suffering from sposmadic seizures. They are more auras, funny feelings that pass, sometimes only in a few seconds, sometimes up to 30 seconds I guess. I know when they are coming and they don’t really affect my quality of life. A neurologist put me on tegretol, as you would know, a horrible drug with horrible side effects. My seizures have reduced in frequency but have not gone away. He puts it down to the operations and being on the heart/lung machine twice? I am going to see someone for a second opinion but would be interested in your thoughts…

    Thanks so much,

    Mitch

    • Larry Creswell, MD says

      Thanks for sharing your story, Mitch. Yes, the discovery of bicuspid aortic valve and aortic enlargement often comes as a surprise to adult athletes. Glad to hear that (after 2 operations), things are fixed up.

      Not sure what to make of seizures. Like you mention, best to seek help from a neurologist perhaps.

    • Anne says

      I don’t have seizures but ever since heart surgery to replace my bicuspid aortic valve a year ago, I have been getting migraine auras without headache – zigzagging patterns of light in my vision which last about 15 minutes each time, plus sometimes double vision and often sparkles of light crossing my vision. I understand that this is something many people get after open heart surgery, something to do with being on the heart lung machine. These visual problems started the day after surgery with me. I haven’t seen a neurologist as, apart from them being weird I have no other symptoms. On the valvereplacement forum I’m on several other people report these same symptoms. It would be nice to know exactly why they happen.
      Anne

      • Mitch says

        Interesting stuff… thankyou for the response. Auras is a great word to describe them hey? Nothing else can really describe them as well. Weird, almost out of body feelings. Mine pass very quickly (less than a minute) and I know they are coming. Don’t hurt, no headache or fatigue afterwards… I am not convinced that they are seizures… What other blog are you a part of where people have had these strange auras? Thanks Anne

  74. Mitch says

    I forgot to say that a mechanical valve replaced the prolapsed valve in the second operation so I am on warfarin(Coumadin) and my INR sits around 3.

    Thanks

  75. Dave says

    At age 53 I just had BAVR surgery Sept. 24, 2014 and opted for the bio as opposed to the mechanical valve. It is now Jan. 16, 2015 and I just surfed for the first time in 4 months here in Costa Rica. I surf everyday if I can and trained by swimming laps, a couple at first, until I could swim a half mile as the physical therapy was just not giving me anything I would call a workout. ( It did however loosen my body by using all rusted parts) As I surf alone and the medical response time here in CR is not as fast , I did not want to be on blood thinners. Apart from a little pain and stiffness on my breast bone, I am back in the water doing what I enjoy most. Life is good and don’t let anything get you down, keep on keeping on!

  76. Rich says

    Hi Dr Cresswell,

    I am a 31 year old cyclist (cycling for 3 years) who has recently being diagnosed with BAV and moderate to severe stenosis.

    I was unaware that I had BAV until I blacked out after coming off the circuit in a criterium, ending up in hospital that afternoon. Looking back I have had a few episodes of dizziness and chest pain in the last 18 months or so, but always thought it was asthma

    I am roughly 4 weeks away from having my surgery to replace the valve with a mechanical one.

    My question is having the BAV with moderate to severe stenosis, do you believe this would effect a persons aerobic capacity on the bike. As I feel that the amount of training I have done in the last couple of years I haven’t had much gain when it comes to races.

    I am hoping to be able to get back on the bike and to full fitness after the surgery and also after getting the all the clear from the doctors.

    A big thank you for this blog as it has been great to read others experiences with the condition.

    • Larry Creswell, MD says

      Yes, moderate to severe aortic stenosis would be limiting.

      Good luck with surgery and getting back to cycling.

      Larry

  77. Kylie Di Tommaso says

    Dear Dr Cresswell,

    My son had a porcine valve replacement at 9 for a congenital aortic stenosis and after developing endocarditis at the age of 15 was given an onxyz mechanical valve and takes warfarin daily.

    He is strong, fit, healthy and has gone on to play first class cricket, football, tennis and basketball.

    Thanks to the wonderful cardiologists at the Prince Charles Hosptal and Mater Hospital in Brisbane, Australia

    I now at 50 face my own journey for a valve replacement in the next few months – I have been fit and healthy and been running 10 km everyday- but recently was becoming out of breath.

    It was discovered that my heart murmur i have had since birth – is in fact an aortic stenosis

    For everyone out there who faces this operation. – put trust in your cardiologists – they will get you back on your feet

    Thankyou Dr Cresswell for your very insightful information and thankyou everyone for sharing your experiences

  78. Kathleen Sobel says

    I am 65 year old woman and recently diagnosed with moderate aortic stenosis. I am an avid tennis player and was wondering if I should continue to play. I play 3 to 4 times a week, in matches, and tennis clinic. Thank you.

    Kathleen

    • Larry Creswell, MD says

      For patients with moderate aortic stenosis, current guidelines suggest limiting activities to those of low intensity.

      I would be important to be certain the stenosis was moderate….and not mild. The issue of which sporting activities is safe deserves careful discussion with your doctor(s).

      • Anne says

        Hi Kathleen,

        I carried on with high intensity weight lifting until my aortic stenosis was severe and at the stage when I was referred for surgery.. This was with my cardiologist’s approval. I think it must depend on each individual.

  79. Andy says

    Hi Dr C!

    I’m 45 years old, relaatively active (gym rat), and have a bicuspid aortic valve. I’ve been experiancing some of the signs very recently that my doc said to watch for when it was time to begin the surgery discussion. Once I have this done, what kind of recovery time am I looking at before i can resume work (insurance sales), working out, etc? Also, what type of valve would you recommend? Thanks!

    • Larry Creswell, MD says

      Most patients who have aortic valve replacement spend a few days in the hospital recovering before they go home. Most are up walking the day after surgery. Walking is usually the recommended exercise for the first month after surgery. Other forms of exercise can usually be resumed by ~2 months.

      The surgical options are complicated.

      If only valve replacement is needed, there are mechanical or bioprosthetic valves to choose from.

      If the valve and nearby aorta both need to be replaced, choices include: mechanical valve with Dacron graft, aortic homograft (cryopreserved from human cadaver donor), Ross procedure (borrow your pulmonary valve to replace the aortic valve and use a homograft to replace the pulmonary valve), or a valve plus aorta borrowed from the pig.

      Need to have detailed discussion with your heart surgeon about what’s possible and needed in your case.

      • Andy says

        What great detailed info! Thank you so much! Your blog is greatly asppreciated and helping give me a little eace of mind!

      • joe says

        Hi Dr creswell. I have severe aortic stenosis for 5 months now. Pains all over the left hand side of my rib cage and upper chest.also palpatations in various parts of my body every day.my left arm is always very stiff.could you give me a rough idea as to the waiting time for my op,as I am getting more concerned every day. Many thanks

        • Larry Creswell, MD says

          Patients with severe aortic stenosis that causes symptoms should get operation for valve replacement soon.

  80. digiro says

  81. Andy says

    Thanks for the detailed info! You’r blog is helping to give me a little peace of mind! Greatly appreciated!

  82. Mark says

    Thursday 11-19-15 I will be having an AVR. Thank you all for sharing your experiences as they have relieved a tremendous amount of anxiety. 🙂 Will report back soon … Dave’s surfing story is truly inspirational. 58yr old male , bi-cuspid – 1 cm, going with the Edwards tissue valve Prescott Az.
    Symptoms- severe fatigue and low BP after heavy exercise ( 3-4 days) (not too much during exercise ). My Cardiologist thought it unusual as well. Good muscle vo2 I guess?? Heavy exercise is 12 mi. MTB 1000′ elevation change 1 hr 45 min. Kicks my butt.. thanks again Dr. Creswell for your Blog, Mark

    • Dave says

      Mark, be prepared to be thirsty after the operation. My first words when the operation was over and I was in a dream like state as they were wheeling me out of the OR was “Dad, I’m Thirsty!” And I remember my Dad looking very, tiny and frail for some reason . Then I immediately fell asleep again for who knows how long, but woke and was very , very thirsty for about 2 days.

      • Mark says

        I’m home , 4 days post op . 25mm Edwards bovine 3300tfx . Sternum looks worse than it feels as no pain meds are needed ( last 2 days) I would rather feel pain than be constipated LOL. Thanks again for all your support, Mark ( I’ll keep you all posted)

        • digiro says

          Congratulations on the successful operation. I agree with you, don’t take the pain killer meds unless you really need them. Good luck, keep us posted

  83. Eliza says

    My son is 17 and has mild to moderate aortic regurgitation and moderate to severe aortic stenosis due to bicuspid valve. Surgery is looming in the next year or so. I have been told that he can’t have TAVI due to his age. Is this a medical or financial restriction, and is it available in the US if not in UK? Thanks

    • Larry Creswell, MD says

      I don’t know the particulars of your son’s condition, but TAVR would be an unusual choice of orocedure for a 17-year-old with bicuspid aortic valve and aortic stenosis.

      In the U.S., there is a mandatory team approach, with both cardiologists and cardiac surgeons, in which patients are evaluated for TAVR. Consensus must be reached I. Order for hospitals and physicians to be paid by Medicare or other insurance plans. TAVR is indeed an expensive technology.

      The TAVR valves are bioprosthetic valves. They do not last forever. We expect them to last ~12-14 years, but after that some patients will have problems with the valve. A young patient like your son would need to expect re-replacement of the valve at some point….and perhaps several times in his lifetime.

      I’d encourage you to speak with his doctor(s) about options that are best for his particular circumstances.

  84. Kaan says

    Hello

    I m writin from Italy. I am 21. I have just learned that i have BAV since i borned.

    Doctors said it is now the lovest level and there is no problem to care about it now, but they also say it can increase and i might have an operation on my 40 s or 50 s.
    I m really worryin about myself. My question is , is there any problem for me to make fitness or somebodybuilding activities ? no one cannot answer it clearly in here. Can i make sports ?

    thanks.

    • Larry Creswell, MD says

      If there is no significant narrowing or leakage of the aortic valve AND there is no significant enlargement of the nearby aorta, then athletes may participate fully in their sports.

  85. Ben B says

    Hello. -Love your blog, by the way-

    I am 31 yrs old. I had a coarctation repair with a subclavian flap when I was 5 days old. I have not had any issues with that (CT scan two years ago revealed normal aortic size). Two years ago, I had an echo which said my AVA was 3.1 cm2. Last week, I had a follow up echo which said my AVA was 2.2 cm2. The NP told me that I was stable and to continue what I have been doing. Both echos showed trace regurgitation.

    I have three questions – 1. What is the margin of error for echo AVA measurements? 2. Should I be alarmed by this? and 3. Are there any life style or dietary changes I could make to slow the progression of stenosis? (I do P90X at home workouts that include a lot of plyometrics, pullups, pushups, dumbbell work (no more than 25 lbs), and yoga.)

    • Larry Creswell, MD says

      There is some degree of uncertainty in AVA measurements with echo, but I would suspect there was some sort of measurement error if the values were 3.1 and then 2.2.

      I’m not aware of any lifestyle or dietary changes which are proven to impact the development of stenosis over time.

  86. Dimitris says

    Dear DR,
    I am 35 year old. I have a BAV heart. I am an amateur runner since 20 years. I have a mild leak. Μy valve has a good broaching and i haven’ t any symptom when i workout. My last exam results before a month :
    aortic root : 29 mm
    aorty : 41 mm
    My cardiologist encourage me to continue training without exaggerations. He says that i can run with safe but he prevent me to weight lift.
    Tell me please your opinion. Thank you

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