Aortic Valve Replacement And Exercise

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Aortic Valve Replacement And Exercise

Postby roly » Fri May 02, 2014 4:54 pm

I am 29 years old and was diagnosed with a bicuspid aortic heart valve when I was 23. Since then the cardiologist has been monitoring changes in my condition and whilst I have not noticed any symptoms (e.g.: dizzy spells, ankle swelling, chest pains, etc), he has recommended surgery based upon internal changes (aorta dilation and left ventricle dimensions).

I regularly partake in sporting activities and since diagnosis, under consultation of the cardiologist have been regularly doing endurance events including long distance triathlons, ultra runs, and high intensity training. Since being recommended for surgery I have been advised to avoid high intensity exercise, advice that I am following. I would like to continue to do similar sport in the future and am interested if anyone has any advice or experience of doing similar kinds of sport post aortic valve replacement. The surgeon is recommending I have a mechanical valve - based upon my age - which will mean I will need to take warfarin. I'd specifically be interested in people's thoughts/experiences about exercise post operation to do with the valve replacement, the warfarin, and whether specific types of valve will be better for doing exercise than others.


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Re: Aortic Valve Replacement And Exercise

Postby Tricky Dicky » Tue May 06, 2014 10:16 am

Hi Roly,

I was due to have my bicuspid aortic heart valve replaced based on echocardiogram, TOE, MRI etc but it was cancelled at a morning appointment with my cardiologist (had an appointment for the pre-op tests in the afternoon). They were so pleased with my exercise test ("nobody who can do that well in an exercise test needs to have their valve replaced" ) that it has been put off for a while.

I guess your measurements but be quite severe if you need a replacement even though you have no symptoms.

Anyway, there are a lot of folk out there doing sport whilst on warfarin and it is something which gets discussed on various sports forums on the www(including singletrackworld and UK climbing) so a good bet would be to post on one of the triathlon or running forums. Most folk agree that there is even more of a need to wear a helmet when cycling as warfarin could lead to internal bleeding following a head injury. Some people carry wound dressings and wear an ID bracelet, and it would be sensible to tell other people who you are training with that you are on warfarin just in case.

I would be interested to hear what you find out.


PS There is an On-X valve mentioned here which appears to not need warfarin.......................
Tricky Dicky
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Location: Camberley

Re: Aortic Valve Replacement And Exercise

Postby Gingerbread Man » Sun May 11, 2014 9:12 am

Hi Rich
I've had two aortic valve resections, as a child, and played competitive football until I was 40 and 5-a-side until nearly 50. The standard wasn't great.
The heart specialists at Bristol never discouraged it, only extreme events (like Marathon).
I guess I can see I lacked stamina and was always very tired after playing but, as far as I know, my life was never in danger and it was great to do.
Bristol told me many times there's people with CHDs worse than mine playing sport at a good level.
In my opinion sport can be a great source of calm, and this must be good for the heart.

Unfortunately arryhthmia caught up with me, cardiac arrest and now a ICD. Today I'm playing a table tennis tournament, again not a great standard. Bristol are more cautious now and ask I don't push myself so hard. I'm 55.

I hope it goes well Rich. Everyone's condition is, I guess, different and advice has to come from the specialists, but I'm certain sport can keep us me sane and alive for many years.

Good luck!
Gingerbread Man
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Re: Aortic Valve Replacement And Exercise

Postby roly » Tue Jul 08, 2014 8:04 pm

Thanks for the advice. Just to be clear I am looking to do extreme endurance events post operation (marathon/Ironman+). Since my original post I have done some reading up and got additional opinions from other surgeons. Every surgeon says I need a valve replacement, and I have 3 main options:

o Mechanical valve:
+ Lasts forever
- Need to take blood thinners which means I will take ~3 times as long to clot and need to take regular medication
- Makes an audible clicking noise
- If I sustain a heavy impact to the chest the valve can break
- Due to the flaps of the valve not opening outwards (see image ... ediagr.jpg) it is narrower than a tissue valve, which can cause an issue doing intense sport.

o Dead tissue valve (normally bovine, pig, or homograft):
+ Same size and shape as normal valve so should have same potential post operation as an ordinary person
- Doesn't last forever - recent studies have shown it lasts around 18 years, however, statistics are done on older patients and does not take into account patients who have died of other causes

o Live tissue valve - normally move the pulmonary valve to the aortic valve and replace the pulmonary valve with dead tissue valve as above (Ross procedure):
+ Same size and shape as normal valve so should have same potential post operation as an ordinary person
+ Pulmonary valve under much less stress than tissue valve so should last longer than dead tissue valve in aortic position (although not backed up by stats)
+ Catheter based pulmonary valve replacements are being performed today, so less chance of needing open heart surgery when pulmonary valve needs replacing
- Still need a valve replacing
- More complex operation as moving a healthy pulmonary valve to replace the aortic valve

Based upon the above I have decided to go for the Ross procedure. I have had to change waiting lists which will mean I have to wait a few more months before the operation.
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Re: Aortic Valve Replacement And Exercise

Postby Melanie Raine » Thu Jul 24, 2014 3:17 pm

Hi, my daughter had a Ross Procedure in Aug 2009 at the age of 15 so almost 5 years ago. Upto about 13/14 she was very fit and athletic and took part in all kinds of sports. As her Aortic Stenosis worsened so did her ability to exercise. She had her aortic valve ballooned in Nov 2008 which was unsuccessful and between then and the OHS she could barely walk the stairs which was a mighty change for the girl who used to do athletics and cross country. After her Ross, she was told she would be able to take up sport again, other than diving (which was not a preferred choice anyway lol). Although she has not gone back to sport, she leads a great life, running her own business and working all the hours she can. As she says, if she had to do it all over again, she would. The cardiologist says her heart is a close to 'normal' as it gets so I think if you take the advice of the people in the know, you won't go far wrong. Good luck.
Melanie Raine
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