15 year old with BAV. limited activity?

[Steve3730]

Hi, my nephew has BAV they told him that everything looks fine and since last year nothing has changed. However when he asked the DR about weightlifting he advised against it.

My nephew plays football and at the rate he is at he has a good chance of playing at a college level or higher. So he was devistated to learn he couldn't liftweights. Is the cardiologist being over protective? is there a level of strength training he can do? thanks for any help on this i'm hoping I can deliver him some hope

 

[kiltedscotsman]

Just a personal experience here, as I found myself in a similar circumstance as your nephew. I was diagnosed with BAV at a young age, was told that my conditon was very mild and it would likely not be until late in life (if ever) that I would require surgical intervention. I did not limit myself in any way - I played hockey, lifted weights, was a volunteer firefighter and eventually became a police officer. The combined stress of all these activities led to a severe deterioration in the condition of my valve and an aneurysm in my ascending aorta at the relatively young age of 29, and surgery at the age of 32.

I'm not saying I regret my choices - I do not - but the choice carried a risk that I accepted. My suggestion is to discuss this in much more detail with your cardiologist.

 

[clay_from_nj]

IMHO, if the BAV is bad enough to negatively affect his lifestyle, I would seriously consider surgery sooner rather than later. Sure, he may not need to have the valve replaced for many years, but should he be limited in the meantime because of it? I think the discussion with his doctors should not only consider what needs to be done to save his life, but what should be done to give him the best possible life.

 

[AZ Don]

First it is important to understand whether your nephew's valve is well functioning or if he has some level of aortic regurgitation or insufficiency. Since he is young and "everything looks fine" I'm guessing that the valve is well functioning and the cardiologist is concerned about the risk of developing an aortic aneurysm. If that is the case then the Cardiologist may be more conservative than some. Generally the advise for those with an aneurysm is to avoid heavy weightlifting, but for those with only a mild aortic dilation, or just a BAV, often there are no restrictions. It may be worthwhile to get a 2nd opinion and to ask the 1st Dr. specifically why your nephew should limit his activity As mentioned above, I think this is also a personal choice. Someone with a BAV has a significant risk of developing an aortic aneurysm, and heavy weightlifting is thought to accelerate this process. While there may be some increased risk, that is at least somewhat mitigated by the monitoring every year or two that is generally done for those with BAV - if the valve deteriorates or an aneurysm develops, it should be detected and these conditions can be repaired. Certainly many people have competed in sports with a BAV - Arnold Schwarzenegger had one, at least until he had his valve replaced. You may want to look for threads on this forum started by GymGuy - I believe that he had a BAV and an aneurysm (repaired) and he is a competitive powerlifter (before and after his surgery). If your nephew chooses to continue in sports, one thing that should be avoided as much as possible is the vasalva maneuver (holding breath while straining).

I have been advised not to lift heavy weights so I have chosen to limit myself to weights that I can lift at least 25 times. I am finding that I can get a good workout from this, but then I am not a competitive athlete. Still, it seems there is some evidence to back up this approach to weight lifting: http://www.valvereplacement.org/for...080-Weight-lifting-with-bicuspid-aortic-valve

Something else to ask the Dr's about is Losartan. It has shown promise in slowing or stopping aortic aneurysm's in those with Marfan's, and some think it may help those with BAV as well, though no definitive proof of this yet: http://www.valvereplacement.org/for...-the-Aorta-(Losartan-and-Marfan-s)&highlight=

 

[ski girl]

I was never given any weight lifting restrictions and I was doing sets heavy enough that I could only manage three reps. I have a wonderful cardiologist who understood that I would rail against restrictions so as soon as I got to where I would need some, he bundled me off to the surgeon.

The last thing a 15 year old boy (and competitive athlete) needs is to feel mollycoddled and like there is something wrong with him - even if there is - so as mentioned above, he may wish to get that valve replaced sooner rather than later and get back in the game to the best of his potential!

 

[AZ Don]

FYI, regarding valve replacement. It is thought that the underlying process that causes the valve to form improperly (resulting in a bicuspid aortic valve) also undermines the formation of the aorta, undermining it's strength. This is why those with a BAV are at higher risk for aneurysm, and have a more aggressive criteria for intervention to correct an aneurysm. Replacing the valve will not change the risk for aortic aneurysm.

 

[clay_from_nj]

I don't believe that BAV automatically comes with aneurysm risk. When he replaced my valve, my surgeon said that my aorta looks just fine. I have been told to exercise with absolutely no restrictions by my surgeon, cardiologist, and GP. That being said, I am at an age where I have passed the greatest risk, as a defective aorta would have probably shown some signs by now. If the nephew actually has evidence of aortic dilation or weakness, it would not be unwise to replace both the valve and aorta sooner rather than later. (Ann Thorac Surg. 2002 Nov;74(5):S1773-6; discussion S1792-9.) As I said before, why live a life of restrictions and limitations if you don't have to?

 

[AZ Don]

I don't believe that BAV automatically comes with aneurysm risk.

?! The first sentence in the article that you referenced says that it does (see below). I think this connection is very well established. While BAV doesn't automatically come with an aneurysm, it does come with the risk. 20% is much higher than the risk in the general population.

Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. http://www.ncbi.nlm.nih.gov/pubmed/12440663

Ascending aortic dilatation occurs more frequently and at a younger age in patients with bicuspid aortic valves (BAV) than it does in patients with normal trileaflet aortic valves (TAV). http://circ.ahajournals.org/content/119/6/880.full

In the Cleveland Clinic experience, with over 5,000 patients with BAVD, 20 % had associated aneurysms.
http://my.clevelandclinic.org/heart/disorders/bicuspid_aortic_valve_disease.aspx

FYI, the Cleveland Clinic article has a lot of good info about BAV.

 

[clay_from_nj]

Just please don't scare those with BAV into thinking that they are doomed to suffer an aneurysm and dissection. According to the above-quoted reference to the Cleveland Clinic experience, 80% of BAVD patients did not have associated aneurysms. There is an increased risk, not a fait accompli. The genetic causes and interrelationships are very complex: http://www.annalscts.com/article/view/1404/2035.

So let me rephrase: precisely, "I don't believe that BAV automatically comes with aneurysm."


I'd worry more about what risk factors I can control and that have almost as great an effect:

BAV conveys an 8-fold increased risk of aortic dissection. (http://www.annalscts.com/article/view/1404/2035)
Current smokers were 7.6 times more likely to have an AAA than nonsmokers. (http://www.ncbi.nlm.nih.gov/pubmed/10587395)
Uncontrolled hypertension remains the most significant treatable risk factor for acute aortic dissection. (http://www.ncbi.nlm.nih.gov/pubmed/23599348)

 

[anne casey]

Steve3730,
My son is almost 18 and in his senior year and a baseball player. He was just told to only lift light weights, more reps and not get out of breath when lifting, no straining. He sadly was also told not to play baseball now his senior year! He is considered severe and surgery is near...now we try to let him enjoy (if possible) his senior year on pins and needles, not knowing if surgery will be necessary before graduation or not. I guess, I'm trying to say I totally feel your frustration with watching by helplessly a teenage boy with BAV, when they just want to be a normal boy and play sports with their friends! Sometimes I wish they would just do surgery, so he can move on with out this "cloud" over his activities.