BAV / 4.4cm ascending aorta dilatation weightlifting

[stoleon1337]

Hi to everyone,

Im 21 year old male ( 185cm, 80kg) , 6 months ago i did MRI and i was diagnosed with bicuspid aortic valve with mild aortic regurgitation( regurgitation fraction 19% ), ascending aorta dilatation to 44mm and mild left ventrical dilatation (EDV 214 ml, 105 ml/m2).

My cardiologist totally refrained me from weightlifting while cardio is off limits. I was curious to ask this question because i think it is a really low probability to suffer aortic dissection / rupture with this diagnosis/measurements, right? I think she said that because it was the most secure answer she could tell me. But , few days ago i contacted cardiosurgeon Allan Stewart and he told me that i can continue to lift , just to avoid ultra heavy ; squats, deadlifts and leg presses. I read alot articles , and every article says the same, dont lift heavier than half of ur bodyweight , dont strain blabla. While he told me i can lift till failure as well, and also can do pull ups, and everything just like normal person, just to avoid ultra heavy compound exercises which would mean powerlifting, right? And thats okay , cuz i am not interested in powerlifting, i always tend to lift in 10-12 reps zone and often lift till failure. He also said to me that after my aorta is fixed, i will have no restrictions at all( " but its not time yet" ), like i would be free to powerlift( which i repeat, would never do) . So , i concluded, if i am able to continue to lift now, and if that will cause some damage, i will know thru echo/yearly monitoring, and ofc i will need to stop if my valve starts leaking more or when my ascending aorta grows to 5cm+ ( near surgery). When talking about my surgery , there is a probability they can fix my valve cuz i "cant develop stenosis" and have only problem with regurgitation like my cardiologist said, therefore i could avoid valve replacement what would be great.

I want to hear your opinon about all this, and what advices did u get from your cardiologist related to weightlifting with this similar diagnosis. After all, i am just afraid of aortic dissection, while i think its like 0,1% to suffer it with 4.4cm dilatation without powerlifting?

Thanks!

 

[pellicle]

After all, i am just afraid of aortic dissection, while i think its like 0,1% to suffer it with 4.4cm dilatation without powerlifting?

well, most important part at the end ... I'd have found that more helpful at the beginning.

First let me say there are two kinds of opinions

1. someone you meet at the pub (Americans may call that a bar) who knows nothing about what you said, didn't listen properly but can't wait to have you listen to his advice
2. a trained medical professional offering an opinion

I don't like to offer opinions in this area without first referring people to appropriate resources and remind them of facts.

So from: RACGP - Aortic aneurysms – screening, surveillance and referral

The natural history is ongoing expansion, with increased risk of rupture as the aneurysm enlarges (Table 2).7 Aneurysms <5.5 cm expand at an average rate of 2–3 mm each year, with larger aneurysms expanding more rapidly. Aneurysms >5.5 cm diameter in men, and >5.0 cm in women, are at significant risk of rupture and should be considered for repair unless major contraindications exist.​

​

Table 2. 12 month AAA rupture risk by diameter​

AAA diameter (cm)​	Rupture risk (%/year)​
3.0–3.9​	0%​
4.0–4.9​	1%​
5.0–5.9​	1–10%​
6.0–6.9​	10–22%​
>7.0​	30–50%​

​

I was advised with mine (5.6cm in 2011, since operated and replaced with graft) that I could have elevated heart rate (from cardiovascular training such as bicycle spin) but to not increase the pressure on the system or increase the risk of rupture.

Let me point out a key thing here:

dont strain blabla. While he told me i can lift till failure as well, and also can do pull ups, and everything just like normal person,

normal people don't train hard ... that's key. Also don't be so dismissive (your whole tone sounded like a teenager dealing with his parents), straining is a significant issue. Many people I observe in the gym do strain when going to muscle failure.

If you think about it your vascular system is a bunch of long skinny tubes which are more or less balloon like. When you do big muscle exersizes (like squats) that's a bunch of big muscles compressing down on the balloon and increasing the pressure.

Your lungs are another big balloon which will be squeezed down when pressure (such as holding your breath and straining) occurs.

I myself (opinion) would suggest that you keep doing exersize, tend towards lighter weights and higher rep counts with slower deliberate movements (and a keen focus on technique).

The figure you gave is in the watch and wait category. I hope you'll continue to get 6 monthly imaging done and I suggest you find a new cardio who isn't as much of a worry wart.

Best Wishes

 

[stoleon1337]

well, most important part at the end ... I'd have found that more helpful at the beginning.

First let me say there are two kinds of opinions

1. someone you meet at the pub (Americans may call that a bar) who knows nothing about what you said, didn't listen properly but can't wait to have you listen to his advice
2. a trained medical professional offering an opinion

I don't like to offer opinions in this area without first referring people to appropriate resources and remind them of facts.

So from: RACGP - Aortic aneurysms – screening, surveillance and referral

The natural history is ongoing expansion, with increased risk of rupture as the aneurysm enlarges (Table 2).7 Aneurysms <5.5 cm expand at an average rate of 2–3 mm each year, with larger aneurysms expanding more rapidly. Aneurysms >5.5 cm diameter in men, and >5.0 cm in women, are at significant risk of rupture and should be considered for repair unless major contraindications exist.​

​

Table 2. 12 month AAA rupture risk by diameter​

AAA diameter (cm)​	Rupture risk (%/year)​
3.0–3.9​	0%​
4.0–4.9​	1%​
5.0–5.9​	1–10%​
6.0–6.9​	10–22%​
>7.0​	30–50%​

​

I was advised with mine (5.6cm in 2011, since operated and replaced with graft) that I could have elevated heart rate (from cardiovascular training such as bicycle spin) but to not increase the pressure on the system or increase the risk of rupture.

Let me point out a key thing here:



normal people don't train hard ... that's key. Also don't be so dismissive (your whole tone sounded like a teenager dealing with his parents), straining is a significant issue. Many people I observe in the gym do strain when going to muscle failure.

If you think about it your vascular system is a bunch of long skinny tubes which are more or less balloon like. When you do big muscle exersizes (like squats) that's a bunch of big muscles compressing down on the balloon and increasing the pressure.

Your lungs are another big balloon which will be squeezed down when pressure (such as holding your breath and straining) occurs.

I myself (opinion) would suggest that you keep doing exersize, tend towards lighter weights and higher rep counts with slower deliberate movements (and a keen focus on technique).

The figure you gave is in the watch and wait category. I hope you'll continue to get 6 monthly imaging done and I suggest you find a new cardio who isn't as much of a worry wart.

Best Wishes

First of all thanks for the answer, but u are talking about Abdominal aortic aneurysm , mine is about ascending aorta, these measurements u put mean nothing to me. ( But somehow i think those are very similar % with outcomes in ascending aorta ?)

But for text under that u are right, i will avoid squats, deadlifts and benchpress. Im gonna use machines , and from isolation exercises dumbells/barbell curl, leg extensions, and compound exercise like overhead(millitary) press, barbell row and will also incorporate calisthenics and bodyweight( like push ups, pull ups) ,everything in 10-12 rep range , 3 sets... What do u think? I just want to build some muscle mass, but its impossible if i wont go till failure ( it would be 12th rep ) . And i am free to continue to use whey protein and creatine , right ?

 

[pellicle]

ut u are talking about Abdominal aortic aneurysm

no, I'm talking about ascending aortic arch ... like I got fixed.

.. What do u think? I just want to build some muscle mass, but its impossible if i wont go till failure (

well I think you've got some wrong and strange ideas because I build muscle mass without going to failure of any heroics. I just didn't strain ... I think you need a better gym trainer too.

And i am free to continue to use whey protein and creatine , right ?

I assume this relates to post surgery and being on warfarin:
yes, although some effect may be found with albumin sources, however as long as you keep it consistent

if it relates to pre-surgery "of course" ... eat what you want (not crap, don't eat crap. Meats, vegetables, some carbs of course..

 

[stoleon1337]

no, I'm talking about ascending aortic arch ... like I got fixed.



well I think you've got some wrong and strange ideas because I build muscle mass without going to failure of any heroics. I just didn't strain ... I think you need a better gym trainer too.


I assume this relates to post surgery and being on warfarin:
yes, although some effect may be found with albumin sources, however as long as you keep it consistent

if it relates to pre-surgery "of course" ... eat what you want (not crap, don't eat crap. Meats, vegetables, some carbs of course..

Everything i ask is before surgery , now. Thanks brother.

 

[pellicle]

Everything i ask is before surgery , now. Thanks brother.

its my observation that many people seem go talk to their cardio or surgeon and sit there blank or empty minded or muddled up badly. They ask weird and irrelevent questions and have no clue. I have accompanied a few friends to specialist visits.

So as a result when they get out a whole range of strange ideas and mis-interpretations seem to be there in their head (either that or their health professionals are utter morons).

Think about things logically, ask questions here and write down and refer to the answers (as if you were studying for a test which failing is the worst result you'll ever have compared to school) when thinking about things >>before and after<< you go see cardiologist or surgeon.

Best Wishes

 

[DachsieMom]

I suggest you read some articles by Dr. Elefteriades at Yale. This is not medical advice. He researched weightlifting with aneurysms. From what I have read, bicuspid valve already puts you at a greater risk of dissecting at lower levels, potentially under 5 cm, and weightlifting would have a similar effect, and I believe was discouraged at 4.5 cm. I encourage you to google Dr. elefteriades and weightlifting and bicuspid - you will find the articles.

 

[pellicle]

From what I have read, bicuspid valve already puts you at a greater risk of dissecting at lower levels, potentially under 5 cm

this is also my understanding

 

[stoleon1337]

I suggest you read some articles by Dr. Elefteriades at Yale. This is not medical advice. He researched weightlifting with aneurysms. From what I have read, bicuspid valve already puts you at a greater risk of dissecting at lower levels, potentially under 5 cm, and weightlifting would have a similar effect, and I believe was discouraged at 4.5 cm. I encourage you to google Dr. elefteriades and weightlifting and bicuspid - you will find the articles.

One wise man once said to me that if that anerusym is so dangerous, they would operate it right away. We cannot live like grandphas. As u see im just seeking for opinions which other people got from their cardiologist and from their own experience. Like i said i read alot articles, and every article or quote u gonna say to me i know it, my cardiologist even asked if i study medicine when i asked her many different questions. I admire ur try to help, thats very kind, but please lets put those articles away. Dissection is a really rare event, im just looking for a folks that are/were in same situation with me and see what they say, what is their experience.

I have questions i asked in 1st post , and everything is as just clear ask sky..

 

[AZ Don]

I see that you already know what's in every article on this subject(?) and so are just asking for opinions. I'm sorry but my opinion is that your risk is much higher than you seem to think and that you should listen to the doctors and take it easy. This doesn't mean no exercise but it does mean some very real limitations. On the chance that over the years that I have lived, researched and followed this subject I may have come across something that you have not yet seen, I did include some references below ... because you absolutely should not just take the word of some person off the internet for medical advise.

From what I have read, bicuspid valve already puts you at a greater risk of dissecting at lower levels, potentially under 5 cm

When I had my surgery in 2013 for a 5.0-5.1 aortic aneurysm, the guidance was surgery for aortic aneurysm at 5.5cm but 5.0cm with BAV. In 2014 the guidelines were changed to 5.5cm for those with BAV, so I don't think this is the consensus anymore. Reference here: https://www.jacc.org/doi/full/10.1016/j.jacc.2014.02.536

In any case, the risks from an aortic aneurysm are very real. Here is an article that references the risk of complications by aortic size and body height. At 4.5cm the risks of complications from an aortic aneurysm range from 4% to 7% per year. See especially figure 7: “Getting beyond diameter”: when to replace the aorta? - Tanweer - Journal of Visualized Surgery
See also a study on weight lifting and aortic dissection. Mean diameter at dissection was 4.63cm: Weight lifting and aortic dissection: more evidence for a connection - PubMed

I saw a mention of 12 reps, but in my view high reps are 15-20, or more. It is definitely possible to build muscle at high reps without going to muscle failure. There are lots of recent articles demonstrating this. The larger your aneurysm gets, the more risks even light weight lifting may pose. This subject has been discussed many times and there is an excellent thread with many links here: Aortic aneurysm (watchful waiting) weight / resistance training

Regarding my experience: Ask enough people and you will likely hear the answer that you want. The doctors are quick to just say don't lift, or don't lift more than xx pounds. That is why I did so much research online. What I took from all that I read is that the risks are quite real and I would sum up the guidance that I have seen as: It seems that intense exercise of any kind, even aerobic may carry some risks for those with aneurysms, though low level aerobic exercise is recommended.

Regarding the surgery. The idea behind the timing of the surgery is to have the surgery when the risk of surgery is lower than the risks from the aneurysm over 1 year. I've never really understood this because if you don't have the surgery for xx years, than you have the risks from the aneurysm over xx years, which is much higher than the risk over 1 year. The risk from the surgery is a one time thing, and quite low for healthy people. Still, open heart surgery is not something to rush into.

Lifestyle changes don't necessarily mean that you have to live like a grandpa. But it is a gift knowing that you have this condition (I know it absolutely does not feel like it) and can take actions to reduce your risk until such time as you can have it repaired. And once repaired virtually all limitations are removed.

 

[stoleon1337]

I've never really understood this because if you don't have the surgery for xx years, than you have the risks from the aneurysm over xx years, which is much higher than the risk over 1 year. The risk from the surgery is a one time thing, and quite low for healthy people. Still, open heart surgery is not something to rush into.

That is what i actually asked myself many time...tbh i would rather choose surgery to be secure than living idk it can be 3 or even 20 years with this aneurysm until i become candidate for one.. ofc im gonna listen professionals, im gonna seek for sport cardiologist. Thanks mate , cheers.

 

[tom in MO]

They make one wait for surgery for a lot of reasons:

• because they don't want the liability if something goes wrong the surgery; they balance risk
• they hope you will move while waiting and some other country will have the expense,
• in the US, they hope you will change insurance companies and some other company will have the expense,
• sometimes there is no change forever and you will never need the operation (or cost).

Right now you have two professional opinions that do not agree. Hopefully you asked the surgeon to send a note to your cardiologist; if not do so. Schedule a consult with your cardiologist and ask them about the surgeons opinion. Remember, those who die of aneurysms or BAV never make it to a surgeon, but they often made it to a cardiologist. After you see the cardiologist, then decide if a third consult is necessary.

When I was your age a friend died of aneurysm they didn't know they had; it can happen. By having it discovered now, you were given a chance she never had.

There is life w/o weight lifting. There are many other ways to exercise.

 

[newarrior]

well, most important part at the end ... I'd have found that more helpful at the beginning.

First let me say there are two kinds of opinions

1. someone you meet at the pub (Americans may call that a bar) who knows nothing about what you said, didn't listen properly but can't wait to have you listen to his advice
2. a trained medical professional offering an opinion

I don't like to offer opinions in this area without first referring people to appropriate resources and remind them of facts.

So from: RACGP - Aortic aneurysms – screening, surveillance and referral

The natural history is ongoing expansion, with increased risk of rupture as the aneurysm enlarges (Table 2).7 Aneurysms <5.5 cm expand at an average rate of 2–3 mm each year, with larger aneurysms expanding more rapidly. Aneurysms >5.5 cm diameter in men, and >5.0 cm in women, are at significant risk of rupture and should be considered for repair unless major contraindications exist.​

​

Table 2. 12 month AAA rupture risk by diameter​

AAA diameter (cm)​	Rupture risk (%/year)​
3.0–3.9​	0%​
4.0–4.9​	1%​
5.0–5.9​	1–10%​
6.0–6.9​	10–22%​
>7.0​	30–50%​

​

I was advised with mine (5.6cm in 2011, since operated and replaced with graft) that I could have elevated heart rate (from cardiovascular training such as bicycle spin) but to not increase the pressure on the system or increase the risk of rupture.

Let me point out a key thing here:



normal people don't train hard ... that's key. Also don't be so dismissive (your whole tone sounded like a teenager dealing with his parents), straining is a significant issue. Many people I observe in the gym do strain when going to muscle failure.

If you think about it your vascular system is a bunch of long skinny tubes which are more or less balloon like. When you do big muscle exersizes (like squats) that's a bunch of big muscles compressing down on the balloon and increasing the pressure.

Your lungs are another big balloon which will be squeezed down when pressure (such as holding your breath and straining) occurs.

I myself (opinion) would suggest that you keep doing exersize, tend towards lighter weights and higher rep counts with slower deliberate movements (and a keen focus on technique).

The figure you gave is in the watch and wait category. I hope you'll continue to get 6 monthly imaging done and I suggest you find a new cardio who isn't as much of a worry wart.

Best Wishes

Rockstar response

 

[Keithl]

When I was diagnosed at 4.3i was told avoid anything that is rapid rise in BP, things like cardio works out which were cardio and gradual built up and steady were OK, but heavy lifting that was strenuous was discouraged.

 

[Unicusp]

As stated above, when BAV & AAA are combined, they usually suspect a potential connective tissue disorder like Marfan's syndrome. I see that you are 6' tall and 176 lbs.. So, you are not super thin and may not have Marfan's but should have it researched further. If you do have some sort of connective tissue disorder, dissection can happen at smaller diameters. I was similar height and weight as you and my ascending aorta went to 5.4cm before I finally went for surgery. The aorta had no bulges, the entire aorta was that size. After surgery, when I asked the surgeon about it he stated that it was "very fragile". So, not sure how long it would have lasted. I was also diagnosed with BAV until they got in there and saw a unicuspid AV. You could also have such a thing. Echo's and CT's did not see it. I was also doing all kinds of exercise but lower weight and high reps, and never hold your breath during lifting.

 

[stoleon1337]

As stated above, when BAV & AAA are combined, they usually suspect a potential connective tissue disorder like Marfan's syndrome. I see that you are 6' tall and 176 lbs.. So, you are not super thin and may not have Marfan's but should have it researched further. If you do have some sort of connective tissue disorder, dissection can happen at smaller diameters. I was similar height and weight as you and my ascending aorta went to 5.4cm before I finally went for surgery. The aorta had no bulges, the entire aorta was that size. After surgery, when I asked the surgeon about it he stated that it was "very fragile". So, not sure how long it would have lasted. I was also diagnosed with BAV until they got in there and saw a unicuspid AV. You could also have such a thing. Echo's and CT's did not see it. I was also doing all kinds of exercise but lower weight and high reps, and never hold your breath during lifting.

Its really weird that CT showed a bicuspid valve and u found out thru surgery that it was unicuspid lol, is that for real.. i mean i did MRI, it stands as a gold standard for heart check

 

[pellicle]

mean i did MRI, it stands as a gold standard for heart check

MRI doesn't have the same resolution as CT with contrast
TEE is also valuable.

Either way what actual difference did this make to his surgery?

Despite improvements in medical imaging it's not Star Trek yet.

Also I dropped by to ask if you have tried slow reps? I try to make mine 2~3 seconds in each direction and do controlled breathing in each direction too. This has the added benefit of preventing momentum assistance swings.

See how that works for you.

Also about building muscle bulk to me that's entirely about vanity. Training has always been something I do to enhance my strength and or endurance. Despite what appears in Hollywood or "entertainment fighting" (world series wrestling comes to mind) the fittest toughest soldiers in Australia are in the SAS and they just look like ordinary blokes, not body builders. Says something right there...

 

[stoleon1337]

MRI doesn't have the same resolution as CT with contrast
TEE is also valuable.

Either way what actual difference did this make to his surgery?

Despite improvements in medical imaging it's not Star Trek yet.

Also I dropped by to ask if you have tried slow reps? I try to make mine 2~3 seconds in each direction and do controlled breathing in each direction too. This has the added benefit of preventing momentum assistance swings.

See how that works for you.

Also about building muscle bulk to me that's entirely about vanity. Training has always been something I do to enhance my strength and or endurance. Despite what appears in Hollywood or "entertainment fighting" (world series wrestling comes to mind) the fittest toughest soldiers in Australia are in the SAS and they just look like ordinary blokes, not body builders. Says something right there...

I stopped working out, tomorrow i have an appointment with cardiologist that knows both sport and cardiology so im gonna listen what she has on her mind. Btw, you already had surgery, right? Why you worry about weights then, you have no weight restrictions , ofc i would avoid valsalva manuever even after surgery, but it wouldnt harm me even if j dont? ( Note ; im just curious about ur precaustions post surgery, im pre surgery guy)

 

[pellicle]

Good Morning

Btw, you already had surgery, right? Why you worry about weights then, you have no weight restrictions

well you seem to have not remembered much of what I've said about myself (which is fine) so I'll remind you of a few things. You perhaps won't read this in detail, perhaps you'll struggle to understand it, but I hope that you'll keep it and consider it from time to time.

I was diagnosed at about 7 (hard to remember because I came from a family who didn't keep records in that way and I seldom reflect on that detail) and monitored yearly and eventually more frequently. I had my first OHS at about 10yo. I was monitored again after that yearly.

At about 28 I had my second OHS which was my first valve replacement. That also meant I was monitored increasingly in the lead up to that and in the follow up, initially yearly falling off to bi-yearly.

Then I went to Japan and more or less forgot about it and lived a rich and full life. However I never stopped paying attention to who I was and what my limits were.

You see we are born knowing nothing of ourselves, our first years are spent copying and following. In our comparisons of ourselves to others (inevitable, for that is what humans do) we see things we are not and want to become. This can be good as that often leads us to become things (Biochemists, Engineers, Outdoorsme n...) but it does not often teach one about ones true self.

In all those many many yearly appointments, those times in hospital beside other heart valve patients and in all those consultations with my surgeon (same guy over many of those years) I started to learn about myself, the physiological side of myself.

Just like your height defines if you can or can not become a basket ball player, and your build defines if you can become a hockey goal keeper (sports which are insignificant in Australia, so I choose those to suite your appreciation of figures) your cardio vascular (CV) system defines you in an internal way which is invisible to most.

you have been given the capacity and opportunity to see that inside yourself now.

There is sport and there is competitive sport; and I was always told to avoid competitive sport. As a younger lad (less than 20) I didn't really understand what that meant, not least because I was blocked from sport (due to surgeries, recovery, parents ...) from when I was in grade 4. By grade 11 I was actually not interested in sport (perhaps because of being bad at it) and so chose to focus on other academic things.

By about 15 I had started lifting weights and worked in my dads business (as well as going to school) which involved a lot of heavy lifting. Nobody even thought of Occupational Health and Safety back then, but I began to see around me people who were injured and couldn't do things because of those injuries.

Weight training as a competitive sport puts huge pressures on your CV system. Once you know you have an aneurysm you know that you must take that seriously or be destroyed by your failure to see that.

In my 20's and 30's (and you are not far into your 20's yet) I saw that competitive sport was like a pyramid (a 3 dimensional one), with thousands of blocks on the base, less on each level with only one on the pinnacle. What most DON'T see is that for every block on the base and for every block on each level there are many more blocks which broke in the making of them, cast aside as rubble in the quarry or ground down to be made something "useful".

As you age you can look around and perhaps see some of that cast aside rubble (if its still alive) in glimpses of "I was the star of my year in Football at my school" ... and consider how many years that school had and how many "was" that never were.

So I say to you (and it will be difficult for you to understand this now, so again I say keep this and refer to it) that because of the foundations of your CV system you will be one of those blocks if you try to be part of that pyramid.

Life is not a movie, and sadly far too many people are influenced by what they see on screens.

This does not mean you can't lift weights nor train at a sport, it simply means you must know yourself well, listen to what your body tells you, listen to the evidence given to you from scans and medical imaging and see that evidence and act on it.

Knowing my own limits is why I'm here today, having done sports like Fencing, Judo, Aikido and having travelled a lot of the world, learned to do things I never imagined possible (such as XC Ski and do it better than many Finns). I to this day am fitter than many I work with, but not as fit as many more.

I have knelt beside (and attended first aid) to people who died on the road before me (more than once). Some thought they were better motorcyclists then the evidence proved. They became the broken blocks in their quest.

Learn moderation in everything and (have the best chance to) live a long and prosperous life. You and I are simply passing on our orbits of life at the moment, and I will of course be dead by the time you are my age, I hope you get there, and I hope you learn many things and develop into a well rounded human. I of course won't ever know if you succeed or fail.

So listen to your surgeons and be guided by them or not, learn about yourself and steer your own ship or don't, train hard or don't ... its no matter to me. I can only do what I have done: advise you based on my personal experience and reflection.

Best Wishes

 

[stoleon1337]

Good Morning


well you seem to have not remembered much of what I've said about myself (which is fine) so I'll remind you of a few things. You perhaps won't read this in detail, perhaps you'll struggle to understand it, but I hope that you'll keep it and consider it from time to time.

I was diagnosed at about 7 (hard to remember because I came from a family who didn't keep records in that way and I seldom reflect on that detail) and monitored yearly and eventually more frequently. I had my first OHS at about 10yo. I was monitored again after that yearly.

At about 28 I had my second OHS which was my first valve replacement. That also meant I was monitored increasingly in the lead up to that and in the follow up, initially yearly falling off to bi-yearly.

Then I went to Japan and more or less forgot about it and lived a rich and full life. However I never stopped paying attention to who I was and what my limits were.

You see we are born knowing nothing of ourselves, our first years are spent copying and following. In our comparisons of ourselves to others (inevitable, for that is what humans do) we see things we are not and want to become. This can be good as that often leads us to become things (Biochemists, Engineers, Outdoorsme n...) but it does not often teach one about ones true self.

In all those many many yearly appointments, those times in hospital beside other heart valve patients and in all those consultations with my surgeon (same guy over many of those years) I started to learn about myself, the physiological side of myself.

Just like your height defines if you can or can not become a basket ball player, and your build defines if you can become a hockey goal keeper (sports which are insignificant in Australia, so I choose those to suite your appreciation of figures) your cardio vascular (CV) system defines you in an internal way which is invisible to most.

you have been given the capacity and opportunity to see that inside yourself now.

There is sport and there is competitive sport; and I was always told to avoid competitive sport. As a younger lad (less than 20) I didn't really understand what that meant, not least because I was blocked from sport (due to surgeries, recovery, parents ...) from when I was in grade 4. By grade 11 I was actually not interested in sport (perhaps because of being bad at it) and so chose to focus on other academic things.

By about 15 I had started lifting weights and worked in my dads business (as well as going to school) which involved a lot of heavy lifting. Nobody even thought of Occupational Health and Safety back then, but I began to see around me people who were injured and couldn't do things because of those injuries.

Weight training as a competitive sport puts huge pressures on your CV system. Once you know you have an aneurysm you know that you must take that seriously or be destroyed by your failure to see that.

In my 20's and 30's (and you are not far into your 20's yet) I saw that competitive sport was like a pyramid (a 3 dimensional one), with thousands of blocks on the base, less on each level with only one on the pinnacle. What most DON'T see is that for every block on the base and for every block on each level there are many more blocks which broke in the making of them, cast aside as rubble in the quarry or ground down to be made something "useful".

As you age you can look around and perhaps see some of that cast aside rubble (if its still alive) in glimpses of "I was the star of my year in Football at my school" ... and consider how many years that school had and how many "was" that never were.

So I say to you (and it will be difficult for you to understand this now, so again I say keep this and refer to it) that because of the foundations of your CV system you will be one of those blocks if you try to be part of that pyramid.

Life is not a movie, and sadly far too many people are influenced by what they see on screens.

This does not mean you can't lift weights nor train at a sport, it simply means you must know yourself well, listen to what your body tells you, listen to the evidence given to you from scans and medical imaging and see that evidence and act on it.

Knowing my own limits is why I'm here today, having done sports like Fencing, Judo, Aikido and having travelled a lot of the world, learned to do things I never imagined possible (such as XC Ski and do it better than many Finns). I to this day am fitter than many I work with, but not as fit as many more.

I have knelt beside (and attended first aid) to people who died on the road before me (more than once). Some thought they were better motorcyclists then the evidence proved. They became the broken blocks in their quest.

Learn moderation in everything and (have the best chance to) live a long and prosperous life. You and I are simply passing on our orbits of life at the moment, and I will of course be dead by the time you are my age, I hope you get there, and I hope you learn many things and develop into a well rounded human. I of course won't ever know if you succeed or fail.

So listen to your surgeons and be guided by them or not, learn about yourself and steer your own ship or don't, train hard or don't ... its no matter to me. I can only do what I have done: advise you based on my personal experience and reflection.

Best Wishes

Hi brother , very interesting story to hear , im glad you succeded in life , hope im gonna as well.

Today i talked with my new cardiologist and she told me not to worry about this and not to worry about aortic dissection , she told me to live life like a normal person, just to avoid extra competitive sports, like i cant participate in any profesionall sport but i can do what i want, she told me to avoid ultra heavy deadlifting and thats it , she will follow me and every change we will know on time. When talking about deadlifting, i dont even do it, but she told me classic bench, squat is okay , but not to go to extreme limits, like extra heavy weights where u tend to really strain and put so much stress on the aorta (=powerlifting), which i dont do either. Im really happy i found such an expert like her, she is one of the best in my country. Thank u all once again for this nice and i would say educational convesation.