Contact sport 11 weeks after BAVR!!

[Bad Mad]

Having looked through forums such as this for about a year now, I thought it was time to tell my story, share stories, and source sound advice from people who have gone through similar situations.

I am a 29 year old male living in Ireland, who after suffering a Broken Jaw in a game of Gaelic Football (Aerobically like soccer, physically more like rugby and Aussie Rules) in 2000, it was dicovered that I had a severly leaking Aortic Valve.

A short time after (Feb '2001) I had a Homograft valve implanted.
As a very keen sports person, I could not wait for a return to competitive sport, and did so successfully to play my first game exactly 11 weeks after surgery! ( Have newspaper clippings etc. to prove this).
Incidently the only medical person who said this was anywhere remotely possible was the surgeon who performed the operation!

I continued to play at a high level (similar to semi-pro or even pro. without the financial rewards!) up until last year (May 2006), when it was dicovered that my ascending aorta had dilated to 4.4cm. Several exercise tests have also shown a BP of approx. 240/100 at maximum exercise. So all things considered I very reluctantly ceased my playing career at the advice of the medical professionals. I now take a 4mg Ace Inhibitor daily called Perindopril to control my BP.

My dilemma was that the advice given in these circumstances isn't based on any hard facts but rather on people with BAV disease having weaker aortas, and the risks associated with an aortic aneurysm. The line I keep getting is:
"There is a small risk involved here." But this was never quantified, so left me thinking should I take this "small" chance continue to play the sport that I love.

My other dilemma was the "what do I do next time" situation. As my valve will probably need replaced again in the next 3/4 years along with the aortic root, do I go for another homograft or do I take the conservative (sensible?) option and get the mechanical valve implanted?

Obvioulsy the advantage of the above is that it would probably be my last ever op. The downside: warafrin, no contact sport and the lifestyle restrictions associated with warafrin.

Option 2 would be to go for another tissue valve, and have the possibility of returning to competitive sport. The downside: The risks associated with a third operation. If I were to consider this option, I would get it done sooner rather than later.

Does this sound crazy for another 4/5 years max. at my sport????

As the only people I have ever really been able to confide in has been medical professionals, I would really love to hear what other people think, or of other people who have been in similar situations.

Sorry about the length of the post folks!

 

[Karlynn]

Welcome Bad Mad!

Regardless of whether you go tissue or mechanical - if they don't deal with the 4.4 aneurysm with this surgery, you may likely be in surgery again for that. What I would be concerned with in them not dealing with it now, is that they really don't know how fast the aneurysm will grow. It may creep along or you may go in within a year or two and find it's 5.5. With BAVD I believe you have more than just a "small" risk of the aneurysm growing. But I'll let those more knowledgable about BAVD address that.

The question I have for you is "What other things do you have in your life that are as important or more important to you than Gaelic Football?" Family, children, love etc? Rather than focusing on a decision that allows you to play "4/5 more years max" of the sport, what are other factors that need to weigh into your decision? Are there other interests that would make it more wise to stay out of the OR as long as possible, or is playing this sport the most important thing to you, with no others relying on you to be healthy for many years. Not that a 3rd surgery would rid you of that ability, but each surgery gets more difficult and we don't haven any crystal balls lying around to tell us whether 3 is too much, or perfectly fine.

It's totally your decision and only you know your capabilities of living well with each choice. Just make sure you have clear, correct information on any of your options before making that choice. Don't hesitate to ask any questions here.

Best wishes.

 

[Bad Mad]

Hi Karyln

Thanks for the welcome and your post.

Yes I do have more important things than the football i.e. Girlfriend, family etc. (almost thought for a sec that was her posting!!) and I suppose that was a major factor in making the decision to quit i.e. The worry I would be putting them through.

Apologies for the lack of clarity in my post. When I get the AVR done again the plan is to repair the aorta as well, given the fact that it will be around that threshold anyway. Don't fancy getting seperate op's if it can be done in the one go. 2 for the price of 1 and all that!
How they go about this will be the question. I know they do some sort of a composite valve/graft thing, that may be a possibility.

Also the cardiologists concern was that aneurysm would grow quicker/rupture as a result of a continuation of my training/playing. The small risk referred to woulod be a dissection/rupture.

As regards the Asending aorta, it's fine. Since 2001 it has grown approx. 1mm at most per year, and I am on the ball as regards regular check-ups etc.
The echos over this past 5 years clarify this.

Thanks again for the sound advice and the comments Karyln. Any further comments would be appreciated.

 

[67walkon]

BM, difficult issues indeed. I have a bicuspid AV and my ascending aorta is now 5.0 cm. We are working on scheduling surgery this summer.

I stopped playing basketball immediately when I looked at the risk factor. Its something I've done all my life and I miss hanging out with the guys. But, I also ride a bike and so far, they say I can do that in moderation until the surgery.

It is hard to switch and abandon something you love, but I am convinced I would really regret not being careful if I were laying on the court dying.

Also, they're telling me that the 3d generation tissue valves are good for, they hope, 15 to 20 years or maybe even more, so thats what I'm going with.

Good luck.

 

[briansmom]

No, it is not stupid to consider the sport you love. However, I do think that you should quit playing until your next surgery. An aortic dissection or rupture is usually an immediate death sentence. Long term - are you able to have a fulfilling life without your sport? My son had to give up off-road motorcycle riding - a sport that he has lived for since he was 2 years old. This has been very hard for him. Our family life and livelihood revolves around off-roading. He is in a 4 wheel caged vehicle now, but it would be better if he could give it up entirely. He is only 16, though and does not have anything else to live for.

 

[Karlynn]

BM -
I hope I didn't sound like I was chastizing you for placing importance on the sport you love. I reread my post and realized that it could have seemed that way, but I didn't mean it that way .

At 4.4 I believe there is only a small risk of disection. But we do have a few members (Ross, our moderator being one) who disected before the 5.0 that many surgeons wait for before operating.

I've also read that the size of the person has a part. If you are taller person 4.4 isn't as big as a 4.4 in someone who is 5 feet tall.

 

[Bad Mad]

Thanks for the replys guys.

67 Walk on: Interesting. My cardiologist mentioned to me the other day about these new tissue valves that will last longer. How old are you?

Have you had a BAV replacement before or will this be your first heart surgery?

Do you hope to return to basketball after thos op?
Do you know if you are going to get the composite valve/graft?

Whilst the life span of the new valve may be 15 - 20 years, would it not be true to say: the more active you are the shorter it will last?
I was told in 2001 my valve would last 10 maybe 15 years. With no complications in this time, I will still be lucky to reach 10 before I need replacement.

Brians mom: It really seems as though Brian has been through the mill at such a young stage in his life. He must be a very strong, resilient individual.
I suppose I have a alot to be greatful for, particularly when I read posts like these. When I was initially diagnosed with BAVD and had to go for surgery I was 23 years old. To get another 5/6 years out of my sport at the highest level, I should be more appreciative. Though this certainly doesn't make me yearn any less ,for an extra 3/5 years playing time (realistically when you get into your 30's it's time for retiring anyway).
I suppose it's more the fact that this came as a bit of a shock to me. In all my reviews by the surgical team since my op in 2001, Aortic dilatation and BP levels were never mentioned. So I had no time to prepare. I was just given the news suddenly (may 2005), that it was too dangerous for me to continue.
And you know yourself, while the body and mind both feel willing, it makes it even harder to stop doing what you love.

The up-side is that I am involved in the coaching side of things, so this keeps me involved just as often.

Karyln: My girlfriend says "good on you"!! But you are right, it is important to prioritise and look at the bigger picture. The Ross that you mention who dissected before 5cm, did he have BAVD?? This would be unusual if he did.

This would be a more common occurrence for people with Marfans syndrome.

Yeh, I did hear that height can be significant when considering aorta diameters. I'm around 5 "11" so not so much in my case.

 

[OldManEmu]

Decisions

Decisions

BM regarding valve life and activity level they are not related.
Tissue valve life is related to metabolic activity.
The younger you are the faster your metabolic rate and hence shorter valve life.
I can understand your desire to continue to do the things some one your age would normally engage in.
Karlynn put it well when she said only you can judge what is most important to you. These are value judgements of a personal nature that two people facing the same decision could reach completely different but equally valid based on their perceptions of quality of life.
Regarding BAVD have you looked at the Bicuspid Foundations web site? I have attached the link.
http://bicuspidfoundation.com/

 

[Bad Mad]

Thanks for that OME.

That makes sense alrite. I did think there was a relationship between valve life and age/exercise. However, would I not be right in saying that a young person can have a slow metabolic rate, just as an older person may still maintain a faster one?

The point I am trying to get at is, a physically active 30 year old of normal weight may have a quicker metabolism rate than a physically active 20 year old (with a similar lifestyle) whom is over-weight? If so, then is it right to make these assumptions based on the age of the person?

Oh. Thanks for the link by the way. I've been on a few times and even emailed a few queries to Aryls, the site administrator. (She was very nice, but unfortunately I never got the reply that was promised from a Dr. Raissi at the Cleveland Clinic.)

Would I be right in saying that you guys pay for your medical treatment/surgery?
Out of interest how much would it cost to get a AVR done at a reputable hospital?

 

[OldManEmu]

BM there is variation at the rate of valve deterioration between individuals of the same age with the same valve. Aortic valves tend to last longer than mitral valve. The younger you are the quicker the valve deteriorates.
Australia has both a national health system and a private health system.
Hospital treatment by the national health system is free, it is covered by your taxes. The private health system requires you to have private health insurance or face significant out of pocket expenses. Most doctors practice in both as the majority of the population do not have private insurance. The performance statistics of the two are similar. The main difference is private rooms (not shared) in private hospitals and the ability to choose when to have surgery in advance rather than being told when you are having it in the national health system.
In the private system if you didn't have private health insurance assuming no complications I believe the cost is about AUD $60K a little over 25K pounds.
With insurance the out of pocket varies on your level of cover.

 

[Bad Mad]

OME

Australia operates the same system as here in Ireland/UK.

I often wondered about the private option. I was contacted by the parents of a young lad last week who were taking him to London on wednesday past to get a stent put in for co-arctation of the aorta. They were going private.

I think it costs approx. £15,000 for a AVR to be done privately here.

Have you heard of any new advances for valve replacement?
I remember reading a few years ago about a few key hole procedures that were carried out. But I suppose long term this method mightn't be as effective.

 

[OldManEmu]

BM I personally had the full sternum opening surgery for my AVR.
There are members here that have had minimally invasive valve replacement, however I can't recall any of them mentioning also having their ascending Aorta or Aortic root replaced this way.
I didn't know that Gaelic Football was played in the north of Ireland until you mentioned it; I had always thought it was confined to the republic.
I am also surprised that you had heard of Aussie rules football half a world away in Ireland, I am actually watching Aussie rules on TV between typing this.

 

[Karlynn]

Someone can correct me if I'm wrong, but I think Tobagotwo (member) has said that it's not the amount of physical activity in younger adults that wear out valve more quickly, but it has more to do with a more active body chemistry in younger adults. I'm not sure if I'm totally right, but I think a 29 year-old that participates in spelling bees won't necessarily have a longer lasting valve than you even tho' you are much more physically active.

 

[67walkon]

BM, I'm 57. The surgeon tells me there will be no restrictions on my activities except no "heavy, heavy" weights. Basketball, running, biking, are apparently all fine.

They are doing my valve, root and ascending aorta. This is my first surgery, but it might not be my last, depending on how long I live. I'm betting that the procedures will be much improved in 15 years. Or maybe hoping is a better word.

 

[Bad Mad]

EMU

I am astonished. Believe it or not, it's played all over the world, even in Australia!! I'm sure you've heard of Tadgh Kennelly, Jim Stynes, Setanta O'Hailpin etc. etc....sure you's have stole some of our most exciting young prospects for a crack at the big time!!

I've been to play Gaelic Football competitively in Boston, NY and Chicago, where, whilst not as big as it is in Ireland, it still has a large following particularly among the Irish and Irish american communities.

I thought you might have been aware of the International Compromise rules series which happens each year between Ireland and Australia. The best players from both sports play in a series, which is a compromised Aussie Rules/Gaelic Football game. This has been going strong pretty much since the mid 80's when the Big Dipper was throwing his weight about!!

The counties in the North of Irland e.g. armagh, tyrone, Donegal and Derry have pretty much dominated the All-Ireland series since the early 90's.
Personally I played for Antrim, who weren't/aren't as successful as their near neighbours. Unfortunatley I never got to represent Ireland in the Compromise Rules series, but did play for my province Ulster on a couple of occasions.

67- Without sounding patronising I am surprised you are considering a tissue valve at your age? Surely, with an almost certain guarantee a mechanical valve would see you out, this would be the wiser option??
* I've re-read your post 67 and realised what you've said re: procedures in 15 years
I can appreciate the dilemma. If only we knew what advances were down the line.*

Stlil a bit lost on the whole metabolism thing. Just a bit curious. I understand from what you guys are saying that the relationship is between age and tissue longetivity and not how physically active you are. But surley we can't always assume that age will determine body chemistry/metabolism rate?

 

[OldManEmu]

BM
Yes I have heard of all these Irish footballers that came to Australia to play Australian rules. The first ones were recruited in the 1980's.
I had always thought they came from the republic and that the Irish international rules team was also chosen from the republic.
I believe the international rules game is popular in Ireland. Unfortunately some of the Australian players choose not to play always in the spirit of the game.
The big dipper is still around in the sports media and doing advertisements on TV.
With age influencing bodily processes, being a football player just think of how quickly an 18 year old recovers from injury compared to a 30+ veteran.

 

[Bionic Man]

My doc told me

My doc told me

My doctor didn't give me a choice of what valve to use because I had to get my aorta replaced (5.3) as well as my aortic valve. At the hospital I went to they ONLY do mechanical valves in instances where the aorta is being replaced. So I wasn't too happy.

However I've found I can play sports and feel pretty great. I've not had bruising or weird things like that playing basketball but I did break a rib 5 weeks after surgery while playing basketball and the recovery was normal without complication. The downside is that I am very anxious not to get hit in the nose so I tend to play more defensively. That's probably a lot more of a problem with rugby where you probably get hit in the face fairly often. I'm taking karate and want to spar (controlled contact) eventually however if I do, I'll be wearing headgear with the face mask.

Ah, well. It's good being alive and it hasn't slowed me down too much.

David

 

[Bad Mad]

Hey Bionic Man

Out of interest what age are you?

If you have Marfans, is your Aorta likely to dilate again or will this correct the problem?

Interesting that you are playing basketball again. I assume you are taking warafrin? Do you play competitively i.e. for a team?

I suppose the risks are small as B'Ball is pretty much a no contact sport.

 

[Magic8Ball]

I guess its your own decision which way you go and whatever you choose will be the right choice...i guess you are just after some different perspectives.

I WAS a 37yr old Taekwondo brown belt, motorcycle riding, borderline alcoholic prior to surgery. Surgery came as a surprise even though i knew about my BAV all my life and had regular checkups (another story all together).

I went st jude mechanical with one piece acending aorta and root.

I've stopped Taekwondo, sold the bike and now drink in moderation.

I feel better now than i did and don't feel the mechanical option has modified my life that much as the old body was beginning to give way anyhow, dodgy calf's, bad back, sore knee's, tight hamstrings etc etc so i was about to give everything up anyway.

The warafin is no big issue for me, home testing for 6 months now, no brusing and ive done some dumb **** since surgery beleive me.

The only thing i miss is the motorbike and i guess i'll get back into that when the kids have left home.

Anyway, i'm hoping that my surgery is a once in a lifetime thing.

Good luck with your decision

 

[Bad Mad]

M8ball

Interesting to hear your story.

What do you reckon is too risky as regards contact when considering do and dont's with warafrin? 5 aside soccer?

Do you think it is safe to reach a high HR during exercise? For example, I can only do recreational stuff at the min. such as 5-aside where my HR would get up to 170 easily (which is prob a little high), but I wonder that when I go under the knife again (assuming that I go for a mechanical), what I'll be able to do.