Predicting Heart Behavior with new Mech. Valve

[TheGymGuy]

Being very mathematically inclined I have to wonder, when your native aortic valve is say 1cm^2 and you go to On-X or some other such 25-29mm valve with larger opening that should mimic a healthy valve, what exactly happens to your heart function?

Let me elaborate. I am an athlete and to make up for serious load and strain that I put on my BAV which is at 1cm^2 my heart has modified its function ever so slightly to allow me to compete.
For example, at the moment I have LVH (left ventricular hypertrophy), and also you could say that due to that hypertrophy my heart is enlarged and has higher mass then before. Come to think of it, people with BAV and stenotic aortic valves all have LVH of varying degrees. Of course, if there is no damage to the heart muscle tissues once the valve is fixed/replaced the heart size/mass and LVH are supposed to reverse. But, I digress....

My main question follows. Since our heart (stenotic aortic valve / BAV patients) is a pump and it pumps with certain power output through a small aortic opening, and when we enlarge said opening with a replacement or a fix, wouldn't our internal pressure fall given similar heartbeat?

Is this the reason that people experience irregular heartbeat after aortic valve replacement?


Edited to add: even with my stenotic aortic valve, my resting heartbeat is around 56 bpm and my ejection fraction is 59%.

 

[Bill B]

Yes, the internal pressure falls after VR resolves the stenosis but that's a good thing and has nothing to do with irregular heartbeat. Arrhythmias after VR are due to physiochemical changes that happen and the trauma of heart surgery.

Your heart, like mine when my valve was very stenotic (0.7 cm^2), has compensated for the elevated internal pressures and resistance to outflow, but that doesn't mean it's "normal" or even doing very well when the LV enlarges and thickens. My heart rate has always been around 60 and my ejection fraction immediately pre-op was 55. Post-op my heart rate was initially very elevated and my ejection fraction was terrible. By relieving the obstruction, you would think ejection fraction would go up. But the thicker left ventrical does not work as well with lower pressures. I had some diastolic (filling) abnormality as well. It can take a long time for the heart to "remodel" back to a normal working condition, and it in fact may never do so completely.

So, your cardiologist is OK with powerlifting in the presence of a 41mm aneurysm?

 

[DavesMom]

GymGuy,

I have the same question as Bill. I have a mech valve with an ascending aortic aneurysm (4.4 cm) and my doc doesn't want me lifting anything above 15 or 20 lbs. Getting my heart rate up too high is also a no-no.

Still, sounds like your doing great!

Best wishes.

 

[dick0236]

.........Of course, if there is no damage to the heart muscle tissues once the valve is fixed/replaced the heart size/mass and LVH are supposed to reverse. But, I digress....

My main question follows. Since our heart (stenotic aortic valve / BAV patients) is a pump and it pumps with certain power output through a small aortic opening, and when we enlarge said opening with a replacement or a fix, wouldn't our internal pressure fall given similar heartbeat?

Is this the reason that people experience irregular heartbeat after aortic valve replacement?

.

At the time of my surgery, I was told that my heart had slightly enlarged due to regurgitation thru the faulty aortic valve causing the heart to work harder to supply my body with blood flow. That "enlargement" was reversed, or at least, arrested after the surgery.

I have no idea concerning your "main question"....but it would be a good quesstion for a cardio.

While I have had occasional "normal" skipped, or irregular, heart beats I have never experienced A-fib(as far as I know) as a number of my friends have....and they have not had valve replacement surgery. A-fib may follow in some patients, but I doubt it is a routine "after effect" of surgery.

 

[TheGymGuy]

Thanks for your responses Bill B, DavesMom and Dick. I am very thankful this community exists, and I hope to contribute here as much as I can.

We knew about aortic stenosis and BAV since my birth. The aortic aneurysm is a new finding that was just found with cardiac mri. For past 10 years I have been getting a yearly echo and an exam. I am not sure that they could see aortic aneurysm with the echo as that never came up. The only reason they scheduled cardiac mri was to get a second opinion on my BAV since the AVA has been going up and down, but staying fairly close to .9 - 1.2 cm^2. Basically, my cardiologist told me that I can have the surgery within next several years last year. This year since the AVA did not change or actually seems to have improved, we scheduled the Cardiac MRI. I do realize that the echo measurement of aortic valve area is obtained by measuring velocity of the blood and then calculating the pressure gradients. Also, the velocity can be slightly off depending on the angle of the echo probe. Anyway, I see why he would schedule the Cardiac MRI and am pretty glad he did.

Ok, on to your main question - am I allowed to lift

I am a competitive powerlifter and do this with permission of my doctor until we found the aneurysm. To add to this some of my Dr's patients are tri-athletes and runners and I think he understands that athletes will alway push the line "a little" harder than most. After having met with the first surgeon (see this thread: http://www.valvereplacement.org/for...nd-I-guess-we-will-be-replacing-BAV-this-year) he suggested that we fix things up asap so that I can get back to my sport. You peak in your mid-40s in powerlifting, and I really want to set some more records. So, the suggestion from the first surgeon is to fix things now and then get back to sport post recovery. Basically, he said that the risk of death from exercising at this point is about 5-6% per year, and the risk of surgery is less, so the suggestion is do surgery soon.

Bill B, I wanted to thank you for your insightful posts. I am pretty knew to the heart surgery topic and hope to learn as much from you guys as I can. I wanted to offer some of my thinking on heart muscle as I am pretty familiar with muscular hypertrophy One thing I know and have lots of experience with, in the layman terms, is that if a muscle is used a lot it gets stronger and grows, i.e goes through hypertrophy (either myofibrillated or sarcoplasmic hypertrophy) and if it is used less or not with as much exertion as before, then, said hypertrophies reverse or stagnate. Heart being a myogenic muscular organ has to abide be the similar rules like most other muscles. This is why, I believe, if you have LVH or enlarged heart with presence of BAV or some other such restriction, unless some of the heart muscle tissue is dead, generally majority of the damage, or hypertrophy, is reversible.

 

[normofthenorth]

Gym guy, I ruptured my second Achilles tendon about a year before my BAV replacement, so I've experienced a bunch of muscle atrophy (esp. the calf muscles) as well as some hypertrophy (LV). The stories I've heard about LV hypertrophy, and the concerns I've heard from my cardiologist about it, all make me doubt that the LV behaves like "just another muscle" that gets bigger with exercise and shrinks with less use. There is a wide-spread concern that allowing the LVH to proceed too far or persist for too long will make it irreversible, at least in part, or create other functional problems.

Also, I'd very slightly edit Bill B's "Arrhythmias after VR are due to physiochemical changes that happen and the trauma of heart surgery" to change "physiochemical" to "physio-electro-chemical". I think many of the arrythmias are currently being attributed as much to faulty heart "wiring" as anything else, and some of the post-op remodeling is from these circuits reestablishing themselves and settling down.

My resting HR is also around 60 or just below, and remained so until my BAVR. But it did NOT get back down there for MANY months post-op. When it did, it spent several weeks way BELOW 60 -- occasionally even down in the THIRTIES(!) -- before returning back to its new=old normal. What a heart does is remarkably intricate and complex, and it usually takes a while for it to settle down after valve replacement -- a job that seems so routine and mechanical in a pump or a car engine. . .

 

[TheGymGuy]

Quick UPDATE:

I asked these questions to a surgeon today and he said that going from 1cm^2 AVA to 2cm^2 will only improve things and that the heart will adapt pretty fast to less resistance in the aortic valve.
Also, he mentioned that my LVH might just be a side-effect from lifting and is not dangerous as it supports the strain that I put on my heart. Also, if I keep on exercising post surgery things will stay as they are minus the BAV and aortic aneurysm. if I was to stop lifting heavy all together the LVH will take care of itself just like we read everywhere else. Anyways, it's always nice to hear that things we read and research are confirmed by a surgeon.

 

[bdryer]

Hi GymGuy

Here is something very important for you to consider pre surgery. I want to emphasize what was said previously in this thread.

What size has your left ventricle hypertrophied to? The normal wall thickness is 11 mm. Studies show that the heart can atrophy back from 16mm to 11mm after the AV is replaced, due to reduction of the required work load from pre to post op. I read that the condition of Athletes heart also can reach a LV wall thickness of 16mm. I remember reading some studies which stated that if the heart hypertrophies > 16mm, their is a chance it may not reduce back to normal thickness.

I was way worse then you on initial diagnosis. My AV was deteriorated to .6cm2 and I developed a 4.5 cm aneurysm of the ascending aorta. My LV wall thickness had already reached 16mm. The hypertrophy caused a bundle branch block, but thankfully I do not and may never require a pace maker. At time of surgery the AV was at .4 cm2.

Like you, I'm hard core regarding athletics. I tuned down my swim, bike, run and wt lifting to brisk walking intensity. I was warned by every specialists I saw to go easy to avoid basically well........terminating myself, or creating an unrecoverable disability.

Had my surgery last Mar 21 and have recovered my strength. I can do the times aerobically but do not cover the same distance. No biggie. I see the cardiologist on Feb 20 the the full regime. IE, echo, stress test, etc. I'm curious to see what my LV wall thickness is almost 1 yr post op.

Best of luck to you. I started lifting 1 mth post op but with very light wts. Go intelligently with how YOU feel and what your body is telling you.

 

[bdryer]

Regarding hypertrophy of the LV.

For those of you waiting for OHS to replace your AV, with significant hypertrophy of the LV, be aware that post op your BP may increase. This happened to me. Why, because with your new AV, their is almost normal Px drop across the AV. Hence the Px in your LV will read the same at the BP cuff. This was explained to me by my surgeon at the 1 mth post op assessment. He doubled my enalapril dose to compensate. As the heart remodels the BP should naturally drop along with, I hope my enalapril dose.

 

[TheGymGuy]

Hey Bdryer, thanks for sharing this. What did you end going with? I suppose I could do a search
Just checked my LV wall thickness and it is 16mm, with mass is at the upper end of normal.

 

[bdryer]

Hey GymGuy

At age 55 I went with On-X. I felt I was to young to be implanted with a tissue valve and escape the wrath of a second OHS. We had the St Jude Regent as a back up. I'm super happy with the On-X.

Dude be real carful to not cause your LV to hypertrophy beyond 16mm...OK? You should recover from the 16mm. I know it's hard to resist lifting heavy. But.....you have to if you want a full recovery. Lift light and seek enjoyment from the pure movement of the lift. Like you I also am a gym rat. My twin Bro and I started lifting in the early 70's and have never stopped. But.........you want to prevent a bundle branch block caused by hypertrophy of the LV, or other associated non recoverable conditions.

 

[bdryer]

http://texasheart.org/HIC/Topics/Cond/bbblock.cfm

I have posted a great link explaining a bundle branch block. Enjoy.

 

[TheGymGuy]

Wanted to update this thread with some numbers. My LV wall thickness is almost back to normal as expected even with all the heavy lifting I'm doing. Had an MRA several months back, will post numbers here for it. Many things have progressed in a positive direction after AVR and Aneurysm repair or should we say ascending aortic replacement.