Valve type and sport

[RunMartin]

Thanks for all your comments and encouragement.

I had another go at the 5K today. It is the same course as last time - they are free and every Saturday at 9:00am. I did not run for two days before hand and set off a bit steadier. I struggled on the 400m hill at 2K again! - the legs felt like they were full of lactic acid at the top and I lost quite a bit of time compared with everyone else on the hill. I felt really good until the hill then struggled to the finish. The good thing is that I knocked 50 seconds off last time! - 23.27. There is the definite feeling that the oxygen is not getting pumped around as efficiently as before but I was really pleased with the small improvement. My next target is to do a 10K on 27th December in a reasonable time (hopefully around 50-55 mins).


Thanks again
Martin

 

[tprice54]

Great run!! And knocking off 50 seonds is impressive!

 

[normofthenorth]

Have you found anything about coumadin making the blood pump easier or improving hemodynamics? That was the part that does not make sense to me. It might have helped hearts in CHF in some other way, which could make sense.
Was you Dad on other meds for his heart?

Lyn, I think the short answer is that you're right and I was wrong. When my Dad had CHF and was on Coumadin (a combo that is common), we were all given the "ACT for Dummies" explanation: His heart is weak, so we're giving him "blood thinners" so his heart can do the job with less effort. I haven't found any detailed information on blood viscosity or the like, but it certainly appears that experts bristle when somebody calls Coumadin a "blood thinner", because that's not what it does -- despite years of misleading simplification to the contrary from my Dad's Doc, etc.

 

[yotphix]

Runmartin,
Congratulations on your improvement. You are making a phenomenal recovery, comparatively speaking. I have been wearing my new 29mm Carbomedics valve for about 18 months now and am still improving when I train to improve. Mostly I just run 9-12 minute miles, depending on what else I have going on though so nothing like you're doing.

I have been thinking about this though. I have looked at the surgery that is done and it seems to me that the new valve will necessarily be smaller overall than the native valve. I have an actual demo from carbomedics on the table in front of me now and it appears, first of all to be 29mm outside diameter. The inside is a fair piece smaller and the whole thing fits inside the space left after the stenotic leaflets were removed. I have pretty much come to the conclusion that, given the above, I can never get flow like I once had, but I have better than I had just before surgery. I know this because my hands and feet aren't always cold anymore. Certainly, the whole kit works way better than it would have if I had done nothing.

It isn't actually easy to calculate the open area of the stenotic native valve. Apparently they actually change a fair bit under pressure. The un-diseased native valve has an area of approximately 3-4cm2. A bileaflet mechanical prosthetic is typically 2.4 - 3.2 cm2. It is possible (though by no means certain) that you have a smaller opening now.

Either way, if you are still improving, it remains to be seen how much of your previous extraordinary fitness you will regain. I know that I have come a very long way since I was 9 months in as you are now.

All the best,

Paul K

One additional thought, is that the tissue valves are also smaller ID than native valves as they too fit inside the annulus.

 

[RunMartin]

It isn't actually easy to calculate the open area of the stenotic native valve. Apparently they actually change a fair bit under pressure. The un-diseased native valve has an area of approximately 3-4cm2. A bileaflet mechanical prosthetic is typically 2.4 - 3.2 cm2. It is possible (though by no means certain) that you have a smaller opening now.

Paul, thanks for your explanation. Before surgery the area of my BAV was about 0.8 cm. I was expecting to be much better than before surgery because of this. My heart must still be remodeling itself. I have started doing runs where I can actually keep running i.e. smaller hills and on roads etc. Doing the 5K runs every few weeks will be a good indicator of any improvement.

Below is a post by Buzz Lanning who had a similar surgery to myself:-

http://www.valvereplacement.org/for...y-All-is-well!&p=405232&highlight=#post405232

Martin

 

[nate_c]

I was thinking about your post during my long run on Saturday and decided to do a more careful analysis of my Garmin data afterward, since I live in an area where I can't help but do lots of steady hills if I go longer than a mile.

My run on Saturday was 11.5 miles, and what I discovered is that like you, I'm a little farther off my pre-surgery pace when I'm going uphill vs flats or downhills (compared to running those same hills in the past). It's a subtle difference, but the trend is definitely there, and as I look back over the last month, it's been there all along, hidden behind the average speeds. So it would seem that I've got a little bit of what you have too. I wonder what the mechanism would be here. I have noticed that my heart feels slower to respond to sudden exertion than it used to (like running up a couple flights of stairs at my parking garage). I wonder if there's a link between these two things, e.g., maybe the heart just takes a little longer to step it up a notch when the body suddenly needs more oxygen... ha! So there's my completely uninformed medical theory of the day...

 

[Philip B]

Love this Thread

Love this Thread

Hi Martin,

It's been fun watching the posts on this thread. I particulary enjoyed the one containing the story about the guy who was placed on coumadin so his heart wouldn't have to work as hard pumping his thinned blood... fun stuff.

The reality of valve replacement surgery is that results vary. Some of us have found that our performance after having mechanical valves implanted is the same as it was before. Others report better performance with mechanical valves... some report worse.

My cycling performance remained unchanged, but found my ability to swing a golf club changed. I simply can't swing a golf club as fast now. I suspect this has something to do with having my chest split open.

I personally believe some of the comments others made concerning the heart re-configuring after a bad valve is replaced.

-Philip

 

[MarkU]

Martin, there are any number of things that could influence exercise performance other than the valve. We all want to see our hearts return to "Normal" after surgery but this is not really what happens, instead, our hearts establish a new level of function after surgery and it can take more than a year to do so. The issue that I am dealing with now is called diastolic dysfunction. Basically, the left side of the heart relaxes between beats and fills with blood; my heart cannot yet do so fully because it has stiffened and does not fully relax. This "stiffness" was caused by the years my heart spent compensating for the stenotic valve and is associated with the "mild hypertrophy" noted in each of my echo cardiograms. One of the primary effects this has is to reduce one's exercise performance. There is debate about how much the stiffness will abate but current thought seems to be that improvement can continue much longer than a year. Current treatment includes using a calcium channel blocker along with an ACE inhibitor; I am taking Verapamil and Lisinopril. I toss this out as a possibility. Take care.

Larry

Prior to my AVR I had developed left ventricular hypertrophy, or enlargement of the left ventricle as my heart worked to overcome the inefficiency of my bicuspid valve.
During surgery they discovered it was worse than expected and my surgeon feared that I had done permanent damage to my heart muscle.
Fortunately with my new mechanical valve in place, the enlargement reversed itself within 18 months post-op.
From a cardiovascular standpoint, I immediately felt better after my AVR. Although it took me nearly a year to feel 100% after my surgery, my recovery had more to do with overcoming the trauma of my surgery.
When I started training seriously for triathlons a couple of years after my surgery, my cardiologist had me go thorugh lab testing to determine my lactic threshold heart rate and VOmax. Using that data, I worked with a coach who was trained in heart rate training. The only limitation my cardiologist imposed on me was to limit my time in zones 4 & 5 while training.
In the ten years since, I've never felt limited by my cardiovascular health.
Unfortunately at age 57, the wear and tear on my bones and joints is starting to catch up with me. I had to give up tennis a few years ago due to chronic tennis elbow, I've struggled with patella tendonitis for many years and most recently was out of action for the past several months with Achilles tendonosis. I'm facing the prospect in the future of limiting myself to low-impact sports, which means my running may be in question. I'm getting around that now by using the Galloway run/walk method, especially for longer distances.
But my St Jude valve keeps ticking away...
Good luck,
Mark