Exercise after Ascending Aortic Aneurysm Grafting

[pbanders]

46 yo male, 5'11" 160 lbs, white, good lipids. Athletic, raced bicycles up to '96, good aerobic fitness. Diagnosed with PAT at 15, went to cardiologist 12/03 w/annoying PAC/PVC's. Holter showed some PAC/PVC's, "nothing to worry about". Echo showed a 5.0 cm dilated aortic root, CT showed 5x5 cm aneurysm restricted to the asending aorta. Other echo findings normal, no aortic regurg. No evidence of Marfans or other connective tissue disorders. Surgery 2/4/03 at Sequoia Hospital (Redwood City, CA), Dr. Vince Gaudiani. Clean cardiac cath. Artery tissue looked good (just big), coronaries did not need re-implantation, mini-sternotomy, 2.8 cm graft, on pump 25 minutes. Recovery was uneventful. Meds are 50 mg metoprolol and 150 mg Avapro daily. Pre-op bp was 120/80, on meds it's about 110/75. Yearly MRI follow-ups are scheduled.

Resumed bike riding 6 weeks after surgery, progressed to rides of 1-3 hours over fairly difficult terrain. No sprint efforts and I limit my anerobic output. I do not lift heavy weights. My HR during exercise is in the 140-150 bpm range at peaks and lower on average.

In general, I feel as if I never had the operation. My aerobic capacity is somewhat less due to the beta blocker, but I've gotten used to it and don't really notice it. My PAC/PVC's have been annoying at time since surgery, but they're episodic and tolerable.

Q's:
1. Is this level of exercise reasonable for my condition? Can I do some light weight lifting?

2. What is the long-term prognosis for my condition? Do grafts ever "wear out"? Am I likely to have another aortic aneurysm?

[Cleveland Clinic]

pbandrs,

thanks for the post.

1. Is this level of exercise reasonable for my condition? Can I do some light weight lifting?

Without evaulating you its impossible to tell you specifically.  Generally there shouldnt really be too many restrictions on your exercise activities this far out from surgery.

2. What is the long-term prognosis for my condition? Do grafts ever "wear out"? Am I likely to have another aortic aneurysm?

Grafts can fail over time. Often its not the actual graft but the area where the the graft is affixed to the aorta. Other problems can occur when the aortic valve is manipulated in surgery. Periodic screening with routine followup should catch these types of changes before they would become too severe.


good luck

[BenjaminJC]

I had major Aortic surgery less than a year ago and I'm doing the NYC Marathon on the 1 year anniversary of my surgery.  I too have many questions and you can see the answers and access a wealth of information on my site www.************.com.

[pms_barbie]

Hello there.  Let me say first I am not a dr and this is just from an experience with a family memeber that had what your talking about
  My grandfather was in his 50s when he was diagnosed with an abdominal aortic aneursym.  His was grafted and he never had a problem with his grafting wearing out or anything  going wrong with it.  However years later like when he was in his 70s he developed another at the base of his brain.  He never had anything done about it and no he never died from it.  You will also have to keep in mind he never quit smoking after being diagnosed with the first one some 20 years earlier.  Good luck to you

[pbanders]

Added info. No family history of aortic aneurysm. Father had fatal MI at 61 (heavy and history of heart failure prior to MI). Mother had minor heart attack at 74 and was stented, died of apparent arrhythmia 6 weeks after surgery (no prior history of arrhythmia). Maternal grandparents lived to 84 (grandfather - stroke) and 94 (grandmother - ovarian cancer). Paternal grandparents ages and reasons of death unknown.

[pbanders]

Bob, I'm not a doctor, I'm only relating what I have learned from my own condition. At your height and with signs of Marfan's, diagnosis of your aortic condition is best done by a professional. Generally, surgery is not indicated until the aneurysm is 5.0 cm, but in Marfan's cases, the limit may be different.

I found my surgeon through a friend of mine who was a perfusionist for over 20 years. She observed during my surgery. What I meant by "artery tissue looked good" was that according to her, the artery tissue in many of the cases she's seen is diseased in appearance. What this means exactly, I don't know, as I've never seen healthy vs. diseased tissue. Despite the tissue appearing healthy, it was thin in the area of my aneurysm and I definitely needed the surgery.

As for symptoms, like most people with a non-dissected aneurysm, I had no symptoms at all. The only reason I went to my cardiologist was that I was having episodic PAC/PVC's that had (and have) nothing to do with my aneurysm. During an echo that was part of my workup the aneurysm was discovered.

Good luck with your condition. You and I are both lucky, in that we've been diagnosed BEFORE we had a dissection, giving us the best possible options to manage our condition. If it were me, I would get whatever workup was necessary to determine if or if not I had Marfan's, as that knowledge may affect the treatment you need.

[bob_sixsix]

Hello pbanders,

Glad to hear your recovery went so well.  I never realized how "normal" life can be after a proceudre like that.

I have been going through testing for a "suspected" dilation or "bubble" of the aortic arch.  You mention that your aortic root was 5.0cm.  I have had 5 echocardiograms done and my aortic root ranged from 3.6cm - 3.9cm but the ascending aorta (above the root - sinotubular junction) has been measured to be 4.4cm.  I am awaiting results from a MRI I had Thursday to see how the rest of the aortic arch looks.  I am 37 years old, 6'6" and weigh 220lbs.  I am in pretty good shape but do have some characteristics of Marfan's (high arch to roof of mouth, flexible thumb and height vs. arm span ratio is greater that 1.07).  I have been experiencing some weird palpatations and have a resting heart rate of 45 - 50bpm.

You mentioned that your "artery tissue looked good, just big".  Does this mean that surgery probably wasn't absolutely neccessary?  Were there any signs of dissection or thrombus pre or post op?  I have had doctors tell me that for my body size the aorta would be larger than normal readings.  What symptoms, if any, did you experience before the procedure?

Please let know if you can offer any help to my questions.

Thanks.

~Bob