aortic root enlargement

[bradpitch92]

My aortic root is about 44 mm big.  the normal is from 30-40 mm i've found out.  Its enlarged because i have Marfans syndrome.  The big question is i wanna play water polo, as a goalie, at a D3 school in college.  So there is a risk of dissection i guess, although small.  Is there anyway, like an MRI, to see the strength of the aorta root and there is increased risk or dissection?  For example.  Get an echo or MRI now, and then after the season, which is just short of 3 months long, get another echo or MRI to see if there was any weakening or a negative effect on it?

[nickppatel]

I'd be surprised if you saw any positive benefits below 100 mg.  But yes, talk to Dr. Dietz.

[bradpitch92]

yeah now she raised it to 50 mg, but that info is awesome ill definitely email him

[nickppatel]

A pulse pressure of 45 is not bad.  Normal is about 40.  60 is kind of high.  So 45 is not that far off normal.

Your doctor really needs to take a closer look at the studies.  37.5 is nothing.  Consider asking her to have a talk with Dr. Dietz at Johns Hopkins - you might send him an email to see if he is willing to talk to your doctor and explain to her that a much higher dose is necessary.

[bradpitch92]

i talked to my doctor and she increased my dose of losartan from 25 to 37.5. Im still tryin to convince her that i need a higher dose.  i also got my blood pressure taken and it was 102/57.  so my pulse pressure would be 45 correct? also is this good or bad

[Tails1962]

Hi Brad, I agree with nickppatel re the leg activity in water polo.  I played water polo for 6 years in my late teens to early twenties (then joined the military) and I have a full understanding on the amount of leg work required just to play water polo, let alone being the goalie.  Just by the mere fact that the leg rotation work to enable the player to tread water, and climb upwards and out to deflect the ball aiming for goal is so strenuous, the aerobic acitivity would increase blood pressure and heart rate to close to maximum recommended levels, which would apply direct pressure on your aorta and the aortic root.  I have been advised by cardiologists to reduced the amount of intense aerobic activity I do to help prevent this form occuring.  If you choose to play, listen to your body when it starts to give out signals toyou, it may help save your life.  A rupture in the root in a scenario like water polo could be a fatal event.

[nickppatel]

"And goalies basically just work on their legs, which keeps the pressure off the chest area."

Not sure what this means.  If you're doing squats or leg presses, you're still increasing intrathoracic pressure to dangerously high levels, which is not good.  And aerobic activity in excess also is not good.

[nickppatel]

Correct.

[bradpitch92]

thanks for that info that'll help. And goalies basically just work on their legs, which keeps the pressure off the chest area.  Also when you said "i dont think this is possible you were talking about seeing if the aorta was weak or not right?

[nickppatel]

I misspoke ...

I said "Try the ARB approach with a max or ultra-max high dosage (as long as your doctor lets you) and see if that reduces aortic size and aortic flexibility (the "pulse pressure" is one way to estimate the flexibility - Google it). "

You actually want to REDUCE aortic size and INCREASE aortic flexibility.  That sentence was poorly worded.

[nickppatel]

I could be wrong, but I don't think this is possible.  Usually the main predictors of aortic dissection are family history, aortic size, and aortic flexibility.  For someone of your aortic size, I would take it easy.  Try the ARB approach with a max or ultra-max high dosage (as long as your doctor lets you) and see if that reduces aortic size and aortic flexibility (the "pulse pressure" is one way to estimate the flexibility - Google it).  If so, then perhaps you can talk to your doctor about athletics.  I assume goalies don't work nearly as hard as the other positions do, so perhaps it's not out of the question.