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enlarged aortic root and physical activity
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enlarged aortic root and physical activity

My son who is 18 years old is 6'3" and weighs about 195. His heart has been followed since he was about 13-14. He was diagnosed with SVT and had a catheter ablation procedure. During that diagnosis, it was discovered that his aortic root dimension was slightly out of range. He is not thought to have Marfan's. In high school he ran cross country and track and field.  His passion is body building/working out and he continued with that activity. One year ago he had an MRA, just recently he had a ECHO. The ECHO showed that in the past year the aortic root increase from 3.5 or so to 3.9.  The cardiologist has recommended a beta blocker, his resting pulse was high despite his athletic involvement.The cardiologist suggests no activity for 6 months so that he can see if the beta blocker appears to be keeping the expansion in check. He lives and breathes and socializes with his weight training and was looking forward to doing club rowing in college, he starts college soon. He has ADHD so physical activity is good for his mental focus. I'm concerned about the impact of not being able to be active on him mentally and physically. While I understand the need to limit the activity, I'd like to think that he could at least do some yoga or activities less stressful than rowing or weight training. His grandfather, who is in his mid 80s was diagnosed with an enlarged aortic root about 25 years ago. At that time it was >4.0, I'm not sure if his was followed after that point. I will find out. He swam in to his 70s and still walks a mile or more daily. I've found some articles discussing studies of elite athletes and aortic root dimensions but would appreciate any article suggestions or information about whether it is know for sure that physical activity increases aortic root size or if studies have been done where dimensions were checked on athletes who stopped heavy activites compared to those who continued heavy activities despite having an enlarged aortic root.
Avatar_dr_m_tn
Hi xantho,
These are all important questions and I can understand your concerns about restricting your sons activity.
The family history may indicate the presence of a genetic mechanism for aortic dilation. In addition to Marfan syndrome there are other conditions which are broadly classified as 'aortopathies', and include familial thoracic aortic aneurysms & Loeys-Dietz syndrome, among others. A review with a clinical geneticist can be very helpful in exploring this possibility and would be important for both diagnostic and prognostic reasons (i.e. being able to predict the likelihood of future events and thresholds for intervention). It can also be important for future family planning.
Cardiologists take progressive increases in aortic dimensions very seriously because of the risk of death due to aortic dissection. Another complication of increasing aortic size is  leakiness of the aortic valve (aortic regurgitation) which can impact ventricular function. Weight lifting results in periodic increases in pressure in the aorta and there is a potential risk of aortic dissection. There are no large studies to support this statement but there are anecdotal reports / case studies, and therefore cardiologists educate patients about this potential risk. A progressive increase in aortic size would be a reason to switch from heavy weight lifting to a program in which lower weights are lifted but with greater repetitions (15 minimum) with a focus on avoiding breath-holding and heavy jerk and lift type actions.
The most relevant article for your question is that by Babaee Bigi in the American Journal of Cardiology 2007. In that study 100 male high intensity (weight lifting) athletes were compared with normal 'controls'. There was evidence of increasing aortic root size with increases in strength training. Note that patients with aortopathies were excluded from this study. Whether Marfans patients and others with aortopathies have further accleration of their aortic root size was not addressed in this study.
Try googling Babaee Bigi American Journal of Cardiology 2007 to view this article. There will be links to other relevant studies also.
I hope this information is useful. There are also physicians and surgeons with a special interest in aortic disorders that may provide individual assessment and advice to your son. If interested, try copying and pasting this link into your web browser:
http://my.clevelandclinic.org/heart/departments-centers/aorta-center.aspx

Take care and good luck
4 Comments
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Avatar_n_tn
Thank you for your reply. It answered some of my questions and gave us some other things to consider, for example a visit with a clinical geneticist. I'll look up that article reference. Currently we are trying to line up a 2nd opinion specifically about the recommended no activity for 6 months while on the beta blocker. Thanks too, for the link for my son.
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Avatar_n_tn
Also, I found the doctor's letter regarding my father's enlarged aortic root, discovered  on an ECHO when he was 60 in the late 1980s. The measurement was 4.7 cm. At that time he was experiencing atrial fibrillation. I will ask if it has been measured since then. He continued swimming, gardening, and walking after this discovery. Both my sister and I were screened at the advice of the doctor and our roots are normal.
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Avatar_dr_m_tn
Hi Xantho,

Given case reports of (1) aortic dissection in patients with aortic dilation and (2) evidence for progressive enlargement of the aorta in athletes who participate in high-intensity weight lifting, I would not recommend that he continue with this activity.

Whether he needs to stop all forms of exercise is unclear and I agree that some alternative form of exercise is important. Based upon the information provided I see no reason why he could not switch to swimming, running, cycling or rowing. Perhaps there is some additional information I am not aware of but in any case I agree that a second opinion regarding exercise may be helpful.

Another thought I had for your case was to contact the National Marfan Support Group. This group also provides advice to non-Marfan patients with other forms of aortic disease. Here is the link: http://www.marfan.org/marfan/2307/About-the-NMF

Take care and good luck.
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