question about bicuspid aortic valve

  Hi!  I am a 21 year old male with a congenital bicuspid aortic heart valve.  I have known about it for a couple of years now.  It has been diagnosed as trivial and mild.  My question is what physical limitations exist with my condition?  I have seen a few cardiologists and they have had differing opinions.  They both told me to take antibiotics when going to the dentist and not to do any heavy weightlifting.  However, they gave different physical activity guidelines.  One cardiologist suggested that I not lift anything over 50 pounds, and that I not even do sit-ups or push-ups.  He said that I may lift light weights to tone.  Another cardiologist was not as conservative.  He said that I could probably bench press up to 75 lbs. and that it was okay to do sit-ups and push-ups.  He also said it was okay to lift fairly heavy furniture once in a while.  I lifted a few heavy sofas today and I have been very worried about this.  Who do I believe?  I don't want to do anything that could worsen my condition.  Also, in case it's relevant, I am 6' tall and I weigh 155 lbs.  Is there a concensus in the medical community in regards to this issue?  Thank you for your time and help!
  David Fisher

[CCF Cardio MD-SGM]

Dear David,
You pose an interesting an important question regarding exercise limitations in the setting of congenital bicuspid aortic valve.  Dr. Joseph Perloff, in a highly regarded text discussing the topic of Congenital Heart Disease in the Adult, advises that "it is prudent to caution against sudden, strenuous, or isometric exercise, especially when there is a dilated aortic root".  As you may know, isometric exercise describes traditional weight-lifting, as done by body builders.   Isotonic exercise, or "toning"-type weight lifting, denotes the use of much smaller weight, with greater repetition.  Isotonic exercise also includes aerobic exercise (running, cycling, swimming, etc.)
From the description of your condition, it sounds as though you have asymptomatic, mild aortic stenosis, with no mention of aortic root dilatation (a condition that is sometimes seen with bicuspid aortic valves).  In this setting,  most experts would agree that isotonic exercise (smaller weight, greater repetitions, aerobic exercise) is best.  It is advisable to avoid heavy weight lifting as part of an exercise regimen, as this imposes a significant load on the aortic valve-- something that may carry negative consequences over the long run.  However, I would think that normal physical activity (including occasionally carrying furniture and the like) is fine.  In essence, this exercise prescription may limit you regarding bench pressing and power-lifting, however, it shouldn't impose any restrictions on the vast majority of other exercises that are available to you.  Finally, I think it would be difficult to impose precise weight limits on what you can lift. It may be more accurate to reiterate that heavy, isometric exercise should not be part of any common routine.
Also, I agree with your cardiologists regarding the important of antibiotic prophylaxis prior to dental procedures or other invasive medical procedures.  Information in the Heart Forum is for general medical purposes.  Specific diagnoses and therapies should only be prescribed by your personal physician.