Only has 2 valves with aorta

[panther376]

Hi,

My son is 14 years of age and had a physical for his Freshman year in  high school and the doctor told us he had a heart murmur.  He has had physical for the past 5 years and this is the first we were told of this.  He sent us to get a echocardiogram.  He called with the results and said my son only has 2 valves in the aorta.  We are scheduled to go to a pediatric cardiologist but not for 2 months.  He told me this was not serious and for me not to worry.  He would not need surgery or any medication expect for when he goes to the dentist. He has no signs of anything being wrong. He is doing very strenous practices everyday for basketball and plays baseball 4 times a week.  He told him to continue doing everything and not worry.
I was wondering about lifting weights...He does this twice a week for a half  hour.  Is this ok.  I have just read so much stuff on the internet that it makes you wonder if he should do anything.  I was just  thinking that if it was very serious we would not wait 2 months to go to a cardiologist plus he would eliminate all strenuous activity.  Should I just listen to him and have him continue his normal life and not worry.  (even though that is hard to do)  Thanks in advance for any advice.

[Jeffrey R Boris, M.D.]

Dear Panther,

It sounds like what your son really has is what is called a bicuspid aortic valve (BAV).  For our other readers, the aortic valve typically is trileaflet, or has 3 cusps.  In BAV, there can be 3 cusps with two of them fully or partially stuck together, or there can be only 2 cusps.  BAV can be associated with development of aortic valve stenosis (obstruction), insufficiency (leakage), and prolapse, as well as aortic root dilation.  BAV occurs in about 0.5 to 2% of the general population, making it the most commonly seen congenital cardiac defect.  The majority of people with BAV have a normal life, and many don’t even know that they have it.  However, they do require lifelong surveillance to ensure that they do not develop the complications listed above.  

In the absence of these complications at this point, everyone would let your son be active, such as participating in aerobic exercise like running and soccer.  A lot of folks might even let him do isometric exercises, like weightlifting, football, and wrestling, although that may be more debatable.  We do know that the connective tissue that makes up and surrounds the valve is abnormal.  There is concern that isometric activities (anything that involves exercise with straining) may accelerate the damage to the valve and the aorta, although we don’t know this for sure.  At any rate, no matter what his heart valve looks like, the American Academy of Pediatrics recommends that if he is going to lift weights and he is under the age of 16 years, he should be doing low weights with a high number of repetitions (i.e. 3 sets of 15 or more repetitions).  The reason for this is his bones, joints, tendons, ligaments, etc. are growing, are relatively soft as compared to those of adults, and are at greater risk of damage with lifting very high weights.  Therefore, it’s not the frequency nor the duration of the weightlifting that matters.  Sports like basketball and baseball are okay, as well, as long as the training does not involve serious isometric activity.

The other thing to know is that BAV can be hereditary, so it would be a good idea for other close family members to be screened for this to make sure that they don’t have it.