Pediatric Heart Expert Forum
aortic valve insufficiency
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aortic valve insufficiency

My son was recently diagonsed with aortic valve insufficiency.  The cardiologist says his valve is leaking in 2 places and is a grade 2-3 leak.  What activity restrictions should he have for everyday things like mowing lawns and sports?  If he were to have a valve replacement would he be able to have normal activity?
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Dear Linda,

It is hard for me to exactly tell you what your son’s activity restrictions should be at this point, because the information that I am seeing here is not complete for my being able to do this.  However, I can give you some information that may be helpful to discuss with your son’s cardiologist.

Aortic valve insufficiency (or regurgitation) is another term for a leak in the aortic valve, the valve between the left ventricle and the aorta.  A valve works just like it would in plumbing—it opens to let fluid behind it move forward, and closes to prevent it from going backward.  When there is aortic insufficiency, it can cause an increased amount of blood volume load on the left ventricle’s ability to pump.  Aortic insufficiency is typically described as trivial, mild, moderate, or severe.  Moderate or severe insufficiency, as you can imagine, can cause more problems with the heart function over time.  As it goes, there are some people who describe the degree of insufficiency on a scale of 0-4, so this may be what your son’s cardiologist is describing.  But, we also grade murmurs on a scale of 1-6 (based on loudness, which can loosely correlate with severity), and so I’m not sure which scale is being referenced here.

Overall, there has been some relaxation over time of activity restrictions with most forms of heart disease, although it does depend on the severity, of course.  For trivial or mild aortic valve insufficiency, some folks may not restrict him at all from any activities AS LONG AS he is getting adequate follow-up and changes can be made in these recommendations if there are changes in the amount of valve leak.  If he has moderate or severe insufficiency, at a minimum, most cardiologists would restrict him from competitive isometric activities, such as weightlifting, wrestling, football, or anything that involves significant straining.  However, that doesn’t mean that he can’t carry out the garbage or bring in the groceries.  Also, if his leak is this bad, some cardiologists will obtain an exercise stress test, especially if they are going to do competitive athletics, as another tool to make sure that they can tolerate exercise AND to even help to decide whether an operation is needed.  If all these are normal, routine aerobic exercise is probably okay.  However, your cardiologist will know his specific findings the best, so he should be the one to tell you his specific recommendations.

So, this leads us to the second part of your question about activity after valve replacement.  The answer is…it depends.  It depends on what kind of surgery he has.  If he has primary valve repair, where the valve is not replaced, he may be able to do most exercise except isometric activities (assuming that there isn’t any significant residual aortic insufficiency).  If he undergoes a Ross procedure, in which his aortic valve is removed, his pulmonary valve is switched over to the aortic position, and another pulmonary valve is put in the pulmonary position, again he would likely be able to anything except isometric activities.  If he has a mechanical prosthetic valve, he will be on anticoagulation medicine to keep blood clots from forming on the valve.  This would likely allow him to do isometric activities BUT he wouldn’t be able to do contact sports because he would be at risk for bleeding.  Again, these are general thoughts; specific recommendations would be based on what his heart valve and left ventricular function are like.  This also may be an obvious statement, but definitely don’t make choices regarding surgical intervention based on future sports participation predictions.  No surgical intervention is perfect for aortic valve disease; I typically tell my patients that aortic valve disease is for life, in one way or another.  It’s more important to make sure that his heart’s function is maximized to last a lifetime with the least number of interventions than to project competitive athletic participation as the end goal.  It is interesting to note that we definitely see a lot of boys with aortic valve disease who REALLY want to participate in football or other major isometric activities, and we have to steer them toward sports in which they can still excel without causing heart damage.  There are lots of other great sports activities in which they can participate and still have a heart that should be able to go the distance through their life.
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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