My 5 year old son has moderate aortic valve stenosis (bicuspid valve) that has not progressed since birth. He has no current restrictions and he is not on medication. He is a very active little guy and is naturally muscular (he likes to climb the door frames). We allowed him to start a gymnastics class and he loves it and his coach loves him! The coach asked us if we would consider allowing our son to join a pre-team class for boys. Our cardiologist referred to the same recommended activity list I've seen other parents mention, i.e. cricket, bowling, table tennis, etc. but then told us to let him be a boy and not restrict him. She also mentioned that the main concern is having to stop doing gymnastics once his condition progresses. We don't want to limit him if there really isn't a medical concern. We don't want our son to become a couch potato but we are not willing to put him at risk either. What are the medical concerns with physical activity that we need to focus on?
This is a tough one. As a cardiologist, I really hate to limit patients. And, for some reason, we commonly see patients who have significant aortic valve disease who also enjoy doing activites that include major isometric activities (e.g. football, weightlifting, gymnastics, etc.). The problem is two-fold: it isn't that he will need to stop doing gymnastics once his condition progresses; he will need to stop it PERIOD as an adolescent. Young children are good at self-limiting their activities, but adolescents tend to "play through the pain" and over-extend themselves. This would be fine if their heart is normal. However, his heart is not and never will be normal, a sad fact associated with a bicuspid aortic valve with aortic stenosis. Competitive isometric activities can potentially damage the valve, elevate his blood pressure unreasonably, and decrease coronary artery blood flow to the heart. Thus the two problems are letting him participate now and stopping him later and letting him participate at all.
Overall, patients with moderate or severe aortic stenosis can undergo balloon valvuloplasty to reduce the amount of obstruction at the level of the valve. If he is a candidate for this, this can certainly reduce (but not eliminate) risk. That said, he shouldn't have to be a couch potato. There are PLENTY of other physical activities in which he should be able to participate, including running, cycling, swimming, etc., in which activity is more aerobic and less "static" (or isometric). It just seems unfair to direct a child toward an activity that he really enjoys, only to have to restrict him from it later.
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