Q:
Three years ago I was diagnosed with severe aortic regurgitation due to a Bisucspid Aortic Valve. I am now 31 years old with a blood pressure stats around 145/50. I’ve always been extremely active playing basketball and lifting weights regularly. Before diagnosis I felt great and had no idea anything was wrong with me. However, since being diagnosed I have been a nervous wreck thinking about the possibility of surgery. In recent weeks I have felt some chest heaviness associated with sprinting and exercise. I’ve also felt shortness of breath too. I can’t tell whether it is angina or just my nerves and anxiety getting the best of me about my condition. Aside from my faulty valve and high blood pressure, every other health measurable (ie. cholesterol, blood sugar,) is excellent.
Here are my questions. I really want to avoid surgery at all costs and am skeptical it will fix the problem. My fear is that I will be worse off in the long run and that my active lifestyle will be taken away from me. Are there any medications or drugs I could take that have shown beneficial to remedying a BAV? If I opt for surgery, will I be damaging my brain and how dangerous is the surgery? Will I be able to lift weights again (with no restrictions)?
I also wanted to ask you your thoughs on Linus Pauling and Vitamin C. He advocates 15 grams of Vitamin C daily and supports its strong correlation with helping and preventing heart disease.
I appreciate your time and support and thank you in advance for your assistance.
A:
Treatment for Bisucspid Aortic Valve (BAV) depends on whether your heart is tolerating your condition. Since you were born with BAV your heart has done pretty well. However, it seems that you have now developed new symptoms that may indicate your heart is starting to fail. If true, it is caused by a mechanical failure of your valve and Linus Paulding, Vit. C or any other medication will not be able to protect you. You will need an operation! As you are in good condition, your prognosis is excellent.
Patients like you often live for many years without the need for any procedure, but once the valve incompetence causes your heart to start failing it is time to fix it. Any further waiting only damages your heart more and worsens your outlook.
Thus, first your heart needs to be checked with a cardiac ECHO to see whether its size is increasing and early sign of failure.
Next, you and your doctors will need to decide what needs to be done. BAV is occasionally associated with an enlarged aorta which also would need to be repaired. Next, you need a recommendation about repair vs. replacement. Surgeons who have specialized in this type of procedure nowadays prefer a repair if at all possible, which would eliminate the need for anti-coagulation to keep your blood thinned with a drug like Coumadin.This is probably the route I would recommend to you.
A decision about a potentially dangerous procedure always needs to be weighed against the alternatives. In your case there is none: Once your heart begins to fail, an active lifestyle and long term survival is no longer possible without surgery. Contrary to that, with a successful procedure, you probably will be able to live out your life like a “normal” person.
You can read more about this here:
Hope this helps,
Dr T