Bicuspid aoritc valve

[nelsonjo]

In 1989 I showed evidence of a mild aortic valvular stenosis.

I am now 44 and went for a echocardiogram last week. I received a call back
from my primary doctor yesterday letting me know that my aortic valve normally 2
cm wide has narrowed to .06 cm I do show leaking (if this means blood falling
back). I was told by the primary care doctor that I’d need valve replacement.

I am to see the cardiologist next Thursday.

I did a week worth of dives in January with no issue, and rode my bicycle
20 miles a day April-August. I commute this way in the summer and at most had a
mild feeling of malaise some days.

I have paid for a dive trip to Cozumel the first week of December (2 tank
dives x 6).

I also have planned another trip the last week of January I am to pay for
next Monday. I don’t want to lose a large amount of non refundable money should
I be unable to dive.

I don’t want to put myself or someone else at risk, and would like a
educated opinion to whether it’s safe to dive given my condition and the fact I
can exercise via bicycle with no serious issue. I’m pretty stubborn about
wanting to go...

I read this posing but it seems to be about dilation, not narrowing:

Bicuspid Valve and Aortic Root
Dilation

[SIZE=+0]Thanks for the help,[/SIZE]

John

 

[TSandM]

A valve diameter of 0.6 cm (and 0.06 is not possible) is between severe and critical aortic stenosis. I am surprised at the functional status you report, given that degree of stenosis, but you are obviously in good condition and have strengthened your heart as the stenosis has worsened.

However, one of the common clinical presentations of such severe aortic stenosis is syncope, in particular syncope with exertion. I personally would not want to be swimming against a current and pass out underwater. It would be bad enough to have this happen while you were riding your bike!

In addition, it makes me worry a little bit about whether your susceptibility to immersion pulmonary edema is significantly increased by combining the hemodynamic changes of submersion with a fixed resistance to left ventricular outflow. There are no data on this at all -- it's just a theoretical concern.

We all make risk assessments, but if I had your diagnosis, I sure wouldn't put the money down for the second trip. I'd get the valve fixed. I've seen people come in, sitting bolt upright, with pink foam coming out of their mouths and gasping for breath as a result of critical AS. You don't want that.

 

[nelsonjo]

Thanks for the reply! Exactly the type of opinions I'm after.


From what I have quickly read, I guessed the primary concern would be syncope.


I want to gain knowledge about exertion on my heart and if diving would be any different than other activities I am able to do like riding my bike / other strenuous activities.


I am slowly coming to the realization I should probably not put the money down on the second trip. A big disappointment. The diagnosis is still settling in.


However, I'm still with hope that I'll be able to do the dives I have scheduled for my first trip. I have been around water since childhood and feel comfortable diving. The dives in Cozumel should be largely drift diving, so don't expect a lot of need to swim against current.


I am to see the cardiologist next Thursday and leave on Saturday.. So trying to understand the risks as quickly as I can.


John

 

[Duke Dive Medicine]

John,
Concur with TSandM. Bear in mind that any recommendations here are by necessity conservative, but I agree with her in that not only are you at risk for syncope, you're also at increased risk of pulmonary edema related to fluid redistribution from immersion. I highly recommend you consult with a trained diving physician before your trip. PM me if you'd like a referral.
Best regards,
DDM