Bicuspid Valve and Aortic Root Dilation

[jimbocollett]

Hi,

I recently found out I have a bicuspid valve and an enlarged aortic root currently measured at 4.5cm. I'm going for an MRI scan soon to get another more accurate measurement of this but I have a few questions that I hoped somebody might be able to help me with.
I currently a Divemaster and was hoping to take this into a long term career by taking my instructors qualifications but I wondered if there may be any pressure issues that might cause any problems for me?
Also, I havent done any further research into it but what are the implications about dive insurance with this kind of problem? Does anyone know what it will mean for me?

Thanks for the help,

James

 

[Duke Dive Medicine]

Hi James,
Just to be clear, do you mean that you have a bicuspid aortic valve?

 

[jimbocollett]

Hi, yeah sorry about that, it is indeed a bicuspid aortic valve. I've been told both the valve and the root are almost cetainly going to have to be replaced at some stage.

 

[Duke Dive Medicine]

Hi, yeah sorry about that, it is indeed a bicuspid aortic valve. I've been told both the valve and the root are almost cetainly going to have to be replaced at some stage.

No worries, thanks for clarifying. How this affects your diving will depend greatly on how your individual condition has affected your heart. Dr. Doug Ebersole (username debersole) is a cardiologist and a recognized expert in the field of diving with cardiac issues. I'll PM him and see if he can jump into the discussion. In the mean time, can you provide more details on your condition? How was this discovered?

 

[jimbocollett]

Thanks, I appreciate the help.

My condition was discovered asa result of tests being carried out to look for a PFO. It seems that no PFO is present but during the heart echo my doctor discovered the bicuspid valve and on further examination the dilated aortic root was also shown. My doctor has been honest in admitting to not knowing the full implications when it comes to diving and I understand this, he is however researching it further for both of our benefits but he suggested I do the same as well to try and get some answers. At the moment I don't have any other measurements than tht of the 4.5cm aortic root. When I have th MRI I will ask for a full copy of the findings as this may help I assume?

Thanks again.

 

[Dr. Doug Ebersole]

A bicuspid aortic valve is a very common condition, affecting about 2% of the population. It means that the valve has two cusps instead of the normal three. The majority of these people never have a problem from the valve. However, in a significant minority of people the bicuspid valve leaks or becomes narrowed over time and requires valve replacement. Did they mention if your echo showed any problems with the valve other than it being bicuspid. Is it narrowed or leaking significantly?

It is common to have a "post-stenotic" dilatation of the aortic root in the setting of aortic valve disease. The normal aortic root can measure up to about 3.9 cm so 4.5 is enlarged but not dramatically so. This would just need to be followed with serial echos to see if it continues to enlarge. If it gets over 5.5 cm or so there is an increased risk and surgery may be considered.

From a diving perspective, if all you have is a bicuspid valve that is not narrowed or leaking and the mildly enlarged aortic root, there should be no problems with your diving. PM me with further questions.

Doug

 

[tompelletier]

Hi. I have a very similar situation, bicuspid aortic valve, aneurysm at 4.4 cm. 54 years old. I'm not a frequent scuba diver, but I'm certified (PADI and NAUI) and I like to go when I get a chance. I'm reading conflicting information about whether diving is safe with this condition. My thoracic surgeon agrees with your suggestion that it is okay, so I feel pretty good about it. But I read something that said not to do the "Valsalva" procedure, where you hold your nose and blow to clear your ears. Supposedly this makes your blood pressure spike, which is not a good thing for aneurysms, of course. What's your opinion about this? And what would be the alternative? I should say that I don't think I've ever been below 40 feet, and don't have any particular plans to go deeper than that.

By the way, part of what is prompting this issue for me is that a life insurance company is saying they don't like the combination of diving and aortic aneurysm. They'd be okay insuring me with one or the other, but not both. This makes me a little nervous. I love snorkeling and diving, but if it really is a risk for the aneurysm, I'd probably stop.

 

[Duke Dive Medicine]

Tom,

An aortic aneurism adds a complication to this condition and should probably be looked at separately. Is it safe to dive with an aortic aneurism? In general, probably not. One consideration is the excess intrathoracic pressure that could result from the Valsalva maneuver, as you said. Another is the influx of blood into the core that happens with immersion (regardless of depth), which could in theory exert transient excess pressure on the aneurism and cause it to enlarge or rupture. This is probably worth re-visiting with your physician.

Best regards,
DDM

 

[tompelletier]

Hi DDM,

Thanks! What you're saying sounds like the opposite of what debersole said. He told jimbocollet that "From a diving perspective, if all you have is a bicuspid valve that is not narrowed or leaking and the mildly enlarged aortic root, there should be no problems with your diving."

Am I misunderstanding?

Tom

 

[abnfrog]

Hi DDM,

Thanks! What you're saying sounds like the opposite of what debersole said. He told jimbocollet that "From a diving perspective, if all you have is a bicuspid valve that is not narrowed or leaking and the mildly enlarged aortic root, there should be no problems with your diving."

Am I misunderstanding?

Tom

im not saying duke is wrong...but from what i know of doug he is right on top of this stuff.............fwiw