Bicuspid Valve and Aortic Root Dilation

[Duke Dive Medicine]

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

Not at all. When you said "aneurism" I pictured a separate anomaly, not an enlarged aortic root. Aneurisms, whether at the aortic root or otherwise, can be stable or unstable and run the gamut from mild enlargement to ready to pop at any point. Yours is at 44 mm - Doug could better speak to whether that falls into the category of "mildly enlarged". If an individual has a small, stable aneurism, exercises regularly (which puts the aneurism under pressure) with no ill effect, has no significant comorbidities and is closely followed, some physicians will ok him/her to dive. That's a lot of "ifs", though, which is why I made the general statement that I did.

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

No argument here.

 

[Dr. Doug Ebersole]

I agree with the first statement above. The second is a judgement call on everyone's part.

You probably have the same condition as the OP -- a bicuspid aortic valve with a somewhat dilated aortic root. The upper limit of normal for the aortic root is 39mm so 44 mm is not very enlarged. I would start to worry around 55mm.

We usually use the word "aneurysm" to imply a separate anomaly and not just a dilated aortic root which is probably where the confusion arose. Again, if you have only a bicuspid valve with mild aortic root dilatation and have no significant narrowing or leaking of the valve, there should be no exclusion from diving.

Valsalva can mildly increase intrathoracic pressure but not for very long so I would not be overly concerned with this. This usual exclusions in aortic insufficiency (leaking) or aneurysmal disease are for activities such as weight lifting where you can have spikes in blood pressure. BTW, aerobic activities such as walking, biking, running, swimming, etc are fine and actually help your physician follow your exercise tolerance changes over time which can be very helpful in judging if and when surgery is indicated.

Just my 2 cents.

Doug

 

[tompelletier]

Okay. Thanks, both of you. I have an ascending arch aortic aneurysm. I thought maybe that was the same as what you're calling a mild root dilation? Is that right? My aneurysm has been stable for the 3+ years at 4.4 cm since it was first identified. I also have a bicuspid valve that I have been told leaks very little. I'm under yearly monitoring with echocardiogram and CT scan. When I asked my thoracic surgeon about diving, he said it was fine. But the life insurance companies, at least some of them, are saying differently, so that made me nervous. I trust my doctor, but while he's an expert in aortic aneuryms, I don't think he's an expert in scuba, so when I googled this issue, and saw some warnings about Valsalva, I thought I'd ask.

I should also add that my surgeon has said that other than not lifting objects of more than half my weight, I'm under no restrictions. I do not have trouble with aerobic exercise. And the original scan that showed the aneurysm also showed that my coronary arteries are clear, so that's the good news.

Thanks again for your help. These things are a little scary.