Comments on: Heart Valve Surgery Exercise Guidelines Health Science Communicator Mon, 09 May 2022 06:12:14 +0000 hourly 1 By: Dr Bill Sukala Mon, 09 May 2022 06:12:14 +0000 In reply to Olivier H.

Hi Olivier,
Thanks for taking the time to leave a detailed comment to explain everything you’ve been through, and you’ve clearly been through a lot over the past few years. I’ve seen a lot of strange things in cardiac rehab but I haven’t come across the exact same thing as your situation. However, as I was reading through your history, the thing that kept coming to mind was that the first surgery might have caused some degree of nerve damage related to chronotropic incompetence. In looking through the article from the link you posted, the authors explicitly mentioned that the “left atrium incision impairs cardiac sympathetic nerves and causes CI…”

I can certainly empathise with you that this must be massively frustrating because it seems the treatment left you worse off than you were in the first place. While I can’t make any comment on the decision to operate, many of the cardiologists and surgeons I’ve worked with have said that if someone is asymptomatic, then it’s sometimes a better option to just monitor over time UNTIL they become properly symptomatic and THEN consider surgical options. Though having said that, there may have been other extenuating circumstances that could have contributed to the recommendation for surgery. In any event, you’ll still need to deal with what’s right in front of you right here and now.

I think you drew the same conclusion that there was some sort of electrical disruption within your heart and, while it’s good that all the other tests came back within normal limits, it would seem that moving forward, it might be worth having a look around for an electrophysiologist, a cardiologist who specialises specifically in cardiac rate and rhythm disorders. I’m not exactly certain what the best course of action would be at this stage but it would certainly be worth your while to get a consult with an electrophysiologist to put all the options on the table. Structurally, based on the information you’ve provided, your heart seems to be ok, but it’s just the electrical innervation seems to have been disrupted.

I don’t know if that moves you in the right direction, but I really couldn’t give you much more information than that. But the more information you can get, the better at this point, especially since you are still young and quality of life is a major factor moving forward (and particularly because you’re an active person).

Feel free to stop back and leave another comment later on after you’ve had more evaluations. The information you provide here may benefit others going through the same or similar situation.

Kind regards,

By: Olivier H Tue, 03 May 2022 02:41:17 +0000 Hello Dr. Sukala. I know you can’t give me medical advice over the internet, but I’m hoping you can suggest some new ideas for my doctors and me to explore about the mystery we’ve been trying to solve for more than two years. Here’s the shortest version of my long saga:

– doctor heard a murmur in mid 2019

– diagnosed with severe MVR

– no symptoms…at 47 I could run as many 8-9 minute miles as I wanted and my resting HR was 49

– decided to do a repair, open procedure that was done in August 2019

– repair seemed to go great (four sets of neochords with a 32mm Edwards Lifesciences ring…I was walking ten or so miles a day four days after surgery

– I did have aflutter four weeks after surgery and was cardio-converted but that was attributed to the trauma of the surgery

– got clearance to run again six weeks after surgery…I was off all post-operative medications by this point

– I took my time running again but it quickly became clear that something was wrong. I would be short of breath almost immediately after starting and could barely run a single 12-minute mile. I tried all sorts of training approaches for months but never really improved. After I stop running totally out of breath, my HR will usually drop really quickly…as much as 40-50 bpm in the first minute after I stop running.

– stress echos and even a stress MRI all showed “normal”

– We finally found on a TEE that I still had a “eccentric jet” of MVR along with SAM…my surgeon said the bad news was I needed another surgery but I was actually happy if it would fix the problem I never had in the first place

– second surgery (Dec 2020) also seemed to go well, but my symptoms are barely better to this day. I can run maybe one 9 or 10 minute mile but I’m struggling to breathe the entire time and can barely finish it. My resting HR is now in the mid-60s and has been since the first surgery

– it was found during the second surgery that the tissue where the neochords were anchored had stretched, so my surgeon added five more sets of neochords between the original ones and anchored them into a thicker part of the muscle. He also lighted my LAA since I’d had aflutter after the first surgery.

– I think I’ve had every test known to try to diagnose this, and I’ve closely monitored all my exercise to try to figure this out.

– one strange thing I’ve noticed is that my heart rate seems very “reactive”…it would spike to 140 if I just went up one flight of stairs soon after the first surgery. I still “feel my breath” just casually walking up a flight of stairs. When I run, though, it will usually never go above 140 and is sometimes as low as 105 when I’m barely able to breathe after a tough hill mountain biking. The few times I’ve seen it go into the 160s or so, I usually feel a little better while running. I don’t get the gradual build of my HR to a steady plateau like I used to…it seems to go up and down minute-to-minute between a pretty narrow range of 110-140 bpm. Again, this is all without any medications like beta blockers, etc.

– all the TTEs and TEEs indicate the repaired valve is good

– I’ve had cardiopulmonary exercise tests showing 34.5 VO2 Max and the only abnormality noted was “abnormal ventilatory efficiency slope” so we looked into pulmonary hypertension

– I recently had a right heart catheterization with exercise that ruled out pulmonary hypertension. VO2 Max was 30.5 at the end of the protocol but my HR was only 108 at that point – I went past the protocol and had to spin double the Watts called for to get my HR up to the range where it is when I’m trying to run.

Sorry this is so long, but I wanted to give you at least the outlines of this long saga. Overall, it feels to me like my HR is not “responding to demand” quickly enough. Not sure if that’s “electrical” or “plumbing” related. I also found this article (link below) recently that seems to indicate problems like mine could be related to the actual incision in my LV for both surgeries. That might explain one of the most confusing parts of this for me – the fact that, even though the first repair failed, fixing that problem didn’t really change my exercise intolerance. If the problem was (coincidentally) related to the incision in the first surgery, that might explain the disconnect between the actual valve repair and my ability to exercise. The reality is that I was running as much as I wanted to with severe MVR before any surgeries, so maybe this isn’t directly related to the valve itself.

Please let me know if you have any other ideas for my doctors and me to explore or if you’ve ever encountered anything like this in your practice. Thanks!

By: Dr Bill Sukala Tue, 28 Sep 2021 02:00:23 +0000 In reply to James Lyon.

Hi Jim,
Thanks for taking the time to leave a comment. Great question. I think the answer to your question would really depend on the specifics of the open heart surgery itself. But, aside from any sternal discomfort, on average, most people feel reasonably well and back to normal by around eight weeks after surgery. There may still be some soft tissue healing happening on the inside but most patients I’ve worked in cardiac rehab with tend to be able to get back to doing most things without any worries by that 2-month mark. Ultimately, you’d have to speak with your surgeon and ask what an expected time frame is for full healing in your case.

On a positive note, I’m very happy to see that you’re going to start in a cardiac rehab program. It looks like you’re an active person so you’ll likely benefit from it to get fine tuned to your body post-surgery to ensure that you’re progressing as safely as possible.

Regarding weight lifting, if your cardiologist deems you stable and low risk, I don’t think you should have any issues doing resistance training (notwithstanding extremely heavy powerlifting or other things that might warrant special consideration).

You’re on the right track and taking all the correct precautions. From here, it’s just a matter of time until you’re feeling like your old self, or possibly even better now that you have that new valve working for you! Hope this helps.

Kind regards,

By: James Lyon Mon, 27 Sep 2021 16:10:12 +0000 Dear Dr Sukala,

I had aortic valve replacement surgery on 1 September 2021 (just under 4 weeks ago). I had an upper mini sternotomy performed with a bovine replacement valve used to replace my leaking/regurgitating aortic valve. I’m 75 and in general good health and have lived a active lifestyle and would like to resume that same level of activity as soon as possible. I plan on engaging in a regular cardiac rehab program starting in 2 weeks. Currently I’m walking twice a day in the neighborhood (roughly a mile each session/ 2 miles each day ). Using my fitbit, I’m keeping my BPM under a 100 BPM level. My question is, a lot is said about the healing of the sternum and how low long it takes to heal, but little is mentioned as to how long it takes to heal the heart itself and the precautions moving forward? I do have plans to resume lifting weights and returning to regular exercise!

Thank you,

Jim Lyon

By: Tony Sun, 11 Apr 2021 12:47:57 +0000 In reply to Jean LaPietra.

@Jean LaPietra, Get your surgery done if your cardiologist recommends it. There is a test that gives numbers that tell when is the best time. I had my mitral valve repaired at Cleveland Clinic in Ohio in 2011. Fatigue is what triggered my attempt to research this. The procedures that are done now are extremely safe and the outcomes are 99% plus effective. Mine was done robotically.

By: Mary Reich Thu, 08 Apr 2021 00:51:06 +0000 If you have a mechanical valve can you use the legxercise

By: Dr Bill Sukala Mon, 08 Mar 2021 03:38:14 +0000 In reply to Jean LaPietra.

Hi Jean,
Thanks for taking the time to leave a comment. I can certainly understand your concerns. While I cannot give any advice or make any recommendations either way, here are some points that would be worth discussing with your cardiologist.

1. While it’s been objectively determined that your aortic valve and mitral valves are leaking, to what extent is your fitness “protecting” you and compensating for the leaky valves?

2. How much longer does the cardiologist think you can go without having the surgery? At some point, you will likely have to have the surgery, but only your cardiologist can give you a more firm answer in this case.

3. Does your cardiologist and/or surgeon think that they can repair your valves rather than a full replacement? If it’s possible to repair them rather than replace them, then this might be a good option in the long-term.

4. If you DO decide on having the surgery, ask if there are any options for minimally invasive surgery INSTEAD of having the full sternal sternotomy. Have a look at this article to get a better understanding: or Google “minimally invasive valve surgery” and inform yourself of the options currently available.

Overall, you will probably find that, if you can have the minimally invasive heart valve surgery, then your recovery time will be much quicker and the overall stress on the body will be less. AND, if your valves are working well (either repaired or replaced), then you will most definitely feel much better (i.e., no shortness of breath etc which may get worse with your worsening valves).

Hopefully this information is helpful, but feel free to stop back and leave a comment again if need be.

Kind regards,

By: Jean LaPietra Mon, 08 Mar 2021 01:14:14 +0000 I am 67 y female. My dr. Referred me to a cardiologist because I was short of breath 2 times in the past 6 months. I feel fine and walk 5 days a week and previously swam 25 laps 5 days per week. I have just had tee and r and l catheterization. The results show a severely leaking aortic valve and a moderate/severe leaking mitral valve. I don’t feel bad and my fear is if I have surgery that I will never get back to how good I feel now. What are the risks if I choose not to have surgery?

By: Dr Bill Sukala Thu, 06 Aug 2020 23:24:06 +0000 In reply to Irene.

Hi Irene
As long as you’re medically stable and you have clearance from your doctor to exercise, realistically, you should be just fine. You mention that you have completed cardiac rehab. If you tolerated that well and without any issues then that is also reassuring. Bottom line: if you’re cleared for exercise by your medical management team, then you should be safe to walk on the treadmill. Hope this helps.

By: Irene Thu, 06 Aug 2020 12:30:16 +0000 A year ago I underwent a TAVI procedure for severe aortic stenosis through the femoral artery. I was very fit as I had always walked every day and was discharged from hospital the following day. I completed the cardio rehab course and have continued my daily walk ever since. I would like to know if its safe to now start walking on a treadmill. Many thanks. Irene