Dear Dr. Roach: I was diagnosed with a bicuspid aortic valve at age 54 (I'm now 62). I see a general cardiologist annually for an echocardiogram and an EKG, and have had one transesophageal echocardiogram. However, he has never ordered a CT or MRI to thoroughly check my aorta. I've read that BAV patients may have a connective tissue disorder, resulting in aortic problems (aneurysm, dissection).
My ascending aorta is mildly dilated, at 4 cm. Knowing that the size can change rapidly and without warning is a concern. Do you think I should insist on a CT or MRI? Other suggestions?
A: The aortic valve, which separates the left ventricle from the aorta (the largest artery in the body), is supposed to have three leaflets. About 1 percent of people have only two leaflets, which is called a "bicuspid aortic valve." Some of the people with bicuspid aortic valves also have risk for enlargement (dilation) of the aorta. You are absolutely right that this dilation can progress much more quickly than in people with three leaflets in their aortic valves.
An echocardiogram is recommended for young people with BAV every one or two years. For people whose aorta dilates to above 4 (right where you are now), the evaluation may need to be more frequent if the aorta is enlarging rapidly (in some people, it can dilate up to 0.9 mm per year).
I can't answer the question about echocardiogram versus CT versus MRI, as the ideal imaging study varies from person to person. In some people, the regular echocardiogram gives good visualization; however, some people need advanced imaging, and I would generally prefer MRI, as it has no radiation and doesn't usually need intravenous contrast for measuring the aorta.
You also should talk to your doctor about screening family members.
Dear Dr. Roach: I've recently seen on the internet that some very prestigious medical schools have had good things to say about doing different kinds of yoga. I was very surprised by the announcements. Would you care to comment on the subject?
A: I'm not surprised at all, as there are many potential benefits to the modern practice of yoga, which has several different styles. The benefits are both physical and mental, and some practitioners find spiritual benefits as well. Yoga is an ancient practice, but it has been studied recently by medical science. There is strong evidence to show that regular yoga practice improves cardiovascular health, strength, flexibility and balance. There is fair evidence that yoga may reduce stress levels and improve overall quality of life. There is some evidence that yoga may help with some specific medical issues, including helping people quit smoking, reducing symptoms of arthritis and reducing overall pain.
Compared with many medications, risks from yoga are small. Musculoskeletal injuries are the most prevalent type of injury, and these are more common in men, possibly because most men tend not to be as flexible as women and may overdo it, especially as beginners. Any exercise has risks, and one recent study showed that about 10 percent of participants in a suburban yoga class in a year developed pain (that's similar to other types of exercise programs). An experienced yoga teacher can help reduce injury.
Readers: The booklet on restless leg syndrome and nighttime cramps offers more tips. Readers can obtain a copy by writing: Dr. Roach, Book No. 306, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.