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Ann Thorac Surg 1997;64:1871
© 1997 The Society of Thoracic Surgeons

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Correspondence

Weight Lifting, Marfan's Syndrome, and Acute Aortic Dissection

Division of Cardiothoracic Surgery, Harbor-UCLA Medical Center, 1000 W CarsonSt, Torrance, Ca 90509

To the Editor:

In 1990 our group at Harbor-UCLA described 4 patients with type A aortic dissection, 3 aged less than 40 years, who had long histories of weight lifting [1]. All had cystic medial changes in the aortic wall, had development of acute dissections (symptoms developed in 2 while they were lifting weights), and underwent successful surgical repair. None of the patients had Marfan's syndrome. It is unclear if weight lifting induced the medial degeneration in these individuals or if the weight lifting simply increased the likelihood of dissection in predisposed individuals with aortic pathology. It is clear, however, that the hemodynamic stresses of weight lifting, including but not limited to the rapid increase in systemic pressure, contributed to the development of aortic dissection in patients with aortic medial degeneration.

We present a 19-year-old man with Marfan's syndrome who was an avid weight lifter and in whom chest pain developed during a workout. He waited 2 days before presenting to our emergency room, and was found to have obvious physical and skeletal manifestations of Marfan's syndrome. Echocardiography revealed an acute type A dissection with aortic insufficiency. At operation a large intimal tear was found in the ascending aorta anteriorly. He underwent St. Jude Medical (St. Paul, MN) valved conduit replacement of the aortic valve and ascending aorta with coronary reimplantation. He has done well and has been advised strongly against further weight lifting.

The aortic medial changes associated with Marfan's syndrome predispose to aortic dissection, which is the most common cause of death in these patients [2]. Any measure to decrease the incidence of hypertension in these individuals should be beneficial in decreasing or at least delaying the onset of acute aortic dissection. We believe that individuals with Marfan's syndrome or evidence of cystic medial disease or family histories of the disorder should be strongly urged to refrain from weight-lifting activities.

References

1. De Virgilio C, Nelson RJ, Milliken J, et al. Ascending aortic dissection in weight lifters with cystic medial degeneration. Ann Thorac Surg 1990;49:638–42.[Abstract/Free Full Text]
2. Murdoch JL, Walker BA, Halpern BA, Kuzma JW, McKusick VA. Life expectancy and causes of death in the Marfan syndrome. N Engl J Med 1972;286:804–8.[Medline]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Fritz J. Baumgartner Bassam O. Omari John M. Robertson Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Baumgartner, F. J. Articles by Robertson, J. M. Search for Related Content PubMed PubMed Citation Articles by Baumgartner, F. J. Articles by Robertson, J. M.