Using A Mobile App To Deliver Hybrid Cardiac Rehabilitation In The Young Cardiac Patient Following Aortic Valve Replacement: A Case Study

HISTORY: A 26-year-old male with known history of ventral septal defect (VSD) repaired at 2 months of age had a general physical. An order for echocardiogram was placed as follow-up from VSD repair. He was an otherwise healthy individual with no cardiac symptoms. He has a history of exercise with heavy weightlifting. PHYSICAL EXAMINATION: Cardiovascular exam reveals regular rate and rhythm, no murmurs or rubs with normal jugular venous pulse. BP and pulse were within normal limits (127/73, 75 bpm). Pulmonary examination was unremarkable with symmetric breath sounds, no wheezes, crackles, rhonchi, or rubs. DIFFERENTIAL DIAGNOSIS: History of VSD repaired at 2 months of age, asymptomatic TEST AND RESULTS: Echocardiogram: - Severely Severely enlarged sinus of Valsalva (diameter 51 mm) - No evidence of residual shunt r/t VSD - Trileaflet aortic valve with regurgitation CT Angiogram Chest Exam: - Dilated aortic root (50 mm) Genetic Testing:- FBN2 c.3805A > G (p.Ser1269Gly) - SMAD2 c.1360_1364del (p.Thr454Aspfs*32) - de novo, likely pathogenic FINAL/WORKING DIAGNOSIS: Thoracic aortic aneurysm without rupture in setting of positive family history of aortic disease TREATMENT AND OUTCOMES: 1.Underwent bentall root replacement, aneurysm repair of ascending aorta, and aortic valve replacement 2.Started on aspirin 81 mg QD, metoprolol 75 mg BID, warfarin per anticoagulation clinic 3.Started outpatient cardiac rehab (CR) 1 month post-op a.37 minutes aerobic exercise, 5 minutes upper-body ROM x 2 days/week4.Baseline CPET 2 months post-op @ 85.9 kg a.Exercise time: 15.3 minutes b.Absolute VO2: 3.36 L/min (39.1 ml/kg/min) c.THR range: 114-130 (moderate), up to 145 bpm (vigorous) 5.Transitioned to home-based CR after 12 onsite sessions with progressive plan delivered through mobile-Health app a.Aerobic exercise + core strengthening 3 days/week i.20-25 min moderate intensity on treadmill ii.20 min HIIT on recumbent bike (2-3 min @ 60-80% HRR, 2-3 min @ 40-60% HRR + 3 min warm-up, 5 min cool-down) b. Lower-body strength training 2 days/weeki.Post-sternal precautions protocol initiated 12 weeks post-op to include upper extremity strengthening exercises c.Flexibility training 2 days/week 6.Follow-up CPET 5 months post-op @ 89.1 kg (+3.2 kg from baseline)a.Exercise time: 18 minutes b.Absolute VO2: 3.44 L/min (38.6 ml/kg/min)