Baylor University Medical Center Proceedings April 2017 - 234

Cardiac rehabilitation for a skydiver after aortic valve
replacement for pure aortic regurgitation and resection
of the ascending aorta complicated by active infective
endocarditis and heart block requiring a pacemaker
Tonja R. Solomon, BSN, RN-BC, Sandra DeJong, BSN, RN-BC, Tim Bilbrey, MBA, Pasquale Carbone, MS,
Mark Campbell, BSc, MSc, Robert D. Parker, PhD, Alessandra Lira, Diogo Amarante, MD, Jeffrey M. Schussler, MD,
and Jenny Adams, PhD
A professional skydiver underwent aortic valve and ascending aorta
replacement complicated by infective endocarditis with root abscess
and pacemaker implantation. He then enrolled in the Baylor Heart and
Vascular Hospital cardiac rehabilitation (CR) program as part of its specificity of testing and exercise training facility. He performed specific skydiving cardiovascular and muscular strength tests at the beginning and the
end of the CR program. His pacemaker was interrogated to ascertain any
arrhythmias or lead displacement over the course of the CR program.
Daily exercise training was customized to match the physical demands
of skydiving, including two sessions at iFLY Dallas. Upon completion of
the daily exercise sessions, the patient performed a simulated free-fall
drop test. He then performed a true jump at Dallas Skydive Center and
subsequently traveled to Arizona for a skydiving competition, where he
performed 35 true jumps with no adverse events or symptoms. This case
illustrates how CR, tailored to a patient's specific needs, can aid in the
return to rigorous activity.

professional skydiver underwent aortic valve surgery,
complicated by infective endocarditis with root abscess.
He chose the Baylor Hamilton Heart and Vascular Hospital cardiac rehabilitation (CR) program because of its
speciﬁcity of testing and exercise training facility. His particular
goal was to participate in an Arizona skydiving competition in
1.5 months. This case report details the speciﬁc testing, exercise
training, and pacemaker device interrogation that he underwent
during CR.
CASE REPORT
The patient, a 39-year-old professional skydiver who had
logged 2500 jumps, presented with severe aortic regurgitation
and left ventricular dilation as a result of a bicuspid aortic valve.
He underwent valve replacement and implantation of an aortic
tube graft. The surgery was complicated by subsequent infective
endocarditis and ascending aortic abscess, and he underwent further surgery on an emergency basis. A dual-chamber permanent
pacemaker was implanted because of frequent manifestations of
symptomatic bradycardia with periods of advanced atrioventricular block. The pacemaker was placed in the left mid chest wall so
the patient would not suﬀer pressure generated by the chute-pack
harness. The patient spent 74 days in the hospital.
234

During the recovery period and treatment of the endocarditis,
the patient had venous thrombosis of the upper limbs and left
jugular vein, requiring continuous use of anticoagulant therapy.
He moved to a CR program in Rio de Janeiro, Brazil, during
which he was limited in recovery by periods of atrioventricular
block and bradycardia during exercise. The amiodarone and bisoprolol were suspended to promote improvement in cardiac performance and exercise tolerance. An echocardiogram showed good
ventricular systolic function, and the aortic valve prosthesis was
in good working condition. Due to his prolonged hospitalization,
the patient was very weak and debilitated. The patient searched
on the Internet for a facility that would provide speciﬁcity of testing and exercise training and subsequently enrolled in the Baylor
Hamilton Heart and Vascular CR program in Dallas, Texas.
Upon entry to CR, the patient's body mass index was
26.5 kg/m2, and his waist circumference was 36.5 inches;
medications included both the rivaroxaban and losartan. Speciﬁc skydiving cardiovascular and muscular strength tests were
performed at the beginning and the end of the CR program.
The cardiovascular tests were performed on a treadmill while
the patient wore a 20-pound chute-pack harness, helmet, and
a calibrated desktop metabolic system (Fitmate MED, Cosmed
USA Inc., Chicago, IL) (Figure 1a) that captured his oxygen
consumption data. Protocols included 2-minute stages at speeds
of 3.3 to 4.2 mph with changes in grade from 0% to 25%. The
indications for terminating the test were those designated by
the American College of Sports Medicine (1). The muscular
strength tests (line gripping, line pulling, and abdominal core)
were performed using a static force gauge that was attached to
a multidimensional strength assessment system (IsoTrack Pro,
JTECH Medical, Midvale, UT) (Figure 1b).
The patient attended 25 CR exercise sessions, 3 times per
week for 8 weeks. Exercise sessions were 75 minutes long and
From the Electrophysiology/Pacemaker Department (Solomon, DeJong) and the
Cardiac Rehabilitation Department (Bilbrey, Carbone, Schussler, Adams), Baylor
Jack and Jane Hamilton Heart and Vascular Hospital; Darwen Leisure Centre,
Darwen, UK (Campbell); Private Consultant, Reno, Nevada (Parker) and Boituva,
São Paulo, Brazil (Lira, Amarante).
Corresponding author: Jenny Adams, PhD, Cardiac Rehabilitation Department,
Baylor Heart and Vascular Hospital, 411 N. Washington, Suite 3100, Dallas, TX
75246 (e-mail: Jenny.Adams@BSWHealth.org).
Proc (Bayl Univ Med Cent) 2017;30(2):234-236

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