Sports Participation and Exercise Restriction in Children with Isolated Bicuspid Aortic Valve

• Published in: The American journal of cardiology 2020-06, Vol.125 (11), p.1673-1677
• Main Authors: Baleilevuka-Hart, Marica, Teng, Brandon J., Carson, Kathryn A., Ravekes, William J., Holmes, Kathryn W.
• Format: Article
• Language: English
• Subjects: Adolescent; Adults; Age; Aorta; Aortic Diseases - diagnostic imaging; Aortic Diseases - epidemiology; Aortic stenosis; Aortic valve; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - epidemiology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Bicuspid Aortic Valve Disease; Cardiology; Cardiovascular disease; Catheters; Child; Child, Preschool; Children; Congenital diseases; Coronary vessels; Dilatation, Pathologic; Dilation; Disease Management; Disease Progression; Echocardiography; Exercise; Female; Guidelines; Heart; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - epidemiology; Heart valves; Humans; Longitudinal Studies; Male; Medical instruments; Participation; Patients; Pediatrics; Practice Guidelines as Topic; Regurgitation; Retrospective Studies; Rheumatic heart disease; Sports; Stenosis; Survival analysis; Task forces; Ultrasonic imaging; Ventricle; Young Adult; Young adults
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.02.039

Our study was to apply the 2015 American Heart Association/American College of Cardiology Athletic Participation Guidelines to a group of otherwise healthy school age children and young adults with bicuspid aortic valve (BAV) and describe the potential competitive sports restriction as they age. We performed a retrospective chart review of children and young adults aged 5 to 22 years with isolated BAV with at least two echocardiograms between 2000 and 2013. Using task force guidelines, exercise restriction was recommended for any of the following: (1) any dilation of the aortic root, (2) any dilation of the ascending aorta, (3) moderate aortic stenosis, (4) severe aortic regurgitation; (5) left ventricular dilation or (6) reduced shortening fraction. Of the 345 patients with isolated BAV, 202 were considered restricted at study entry. The final cohort included 123 children and young adults. Over the course of follow up, 36% (44 of 123) met restriction criteria. The most likely cause for restriction was aortic dilation (34%). Progression of aortic valve disease occurred in a minority of patients (3%). There were no reports of death, dissection or catheter or surgical based intervention. In conclusion, we found that strict adherence to current guidelines would result in restriction of more than 1/3 of school age children and young adults with BAV from some form of competitive athletics during school age years. Strict application of the current guidelines in this age group may lead to over-restriction of youths from competitive sports.