Abstract
When an athlete presents with acquired valve disease during pre-participation examination, this often leads to an intensive discussion among the medical staff. Up to now the knowledge of the influence of physical activity on the progression of valvular heart disease (VHD) and ventricular dysfunction is rare. The recommended type of activity (either isometric or dynamic) for a patient with VHD is crucial as it can influence the progression of valvular heart disease as well as ventricular function and the dimensions of heart chambers. Valve defects with a regurgitant component are often better tolerated than stenotic lesions. Dynamic exercise primarily causes increased volume load to the ventricle, whereas static exercise causes mainly a pressure load. Of course, all sports are a combination of these types of effort, but their proportion varies between disciplines. Following adequate clinical evaluation and symptomatic status, echocardiography is the key technique to confirm the diagnosis of VHD as well as to assess its severity and thus prognosis. Indices of left ventricular enlargement and function as well as pulmonary artery pressure are also strong prognostic factors. Transesophageal echocardiography and a stress test to evaluate functional capacity is also of utmost importance to find out if an individual can tolerate the level of exertion expected from the type of sport wished to be engaged in.
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1.1 Questions
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1.
What is the most frequent cause of mitral valve regurgitation (MVR) and how can it be diagnosed adequately?
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2.
Are athletes with bicuspid aortic valve (BAV) allowed to perform sport on a higher level?
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Which left ventricular size can be accepted in athletes with MVR?
1.2 Answers
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The prolapse of leaflets (mitral valve prolapse (MVP)) is the most frequent cause of MVR and can appear as a single or bileaflet protrusion. Typical symptoms are dyspnea, exercise intolerance and auscultation. Many individuals are asymptomatic. MVR can be assessed by Doppler-echocardiography. Next to the valve function the extent of left atrial enlargement should also be evaluated, because of the proclivity for atrial fibrillation.
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Congenital BAV is one of the most common congenital heart diseases appearing in up to every 50th individual and can lead to both AVS and aortic valve regurgitation. A normally functioning BAV usually does not represent a limit for competitive sport but these athletes need regular follow-up evaluation of both aorta and left ventricular size.
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The relevance of MVR in athletes should also be based on LV end-systolic volume. A cut-off of 35Â mm/m2 in men (respectively 40Â mm/m2 in women) turned out to be useful to distinguish individuals with LV enlargement of clinical relevance.
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van Buuren, F., Mellwig, K.P. (2020). Specific Cardiovascular Diseases and Competitive Sports Participation: Valvular Heart Disease. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_16
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DOI: https://doi.org/10.1007/978-3-030-35374-2_16
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