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Bicuspid aortic valve

Evaluation of the ability to participate in competitive sports: case reports of two soccer players

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Two competitive soccer players aged 23 and 17 years with known bicuspid aortic valve presented for sportsmedical preparticipation screening. Both athletes were well trained and had a maximal oxygen uptake of 61 and 60 ml/min/kg, respectively. Echocardiography of the first athlete revealed an eccentric hypertrophy of the left ventricle (end–diastolic diameter 58–59 mm, septal and posterior myocardial wall thickness 12–13 mm) with good systolic and diastolic function and a functional bicuspid aortic valve with mild regurgitation. In the second athlete, echocardiography showed a bicuspid aortic valve with moderate regurgitation and a relative stenosis, a hypertrophied left ventricle (end–diastolic diameter 62–63 mm, myocardial wall thickness 13–16 mm) and dilation of the ascending aorta of 46 mm, which was confirmed by magnetic resonance imaging. According to international guidelines, the first athlete was allowed to participate in competitive soccer. Nevertheless, regular cardiologic examinations in intervals of 6 months were recommended. In the second case, the athlete was not allowed to take part in competitive sports due to the extended ectasy of the ascending aorta and the concomitant risk of an aortic rupture. In addition, the left ventricular hypertrophy has to be considered as pathologic. Therefore, the athlete was only allowed to exercise in recreational sports with low and easily controllable intensities.


In athletes with bicuspid aortic valve, besides the evaluation of the aortic valve, physiologic adaptations of the heart have to be differentiated from pathological changes. Furthermore, the aorta deserves special attention, because in the case of a (probably genetically determined) dilated ascending aorta, an elevated risk for aortic rupture is present during intensive and competitive exercise. A general judgement in athletes with bicuspid aortic valves on their ability to participate in competitive sports is, therefore, not possible.

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  1. Bonow R, Braunwald E (2005) Valvular heart disease. In: Zipes D, Libby P, Bonow R, Braunwald E (eds) Braunwald’s Heart Disease: a textbook of cardiovascular medicine. 7th Edition. Elsevier Saunders, Philadelphia, pp 1553–1632

  2. Borger M, Preston M, Ivanov J et al (2004) Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg 128:677–668

    Article  PubMed  Google Scholar 

  3. Devereux R, Alonso D, Lutas E et al (1986) Echocardiographic assessement of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    CAS  PubMed  Google Scholar 

  4. Dickhuth H, Roecker K, Niess A, Hipp A, Heitkamp H (1996) The echocardiographic determination of volume and muscle mass of the heart. Int J Sports Med 17:132–139

    Google Scholar 

  5. Eckart R, Scoville S, Campbell C et al (2004) Sudden death in young adults: a 25–year review of autopsies in military recruits. Ann Intern Med 141:829–834

    PubMed  Google Scholar 

  6. Fedak P, David T, Borger M, Verma S, Butany J, Weisel R (2005) Bicuspid aortic valve disease: recent insights in pathophysiology and treatment. Expert Rev Cardiovasc Ther 3:295–308

    Article  PubMed  Google Scholar 

  7. Fedak P, de Sa M, Verma S et al (2003) Vascular matrix remodeling in patients with bicuspid aortic valve malformations: implications for aortic dilatation. J Thorac Cardiovasc Surg 126:797–806

    Article  PubMed  Google Scholar 

  8. Fedak P, Verma S, David T, Leask R, Weisel R, Butany J (2002) Clinical and pathophysiological implications of a bicuspid aortic valve (case report). Circulation 106:900–904

    Article  PubMed  Google Scholar 

  9. Januzzi J, Isselbacher E, Fattori R et al (2004) Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 43:665–669

    Article  PubMed  Google Scholar 

  10. Keane M, Wiegers S, Plappert T, Pochettino A, Bavaria J, Sutton M (2000) Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 102:III35–39

    CAS  PubMed  Google Scholar 

  11. Kindermann W (2000) Das Sportherz. Deut Z Sportmed 51:307–308

    Google Scholar 

  12. Kindermann W (2005) Plötzlicher Herztod im Sport. Deut Z Sportmed 56:106–107

    Google Scholar 

  13. Larson E, Edwards W (1984) Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 53:849–855

    Article  CAS  PubMed  Google Scholar 

  14. Löllgen H, Dirschedl P (1989) Die kardiovaskuläre Gefährdung im Breitensport. Deut Z Sportmed 40:212– 221

    Google Scholar 

  15. Maron B (2005) Cardiovascular disease in athletes. In: Zipes D, Libby P, Bonow R, Braunwald E (eds) Braunwald’s heart disease: a textbook of cardiovascular medicine. 7th Edition. Elsevier Saunders, Philadelphia, pp 1985–1991

  16. Maron B, Poliac L, Roberts W (1996) Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol 28:428–431

    Article  CAS  PubMed  Google Scholar 

  17. Maron B, Zipes D et al (2005) 36th Bethesda conference: eligibility recommondations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 45:1312–1375

    Google Scholar 

  18. Nataatmadja M, West M, West J et al (2003) Abnormal extracellular matrix protein transport associated with increased apoptosis of vascular smooth muscle cells in marfan syndrome and bicuspid aortic valve thoracic aortic aneurysm. Circulation 108:II329–334

    Article  PubMed  Google Scholar 

  19. Neumayr G, Pfister R, Mitterbauer G, Hörtnagel H (2001) Asymptomatischer Herzschaden durch extreme Ausdauerbelastung? Deut Z Sportmed 52:253–257

    CAS  Google Scholar 

  20. Northcote R, Evans A, Ballantyne D (1984) Sudden death in squash players. Lancet 21:148–151

    Google Scholar 

  21. Pelliccia A, Culasso F, DiPaolo F, Maron B (1999) Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 130:23–31

    CAS  PubMed  Google Scholar 

  22. Pelliccia A, Maron B, Spataro A, Proschan M, Spirito P (1991) The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 324:295–301

    CAS  PubMed  Google Scholar 

  23. Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W (2002) Athlete’s heart: right and left ventricular mass and function in male endurance athletes and untrained control subjects determined by magnetic resonance imaging. J Am Coll Cardiol 40:1856–1863

    Article  PubMed  Google Scholar 

  24. Scharhag J, Urhausen A, Schneider G, Rochette V, Kramann B, Kindermann W (2003) Vergleich echokardiographischer Methoden zur linksventrikulären Muskelmassenbestimmung mit der MRT bei Ausdauerathleten mit Sportherz und Untrainierten. Z Kardiol 92:309–318

    Article  CAS  PubMed  Google Scholar 

  25. Sharma S, Maron B, Whyte G, Firoozi S, Elliott P, McKenna W (2002) Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 40:1431–1416

    Article  PubMed  Google Scholar 

  26. Spittell P, Spittell JA, Joyce J et al (1993) Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 68:642–651

    CAS  PubMed  Google Scholar 

  27. Thompson P, Funk E, Carleton R, Sturner W (1982) Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535– 2538

    Article  CAS  PubMed  Google Scholar 

  28. Urhausen A, Kindermann W (1998) Der plötzliche Herztod im Sport. Ther Umsch 55:229–234

    CAS  PubMed  Google Scholar 

  29. Urhausen A, Kindermann W (1992) Echocardiographic findings in strength– and endurance–trained athletes. Sports Med 13:270–284

    CAS  PubMed  Google Scholar 

  30. Urhausen A, Kindermann W (1999) Sports–specific adaptions and differentiation of the athlete’s heart. Sports Med 28:237–244

    Article  CAS  PubMed  Google Scholar 

  31. Virmani R, Robinowitz M, McAllister H (1982) Nontraumatic death in joggers. A series of 30 patients at autopsy. Am J Med 72:871–874

    Article  Google Scholar 

  32. Waller B, Roberts W (1980) Sudden death while running in conditioned runners aged 40 years or over. Am J Cardiol 45:1292–1300

    CAS  PubMed  Google Scholar 

  33. Whyte G, George K, Sharma S et al (2004) The upper limit of physiological cardiac hypertrophy in elite male and female athletes: the British experience. Eur J Appl Physiol 92:592– 597

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jürgen Scharhag.

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Scharhag, J., Meyer, T., Kindermann, I. et al. Bicuspid aortic valve. Clin Res Cardiol 95, 228–234 (2006).

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