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Congenital bicuspid valves occur in 1–2% of the population, with variations in the degree of valvular heart disease depending upon which raphes are fused. Fusion of the right and left cusps is more likely to be associated with a functionally normal valve than fusion of the right and non–coronary cusps. At the University of Virginia, all Division I intercollegiate athletes have been screened by echocardiography (TTE) since 2010. In this population, we have identified 7 athletes with bicuspid aortic valves (BAV) and 3 of these with aortopathy.
All incoming Division I intercollegiate athletes at the University of Virginia undergo history and physical exam as well as electrocardiographic (ECG) screening. In the last two years, we have implemented additional screening with congenitally focused TTE.
Of the 670 athletes screened, we identified 7 athletes with BAV, 5 with right and left cusp fusion and 2 with right and non–coronary cusp fusion. There were 5 males and 2 females. Three athletes had evidence of aortopathy. Two BAVs were found utilizing congenital TTE screening. No athlete had more than mild to moderate aortic regurgitation.
There is a significant incidence of congenital bicuspid aortic valves in elite athletes participating in intense training, and associated dilation of the aorta was present in half of these athletes. Two of three athletes with aortopathy had right to left fusion patterns that are more likely to be functionally normal and thus are more likely to elude detection. The prevalence of bicuspid aortic valves is 5 times the expected rate of HOCM (1/500) in this population. This population demonstrates an aortopathy prevalence of 2.5 times that of HOCM. Detection of aortic root abnormalities allowed adjustment of training regimens to minimize isometric training. Because only half of our student athletes underwent screening TTE, this may well be an underestimation of the prevalence in this population. While ECG athletic screening is becoming more common, focusing on ECG neglects other findings that may influence training choices and may necessitate further examination later in life.
South, Room 102
Sunday, March 10, 2013, 11:15 a.m.–11:30 a.m.
Session Title: Evaluating the Athlete's Heart: Emerging Science
Abstract Category: 30. Sports and Exercise Cardiology: Sports Medicine
Presentation Number: 930–5
- 2013 American College of Cardiology Foundation