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Aortic stenosis (AS) has long been considered an important cause of death in young people. Aortic dissection and rupture are catastrophic conditions, not usually associated with demise the young. The role of these conditions as causes of athletic field deaths and their identification by routine preparticipation screening is not well understood.
The US National Registry of Sudden Death in Young Athletes was accessed to analyze occurrences of sudden death due to aortic disease (AD) (including aortic dissection, rupture, coarctation) and AS.
Of the 2588 deaths in the Registry, 44 (1.7 %) events related to AS (n=19) or AD (n=25) were identified. AD (including 3 Marfan) was due to dissection in 15, rupture in 8, and coarctation in 2. Athletes were 17.6±5.1 years old (range: 11–36); 4 were female and 40 male. The most prominent sports represented were football and basketball (n=13 each), followed by baseball and softball (n=7). AS deaths occurred during or just after exercise in 18 of 19. AD deaths occurred during exercise (n=16), sedentary activity (n=6) or sleep (n=2). Of the 16 available autopsies for AS deaths, 12 were found to have bicuspid aortic valves (BAV) and 4 had dilated aortas. Of the AD autopsies, most had tamponade (n= 14) related to aortic dissection/rupture while none of these athletes underwent emergent surgical repair for AD. Data regarding preparticipation screening (history and physical) was available in 34/44 athletes, 32 of whom were cleared to play (3 with restrictions). Of the 34, 14 had been assessed specifically by cardiologists, 3 of the athletes had prior heart surgery, 3 had known aortic abnormality and 8 had been previously diagnosed with AS or BAV.
AS and AD are uncommon but important causes of sudden death among young competitive athletes, usually while engaged in basketball and football. Almost 75% of the athletes in this series had been cleared to participate in sports and 1/3 had been evaluated by a cardiologist. Despite wide spread screening, the process failed to detect important cardiovascular abnormalities in 2/3 of the deaths. In the remaining 1/3, suspicion of cardiovascular conditions was raised but the athletes continued to compete.
South, Room 102
Sunday, March 10, 2013, 11:45 a.m.–Noon
Session Title: Evaluating the Athlete's Heart: Emerging Science
Abstract Category: 30. Sports and Exercise Cardiology: Sports Medicine
Presentation Number: 930–7
- 2013 American College of Cardiology Foundation