Bicuspid aortic valve - Evaluation of the ability to participate in competitive sports: Case reports of two soccer players

Two competitive soccer players aged 23 and 17 years with known bicuspid aortic valve presented for sports-medical 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. Conclusion: 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.