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      An Athlete With Bicuspid Aortic Valve Regurgitation and Left Ventricular Dilatation : A Clinical Conundrum

      case-report
      Author(s): , MBChB ∗ , , MBChB, , MBChB, , MBChB, , MBBS, MD, , BS, MBChB, MD, , MBBS, MD
      Publication date (Electronic):
      Journal: JACC Case Reports
      Publisher: Elsevier
      Keywords: aorta, bicuspid aortic valve, echocardiography, exercise, left ventricle

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          Abstract

          The physiologic cardiac adaptations caused by intensive exercise and the pathophysiologic changes caused by significant regurgitant valvular lesions can be challenging to differentiate. We describe the clinical course of an asymptomatic 31-year-old elite triathlete with a moderately regurgitant bicuspid aortic valve and severe left ventricular and aortic dilatation. ( Level of Difficulty: Intermediate.)

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          OUP accepted manuscript

          (2020)
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            Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes.

            Andre La Gerche, Andrew Burns, Don Mooney … (2012)
            Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes. Forty athletes were studied at baseline, immediately following an endurance race (3-11 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 ± 14.0 vs. 25.4 ± 21.4 ng/L, P = 0.003) and cTnI (0.01 ± .03 vs. 0.14 ± .17 μg/L, P < 0.0001) increased post-race and correlated with reductions in RVEF (r = 0.52, P = 0.001 and r = 0.49, P = 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration (r = -0.501, P < 0.0001) and VO(2)max (r = -0.359, P = 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 ± 5.9 vs. 51.1 ± 3.7%, P = 0.042) than those with normal CMR. Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.
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              Clinical significance of the bicuspid aortic valve.

              C. Ward (1999)
              Article 0 comments Cited 68 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Nikhil Chatrath
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 03 November 2022
                Publication date Collection: 03 May 2023
                Publication date (Electronic): 03 November 2022
                Volume: 13
                Electronic Location Identifier: 101495
                Affiliations
                [1]Cardiovascular Clinical Academic Group, St George’s, University of London, London, United Kingdom
                Author notes
                [∗ ] Address for correspondence: Dr Nikhil Chatrath, Cardiovascular Clinical Academic Group, St George’s, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom. nchatrat@ 123456sgul.ac.uk
                Article
                Publisher Item ID: S2666-0849(22)00389-8 Publisher ID: 101495
                DOI: 10.1016/j.jaccas.2022.05.021
                PMC ID: 10157104
                SO-VID: 81846830-682c-487b-ab2e-d80e6a4703f4
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 4 April 2022
                Date revision received : 2 May 2022
                Date accepted : 19 May 2022
                Categories
                Subject: Case Report
                Subject: Heart Care Team/Multidisciplinary Team Live: Sports Cardiology

                Keywords: aorta,bicuspid aortic valve,echocardiography,exercise,left ventricle
                Data availability:
                Keywords: aorta, bicuspid aortic valve, echocardiography, exercise, left ventricle

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