Bicuspid aortic valve: a literature review and its impact on sport activity

Abstract

The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. A literature search was performed using the key words 'bicuspid aortic valve', 'pathophysiology', 'exercise' and 'training'. BAV is the result of a complex developmental process where several genes seem to lead to abnormal valvulogenesis. Complications associated with BAV include aortic stenosis (AS) and regurgitation, infective endocarditis and aortic dilation and dissection. Moreover, BAV may be associated with other cardiovascular anomalies, mainly aortic coarctation. There is greater awareness of BAV in the young population who practice sport, with an increasing interest on the impact of regular and competitive exercise on athletes with BAV. The early identification of BAV through pre-participation screening is of paramount importance, and the justification of the more appropriate diagnostic methods is still an area of debate. A normally functioning BAV usually does not represent a limit for practising sport. The stress of regular and intense exercise on an abnormal aortic valve may favour its early deterioration and accelerate the development of complications. Therefore, athletes with BAV warrant regular follow-up, which should include echocardiographic assessment at least every year. The eligibility for participation and ability to continue to practise competitive sports in athletes with BAV cannot be generalized, but needs to be individualized depending on age, severity of lesions and type of sport. Further studies are required to elucidate the impact of physical training and competitive sports on the natural course of the BAV.

Exercise Training in Athletes with Bicuspid Aortic Valve Does Not Result in Increased Dimensions and Impaired Performance of the Left Ventricle

“…In athletes, competitive sports activity is normally allowed if the valve dysfunction or the other complications associated are not severe [9, 16]. Some aspects remain unsolved, especially in athletes who train regularly.…”

Bicuspid aortic valve hemodynamics does not promote remodeling in porcine aortic wall concavity

“…Despite its seemingly low incidence, the BAV is responsible for causing more valvular and vascular disease compared to all other congenital heart defects combined [4] . Unlike the normal tricuspid aortic valve (TAV) which consists of three leaflets, the BAV forms with only two [5][6][7] . While there are different BAV morphogenic phenotypes [8][9][10] , the most common is referred to as the type-I BAV and is characterized by the presence of two cusps of unequal size and one fibrous raphe marking the site of fusion on the larger leaflet [5] .…”

Homologous in vitro fertilization in Turner syndrome: insights from a case report

“…Even though there may be an increased risk of aortic dissection during pregnancy, three studies of a small number of pregnant women with Turner syndrome actually found no cases of aortic dissection or rupture (11). In fact, the natural evolution of bicuspid aortic valve is not completely clear even for men engaged in strenuous sporting activities (12). On the basis of aortic dissection observations in a patient with normal ascending aortic diameter, others suggested that pregnancy is contraindicated in patients with Turner syndrome with normal aortic diameter (13).…”