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Sports_BAV_Overview.html
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<!DOCTYPE html>
<html lang="en">
<!-- defines the default zoom for mobile devices -->
<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Bicuspid Aortic Valve</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
-webkit-margin-after:0;
-webkit-margin-start:0;
-webkit-margin-end:0;
}
</style>
</head>
<body>
<div class="topbar">
<a href="index.html">Pedi CardioRef</a>
<div class="guidelinebar">
<a target="_blank" rel="noopener noreferrer" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000243">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015)
Task Force 7: Aortic Diseases, Including Marfan Syndrome</a>
</div>
</div>
<section style="margin:10px">
<p class="topspace"></p>
<label><b>By the ACC/AHA 2015 guidelines, should my patient with</label>
<select name="disease" id="dz" class="InputBox" onChange="goThere();">
<option value="">*Select Disease*</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HCM">Hypertrophic Cardiomyopathy </option>
<option value="LVNC">Left Ventricular Non-Compaction </option>
<option value="DilRestr">Dilated or Restrictive Cardiomyopathy </option>
<option value="ARVC">Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) </option>
<option value="Myo">Myocarditis </option>
<option value="Peri">Pericarditis </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="ASDVSDPDA">ASD, VSD, or PDA </option>
<option value="PS">Pulmonic Stenosis </option>
<option value="AS">Aortic Stenosis </option>
<option value="Coarct">Coarctation </option>
<option value="Cyan">Cyanotic Heart Disease, unrepaired or with palliative shunt </option>
<option value="TOF">Tetralogy of Fallot, s/p repair </option>
<option value="TGA_Must">d-transposition (d-TGA), s/p atrial switch (Mustard/Senning)</option>
<option value="TGA_Art">d-transposition (d-TGA), s/p arterial switch </option>
<option value="CCTGA">Congenitally-corrected TGA (CC-TGA, L-TGA)</option>
<option value="Fontan">Fontan </option>
<option value="Ebstein">Ebstein Anomaly </option>
<option value="AnomCoronary">Anomalous Coronary Artery Origin</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="PVR">Elevated PVR in CHD </option>
<option value="VentricularDysfxn">Ventricular Dysfunction s/p CHD Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Valve_AS">Aortic Stenosis</option>
<option value="Valve_AR">Aortic Regurgitation </option>
<option value="Valve_MS">Mitral Stenosis</option>
<option value="Valve_MR">Mitral Regurgitation </option>
<option value="Valve_Hx">History of Mitral or Aortic Valve Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HTN">Hypertension </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="AoDiseases_and_Marfan">Aortic Diseases and Marfan Syndrome</option>
<option value="BAV">Bicuspid Aortic Valve</option>
<option value="Marfan">Marfan Syndrome</option>
<option value="TAA">Thoracic Aortic Aneurysm, familial or unexplained</option>
<option value="LoeysDietz_EhlersDanlos">Loeys-Dietz or vascular Ehlers-Danlos</option>
<option value="AoEnlarge">Enlarged Aorta, non-syndrome non-familial</option>
<option value="Ao_Surgery">S/p Surgery for Aortic Enlargement/Dissection</option>
<option value="Chronic_AoDissection">Chronic Aortic Dissection or Branch Aneurysm</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="CoronaryOverview">Coronary Artery Disease </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Syncope">Syncope </option>
<option value="Arrhythmia">Arrhythmias (SVT, PVC, Vtach, etc.) </option>
<option value="ConductionDefect">Conduction Defects (AV block, brady, pacemaker, RBBB/LBBB)</option>
<option value="Channelopathies">Channelopathies (LQTS, CPVT, Brugada, etc.) </option>
<option value="ICD">Implantable Cardioverter-Defibrillator (ICD) </option>
</select>
<span>participate in organized sports?</span></b>
<br><br>
<section id="question">
Should my patient with <b>Bicuspid Aortic Valve</b> participate in organized sports?
</section>
</section>
<!-- End of 10px margin section. Consider changing template. -->
<br>
<!-- navigation bar for disease sub-categories -->
<nav>
<a href="Sports_BAV_Overview.html" class="active">Bicuspid Aortic Valve</a>
<a href="Sports_Marfan_Overview.html">Marfan</a>
<a href="Sports_TAA_Overview.html">Familial Thoracic Aortic Aneurysm (or unexplained TAA)</a>
<a href="Sports_LoeysDietz_EhlersDanlos_Overview.html">Loeys Dietz or Ehlers Danlos</a>
<a href="Sports_AoEnlarge_Overview.html">Enlarged Aorta, without syndrome, non-familial</a>
<a href="Sports_Ao_Surgery_Overview.html">S/p Aortic Surgery</a>
<a href="Sports_Chronic_AoDissection_Overview.html">Chronic Aortic Dissection or Branch Aneurysm</a>
</nav>
<div class="largeanswerbox">
<h1 align="center">Bicuspid Aortic Valve</h1>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Aortic root or ascending aorta dilation</li>
<li>Valvular function (see Task Force 5 on valvular heart disease)</li>
<li>Any associated connective tissue disorder</li>
<br>
</ul>
<p class="sectiontitle">Need to perform:</p>
<p>"Athletes with BAV and aortic dimensions above the normal range
(scores 2–3 or aortic diameters measuring 40–42 mm in men or 36–39 mm in women)
should undergo echocardiographic or MRA surveillance of the aorta every 12 months,
with more frequent imaging recommended for increasing aortic z score."</p>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>}
</section>
<section id="answer_arrow_section">
<section class="quarter_invisible">⇙</section>
<section class="quarter_invisible">⇙</section>
<section class="quarter_invisible">⇘</section>
<section class="quarter_invisible">⇘</section>
</section>
<section id="answer">
<section class="quarter_left">
<p class="sectiontitle">No dilation</p>
<p>"Athletes with BAV can participate in all competitive athletics
if the aortic root and ascending aorta are not dilated
(ie, z score < 2, or < 2 standard deviations from the mean, or < 40 mm in adults).
The function of the BAV (whether stenotic or regurgitant) is also important in determining participation recommendations
(see Task Force 5 on valvular heart disease)."
</p>
<div class="verdict_ok"><b>All sports = acceptable</b> (but see Task Force 5)</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">Mild-moderate aortic dilation, no connective tissue disorder</p>
<p>
"For athletes with a BAV and a mild to moderately dilated aorta
(score 2–3.5 or aortic root or ascending aortic diameters measuring 40–42 mm in men or 36–39 mm in women)
and no features of associated connective tissue disorder or familial TAA syndrome,
participation in low and moderate static and dynamic competitive sports
with a low likelihood of significant bodily contact (classes IA, IB, IC, IIA, IIB, and IIC)
may be considered.
For these athletes, avoidance of intense weight training should be considered."
</p>
<div class="verdict_maybe"><b>Class IA, IB, IC, IIA, IIB, IIC with low likelihood of bodily contact =
may consider.</b> Also, avoid intense weight training.</div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Aorta 43-45mm</p>
<p>"For athletes with a BAV and a dilated aorta measuring 43 to 45 mm,
participation in low-intensity competitive sports (class IA)
with a low likelihood of bodily contact may be considered."
</p>
<div class="verdict_maybe"><b>Class IA with low likelihood of bodily contact = may consider.</b></div>
<p class="rec_class">(Class IIb Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Severe aortic dilation</p>
<p>
"Athletes with BAV and a severely dilated aorta (score >3.5 to 4 or >43 mm in men or >40 mm in women)
should not participate in any competitive sports that involve the potential for bodily collision."
</p>
<div class="verdict_no">No sports that involve potential for bodily collision</div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
<hr>
<p>
Athletes with BAV and a markedly dilated aorta (>45 mm)
should not participate in any competitive sports.
</p>
<div class="verdict_no">No competitive sports</div>
<p class="rec_class">(Class III Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
</section>
</div>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000243"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force .</a>
A Scientific Statement From the AHA and ACC. Circulation 2015</i> Task Force 7: Aortic Diseases, Including Marfan Syndrome
<br><br><b>Disclaimer:</b> This website is derived from published guidelines, but does not constitute medical advice nor does it replace clinical judgement. Only the text in quotation marks are direct quotations from the original guidelines. Text not in quotations as well as the method of information display are all that of the website creator and are not part of the original published guidelines. Please consult a physician to discuss any patient-specific matters.
</p>
<section class="key">
<p><b>Key:</b> BAV = bicuspid aortic valve, MRA = magnetic resonance angiography
</p>
</section>
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