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Sports_Valve_Hx_Overview.html
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<!DOCTYPE html>
<html lang="en">
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<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: Sports Participation Selector Guide: History of aortic or mitral valve surgery (based on AHA/ACC 2015 guidelines) </title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
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<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.0000000000000241">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 5: Valvular Heart Disease</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">Pulmonary hypertension 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>a history of aortic or mitral valve surgery</b> participate in organized sports?
</section>
</section>
<br>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Type or surgery or valve replacement</li>
<li>Severity of residual stenosis and regurgitation</li>
</ul>
</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">(Aortic or mitral) bioprosthetic valve, not on anticoagulants</p>
<p>"It is reasonable for athletes with aortic or mitral bioprosthetic valves,
not taking anticoagulant agents, who have normal valvular function and normal LV function to
participate in low-intensity and some moderate-intensity competitive sports (classes IA, IB, IC, and IIA)."
</p>
<div class="verdict_maybe">If normal valvular function, normal LV function: Class IA, IB, IC, and IIA sports = reasonable</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleleft">
<p class="sectiontitle">(Aortic or mitral) mechanical valve, on anticoagulants</p>
<p>
"Athletes with aortic or mitral mechanical prosthetic valves taking anticoagulant agents
with normal valvular function and normal LV function can reasonably participate in
low-intensity competitive sports if there is low likelihood of bodily contact (classes IA, IB, and IIA)."
</p>
<div class="verdict_maybe">If normal valvular function, normal LV function:
Class IA, IB, IIA sports = reasonable, if low likelihood bodily contact</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_middleright">
<p class="sectiontitle">Mitral stenosis, s/p either surgical commissurotomy or percutaneous balloon valvotomy</p>
<p>"It is reasonable for patients with MS who have undergone successful percutaneous mitral balloon valvotomy or
surgical commissurotomy to participate in competitive sports based on the residual severity of the MS or MR
and pulmonary artery pressures at rest and with exercise."
</p>
<div class="verdict_maybe">Depending on residual valve dysfunction and PA pressures at rest/exercise: Sports may be reasonable</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
<section class="quarter_right">
<p class="sectiontitle">Surgical repair (for MR, or aortic valve repair)</p>
<p>
"Athletes who have undergone mitral valve repair for MR or surgical aortic valve repair,
have no or mild residual AR or MR, and have normal LV systolic function may be considered for
participation in sports at the discretion of the managing physician
if there is low likelihood of bodily contact (classes IA, IB, and IIA)."
</p>
<div class="verdict_maybe">If no/mild residual AR or MR, normal LV systolic function:
Class IA, IB, IIA sports may be considered if low likelihood bodily contact (at discretion of physician)</div>
<p class="rec_class">(Class IIa Recommendation; Level of Evidence C)</p>
</section>
</section>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000241"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities. Task Force 5: Valvular Heart Disease.
A Scientific Statement From the AHA and ACC.</i></a> <i>Circulation 2015</i>
<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> MR = mitral regurgitation, AR = aortic regurgitation, MS = mitral stenosis, AS = aortic stenosis, LV = left ventricle
</p>
</section>
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