Different presentation of bicuspid aortic valve in 169 sportsmen.

OBJECTIVE Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly (1-2%) in the general population. Aims of our study were: 1) to evaluate the different patterns of presentation of BAV; 2) to compare different BAV morphological phenotypes. METHODS Since 1986 to 2009, 169 sportsmen with BAV (mean age 22±10.4, range 7-67 years), were evaluated for different reasons in our Institution. Each subject underwent a thorough cardiological evaluation comprehensive of clinical examination, resting and exercise ECG, echocardiogram, 24h-Holter monitoring and, when indicated, magnetic resonance imaging of the heart and/or angio-CT of coronary arteries. RESULTS BAV was associated with cardiac pathologies/abnormalities in 46/169 (27%) sportsmen. After excluding subjects with significant cardiac pathologies (10 cases), aged <12 or >50 years (8 cases), the remaining 151 were classified in 4 groups: group 0, (22 cases, 14.6%) with an “almost normal valve”; group 1, (94 subjects, 62.2%) with regurgitation; group 2, (16 cases, 10.6%) with stenosis; group 3, (19 subjects, 12.6%) with isolated aortic dilation. Moreover, taking into account BAV morphology, 109 cases (72.2%) showed antero-posteriorly (AP) and 42 (27.8%) latero-laterally (LL) oriented cusps. Sportsmen with AP-BAV showed larger aortic diameter (34.7±5.9 vs 31.7±6.1) and a greater proneness to progressive dilation during follow-up (+0.04±0.08 vs +0.02±0.05 mm/year). DISCUSSION & CONCLUSION As other cardiac pathologies/abnormalities are frequently observed in sportsmen with BAV, a thorough cardiological investigation must always be carried out. Several patterns of BAV presentation exist, possibly with different outcome. Valve morphology, finally, seems to be a predictive factor for its prognosis.