Specific Cardiovascular Diseases and Competitive Sports Participation: Valvular Heart Disease

When an athlete presents with acquired valve disease during pre-participation examination, this often leads to an intensive discussion among the medical staff. Up to now the knowledge of the influence of physical activity on the progression of valvular heart disease (VHD) and ventricular dysfunction is rare. The recommended type of activity (either isometric or dynamic) for a patient with VHD is crucial as it can influence the progression of valvular heart disease as well as ventricular function and the dimensions of heart chambers. Valve defects with a regurgitant component are often better tolerated than stenotic lesions. Dynamic exercise primarily causes increased volume load to the ventricle, whereas static exercise causes mainly a pressure load. Of course, all sports are a combination of these types of effort, but their proportion varies between disciplines. Following adequate clinical evaluation and symptomatic status, echocardiography is the key technique to confirm the diagnosis of VHD as well as to assess its severity and thus prognosis. Indices of left ventricular enlargement and function as well as pulmonary artery pressure are also strong prognostic factors. Transesophageal echocardiography and a stress test to evaluate functional capacity is also of utmost importance to find out if an individual can tolerate the level of exertion expected from the type of sport wished to be engaged in.