Aortic Root Dilatation in Athletic Population

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome

“…[15][16][17] Chronic intense weight training may influence aortic dimension. 18 Furthermore, elite athletes have slightly larger aortas at the sinuses of Valsalva than nonathletic control subjects.…”

“…16,17 Of 2317 Italian athletes, 17 males (ages 25±7 years; height 188±10 cm; BSA 2.17±0.25 m 2 ) had aortic diameters >40 mm and were allowed to continue participation. 16,17 Over an 8±5 year follow-up, the aortic root increased mildly in diameter from 40.9±1.3 to 42.9±3.6 mm in these 17 athletes, and none experienced acute aortic dissection. Two athletes had progressive aortic dilation to 50 mm by ages 38 and 50 years, respectively.…”

“…Two athletes had progressive aortic dilation to 50 mm by ages 38 and 50 years, respectively. 17 The risk of aortic dissection in the general population is related to many factors, foremost of which is the severity of aortic dilation, and is sometimes triggered acutely by heavy weight lifting or strenuous exercise, including competitive sports. 21-22a However, some patients with acute aortic dissection do not have a markedly dilated aorta at the time of dissection.…”

“…28 Characterizing an aortic diameter of >40 mm as enlarged in males is an arbitrary but also useful definition, because very few apparently healthy young male athletes have been reported with aortic root diameters >40 mm. 17,19 For example, in a study of >2000 Italian athletes, the 99th percentile value of aortic diameter by echocardiogram was 40 mm in males and 34 mm in females. 16 In a Japanese study, only 6 of 1562 male athletes (0.38%) had an aortic root dimension >40 mm, and 2 of these also had phenotypic features of the Marfan syndrome.…”

“…29 In an evaluation of >1000 female Italian athletes, the 99th percentile for aortic size at the sinuses of Valsalva was 34 mm, and no woman had an aortic diameter >36 mm. 16,17 Guidelines for participation in competitive sports have been lacking for those patients with mildly dilated aortic dimensions (ie, z scores of 2-2.5, or 1-2 mm above the normal ranges described above) and no diagnosis of an underlying connective tissue disorder, family history of aortic disease, or pathogenic gene mutation associated with aneurysm disease. 17 In this situation, there are difficult individual choices regarding sports participation to be made on a case-by-case basis.…”