Inherited Aortic Disease and Sports Participation

In recent years, there have been multiple athletes who have succumbed to aortic dissection or rupture due to inherited thoracic aortic disease. These events have led to increased scrutiny toward sports participation among those with aortic root disease, particularly with inherited aortic conditions. While aortic dilation and dissection typically occur in elderly patients with long-standing hypertension, there are several genetic etiologies such as bicuspid aortic valve, Marfan and Loeys–Dietz syndromes, as well as non-syndromic genetic etiologies known as familial thoracic aortic aneurysm and dissection, that contribute to aortopathies and increased risk for aortic dissection in the young. Medical therapy alone has been found to be minimally effective in halting aortic growth and preventing aortic dissection or rupture. The standard approach to preventing ascending aortic dissection remains the use of early surgical repair of aortic aneurysms. In 2015, the American Heart Association/American College of Cardiology published a joint scientific statement on sports participation for competitive athletes with aortic diseases, including Marfan syndrome. The recommendations permit athletes with Marfan syndrome and other inherited aortic diseases to participate in low and moderate static and low dynamic competitive sports; competitive basketball is contraindicated. However, it should be recognized that there is scant data on the effect exercise has on aortic disease progression/dissection, and during discussions with athletes and coaching staff, it is paramount that the recommendation limitations, based primarily on expert opinions and/or small scale clinical evidence, be acknowledged.