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首页> 外文期刊>Sports medicine >Aortic root disease in athletes: Aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome
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Aortic root disease in athletes: Aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome

机译：运动员的主动脉根部疾病：主动脉根部扩张，冠状动脉异常，双尖瓣主动脉瓣和马凡氏综合征

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Two professional athletes in the US National Basketball Association required surgery for aortic root dilation in 2012. These cases have attracted attention in sports medicine to the importance of aortic root disease in athletes. In addition to aortic root dilation, other forms of aortic disease include anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. In this review, electronic database literature searches were performed using the terms "aortic root" and "athletes." The literature search produced 122 manuscripts. Of these, 22 were on aortic root dilation, 21 on anomalous coronary arteries, 12 on bicuspid aortic valves, and 8 on Marfan's syndrome. Aortic root dilation is a condition involving pathologic dilation of the aortic root, which can lead to life-threatening sequelae. Prevalence of the condition among athletes and higher risk athletes in particular sports needs to be better delineated. Normative parameters for aortic root diameter in the general population are proportionate to anthropomorphic variables, but this has not been validated for athletes at the extremes of anthropomorphic indices. Although echocardiography is the favored screening modality, computed tomography (CT) and cardiac magnetic resonance imaging (MRI) are also used for diagnosis and surgical planning. Medical management has utilized beta-blockers, with more recent use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins. Indications for surgery are based on comorbidities, degree of dilation, and rate of progression. Management decisions for aortic root dilation in athletes are nuanced and will benefit from the development of evidence-based guidelines. Anomalous coronary artery is another form of aortic disease with relevance in athletes. Diagnosis has traditionally been through cardiac catheterization, but more recently has included evaluation with echocardiography, multislice CT, and MRI. Athletes with this condition should be restricted from participation in competitive sports, but can be cleared for participation 6 months after surgical repair. Bicuspid aortic valve is another form of aortic root disease with significance in athletes. Although echocardiography has traditionally been used for diagnosis, CT and MRI have proven more sensitive and specific. Management of bicuspid aortic valve consists of surveillance through echocardiography, medical therapy with beta-blockers and ARBs, and surgery. Guidelines for sports participation are based on the presence of aortic stenosis, aortic regurgitation, and aortic root dilation. Marfan's syndrome is a genetic disorder with a number of cardiac manifestations including aortic root dilation, aneurysm, and dissection. Medical management involves beta-blockers and ARBs. Thresholds for surgical management differ from the general population. With regard to sports participation, the most important consideration is early detection. Athletes with the stigmata of Marfan's syndrome or with family history should be tested. Further research should determine whether more aggressive screening is warranted in sports with taller athletes. Athletes with Marfan's syndrome should be restricted from activities involving collision and heavy contact, avoid isometric exercise, and only participate in activities with low intensity, low dynamic, and low static components. In summary, many forms of aortic root disease afflict athletes and need to be appreciated by sports medicine practitioners because of their potential to lead to tragic but preventable deaths in an otherwise healthy population.
机译：美国国家篮球协会的两名专业运动员在2012年要求进行主动脉根部扩张手术。这些病例在运动医学中引起了人们对运动员主动脉根部疾病重要性的关注。除主动脉根部扩张外，其他形式的主动脉疾病还包括冠状动脉异常，双尖瓣主动脉瓣和马凡氏综合症。在这篇综述中，电子数据库文献搜索是使用术语“主动脉根”和“运动员”进行的。文献检索产生了122篇手稿。其中22例发生在主动脉根部扩张，21例发生在异常冠状动脉，12例发生在二尖瓣主动脉瓣以及8例发生在马凡氏综合症。主动脉根部扩张是一种涉及主动脉根部病理性扩张的疾病，可能导致危及生命的后遗症。需要更好地描述运动员和特别是高风险运动员中的状况。一般人群中主动脉根部直径的标准参数与拟人化变量成正比，但这尚未在运动员达到拟人化指标极限时得到验证。尽管超声心动图是首选的筛查方式，但计算机断层扫描（CT）和心脏磁共振成像（MRI）也可用于诊断和手术计划。医疗管理已经使用了β受体阻滞剂，最近还使用了血管紧张素转化酶（ACE）抑制剂，血管紧张素II受体阻滞剂（ARBs）和他汀类药物。手术适应症基于合并症，扩张程度和进展速度。运动员主动脉根部扩张的管理决策是细致入微的，并将受益于循证指南的制定。冠状动脉异常是运动员的另一种主动脉疾病。诊断传统上是通过心脏导管检查，但最近包括超声心动图，多层CT和MRI的评估。应限制这种情况的运动员参加竞技运动，但可以在手术修复后6个月获准参加。二尖瓣主动脉瓣是另一种形式的主动脉根部疾病，对运动员具有重要意义。尽管传统上将超声心动图用于诊断，但事实证明，CT和MRI更为灵敏和特异。二尖瓣主动脉瓣的管理包括通过超声心动图监测，使用β受体阻滞剂和ARB的药物治疗以及手术。运动参与指南基于主动脉瓣狭窄，主动脉瓣关闭不全和主动脉根部扩张的存在。马凡氏综合症是一种遗传性疾病，具有多种心脏表现，包括主动脉根部扩张，动脉瘤和解剖。医疗管理涉及β受体阻滞剂和ARB。手术管理的阈值与一般人群不同。关于体育参与，最重要的考虑因素是早期发现。患有马凡氏综合症烙印或有家族史的运动员应接受检查。进一步的研究应确定在较高的运动员进行的运动中是否应进行更积极的检查。应限制患有马凡氏综合症的运动员进行与碰撞和重度接触有关的活动，避免进行等距运动，并且仅参加强度低，动态低和静态低的运动。总而言之，许多形式的主动脉根部疾病困扰着运动员，运动医学从业者需要赞赏，因为它们有可能在原本健康的人群中导致悲剧性但可预防的死亡。

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