MEDICAL AREA   

Medicina dello Sport 2010 December;63(4):539-46

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English, Italian

Simple congenital heart disease and physical fitness certification for competition sports

Cifra B. ¹, Marcora S. A. ², Tranchita E. ¹, Giordano U. ¹, Turchetta A. ¹, Giannico S. ², Fintini D. ¹, Calzolari A. ¹

¹ Unit of Cardiorespiratory and Sports Medicine, Bambino Gesù Hospital, Rome, Italy 2 Follow-up Service for Operated Cardiopatics, Bambino Gesù Hospital, Rome, Italy

Aim. The aim of the study was the evaluation of patients, operated or not for simple congenital heart defects, requesting physical fitness certification for participation in competition sports.
Methods. The study population was 150 patients (108 males, 42 females, mean age, 17±4 years) selected by the Cardiorespiratory and Sports services among referrals from the Cardiosurgery follow-up services, Ospedale Pediatrico Bambino Gesù, Rome, Italy. The case series comprised 52 patients with interatrial defect; 16 with interventricular defect, 29 with aortic coarctation, 26 with aortic defects (8 with aortic insufficiency, 15 with bicuspid aortic valve, and 3 with subaortic valve membrane), 15 with pulmonary stenosis, 7 with mitral prolapse, 4 with mitral insufficiency, and 1 with patent ductus arteriosus (Botallo’s duct). Surgery for correction of the congenital defect had been performed in 47/150 (31%) patients: percutaneous closure for interatrial defect (N.=29; mean age at surgery, 7.4±2.1 years); patch for interventricular defect (N.=14; mean age at surgery, 6±2 years); end-to-end anastomoses (N.=6/13) and subclavian flap aortoplasty (N.=7/13) for aortic coarctation; mean age at surgery, 11.2 months). In this study, all patients underwent complete cardiorespiratory work-up, including: 12-lead ECG; resting blood pressure (Riva-Rocci method); spirometry; treadmill stress testing (according to Bruce); 24-h Holter monitoring ; and mono 2D color-Doppler echocardiography.
Results. Of the 150 patients, 36 (24%) were judged physically unfit for competition sports according to the Cardiology Committee for Sports Fitness (COCIS) cardiology guidelines: 15/36 (42%) had been operated and 21/36 (58%) had not. The reasons for unfitness judgment were: complex ventricular hyperkinetic arrhythmia (N.=6; 3 operated for interatrial defect, 2 for interventricular defect, 1 with bicuspid aortic valve); elevated blood pressure at treadmill stress testing (N.=15; 10 operated for aortic coarctation and 5 not operated); suspected Marfan syndrome (mitral prolapse) (N.=1); other reasons (N.=14; 9 with bicuspid aortic valve with aortic bulb dilatation, 2 with subaortic valve membrane with significant gradient, 1 with moderate aortic insufficiency, 2 with moderate-to-severe pulmonary stenosis).
Conclusion. In this series, 36/150 (24%) patients were found physically unfit for competition sports; this indicates that current Italian health care norms regulating fitness for participation are both appropriate and justifiable. While a simple congenital heart defect, whether surgically corrected or not, does not necessarily contraindicate issuing certification of physical fitness for sports, accurate assessment is warranted to ensure that sports activities will be beneficial and not harmful in these patients.