In any competitive sports.

PROSTHETIC HEART VALVES

Several general comments apply to all patients who have

undergone valve replacement. First, although most patients

improve after valve replacement and many become asymptomatic,

the long-term mortality after operation is greater

than that of a normal population of similar age. Second, a

transvalvular gradient of varying severity is present in most

patients after valve replacement (5,19). Third, although

hemodynamic variables at rest may be essentially normal

after valve replacement, many patients have an abnormal

response to exercise (20). Finally, after valve replacement

(with few exceptions) patients with mechanical prostheses

require anticoagulant agents, and those with bioprosthetic

valves in sinus rhythm usually do not. In assessing the

athlete’s capacity for physical activity, exercise stress testing

to at least the level of activity performed in the competitive

sport is valuable.

1338 Bonow et al. JACC Vol. 45, No. 8, 2005

Task Force 3: Valvular Heart Disease April 19, 2005:1334–40

Effects of exercise.There are insufficient data to determine

whether vigorous repetitive exercise after valve replacement

has any long-lasting effect on ventricular or prosthetic valve

function. The patient should be made aware of these

deficiencies in our knowledge before deciding whether to

participate in competitive athletics. Because mechanical and

most tissue valves have reduced effective valve areas, they

perform best at normal heart rates. Therefore, a sustained

heart rate greater than 120 beats/min might result in

elevated valve gradients and cardiac outputs that are less

than normally expected.

Recommendations:

1. Athletes with a bioprosthetic mitral valve not taking

Anticoagulant agents and who have normal valvular

Function and normal or near-normal LV function can

Participate in low and moderate static and low and

Moderate dynamic competitive sports (classes IA, IB,

IIA, and IIB).

2. Athletes with a mechanical or bioprosthetic aortic

valve, with normal valve function and with normal

LV function, can engage in low and moderate static

And low and moderate dynamic competitive sports

(classes IA, IB, and IIA). Athletes participating in

Greater than low-intensity competitive sports (class

IA) should undergo exercise testing to at least the

Level of activity achieved in competition to evaluate

Exercise tolerance and symptomatic and hemodynamic

Responses.

Independent of other considerations, athletes with a

mechanical or bioprosthetic mitral valve or aortic

valve who are taking anticoagulant agents should not

Engage in sports involving the risk of bodily contact

(see Task Force 8: Classification of Sports) or the

Danger of trauma.

VALVE REPAIR OR

PERCUTANEOUS MITRAL BALLOON VALVOTOMY

Several general comments apply to athletes who have

undergone valve repair or percutaneous mitral balloon mitral

valvotomy (PMBV). The benefits of surgical mitral valve

repair for MR appear to persist long term, but the effects of

strenuous exercise on repaired mitral valves have not been

studied systematically. After treatment for MS with PMBV

or either closed or open surgical mitral commissurotomy,

the patient should have no disability if there has been no

injury to the left ventricle or development of significant

MR. After aortic valvuloplasty in young patients with

congenital AS, there is the risk of subsequent endocarditis,

AR, or recurrent AS. Athletes should be evaluated for

competitive sports on the basis of their residual hemodynamic

state.

Recommendations:

Date: 2016-03-03; view: 876