Sporcularda Aort Hastalıkları
Özet
Yoğun atletik antrenman, kardiyovasküler sistemin verimliliğini artırmak için önemli fizyolojik adaptasyonlara yol açar. Bu süreçte aorta, egzersiz sırasında maruz kaldığı hemodinamik stres nedeniyle kritik bir rol oynar. Bikuspid aort kapağı (BAV) en yaygın doğuştan kalp anomalilerindendir ve aort kapağının iki yaprakçıklı olması ile karakterizedir. Genellikle asemptomatiktir ve erkeklerde daha sık görülür. BAV’lı sporcular spor yapmaya devam edebilir, ancak düzenli kardiyolojik takip gereklidir.
Marfan sendromu (MFS), genetik bir hastalık olup, aort kökü genişlemesi ve anevrizma riskini artırır. MFS’li sporcuların erken teşhisi ve düzenli izlenmesi hayati önem taşır. Ağır ve izometrik egzersizlerden kaçınmaları, düşük yoğunluklu sporlarla ilgilenmeleri önerilir. Aort kökü genişlemesi, hem BAV hem de Marfan sendromlu hastalarda sık görülür ve ani kardiyak ölüm riskini artırabilir. Egzersiz sırasında artan hemodinamik yük diseksiyon riskini yükseltir.
Bu makale, BAV, Marfan sendromu ve aort kökü genişlemesinin sporcu sağlığına etkilerini ele alarak düzenli kardiyolojik muayeneler ve erken teşhisin önemine dikkat çeker. Sporcuların kalp sağlığı düzenli izlenmeli ve uygun spor dallarına yönlendirilmelidir.
Referanslar
De Mozzi P, Longo UG, Galanti G, Maffulli N. Bicuspid aortic valve: a literature review and its impact on sport activity. Br Med Bull. 2008;85:63-85.
Mordi I, Tzemos N. Bicuspid aortic valve disease: a comprehensive review. Cardiol Res Pract. 2012;2012:196037.
Basso C, Boschello M, Perrone C, Mecenero A, Cera A, Bicego D, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol. 2004;93(5):661-3.
Nistri S, Basso C, Marzari C, Mormino P, Thiene G. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol. 2005;96(5):718-21.
Spaziani G, Girolami F, Arcieri L, Calabri GB, Porcedda G, Di Filippo C, et al. Bicuspid Aortic Valve in Children and Adolescents: A Comprehensive Review. Diagnostics (Basel). 2022;12(7).
Niaz T, Fernandes SM, Sanders SP, Michelena H, Hagler DJ. Clinical history and management of bicuspid aortic valve in children and adolescents. Prog Cardiovasc Dis. 2020;63(4):425-33.
Fernandes SM, Sanders SP, Khairy P, Jenkins KJ, Gauvreau K, Lang P, et al. Morphology of bicuspid aortic valve in children and adolescents. J Am Coll Cardiol. 2004;44(8):1648-51.
Michelena HI, Desjardins VA, Avierinos JF, Russo A, Nkomo VT, Sundt TM, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation. 2008;117(21):2776-84.
Yim ES. Aortic root disease in athletes: aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. Sports Med. 2013;43(8):721-32.
Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol. 2005;45(8):1318-21.
Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372-92.
Isselbacher EM, Preventza O, Hamilton Black J, 3rd, Augoustides JG, Beck AW, Bolen MA, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482.
Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(14):1422-45.
Jensen T, Tran P, Kjaer M. Marfan Syndrome and Exercise: A literature review. Translational Sports Medicine. 2020;3.
Maron BJ, Chaitman BR, Ackerman MJ, Bayes de Luna A, Corrado D, Crosson JE, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109(22):2807-16.
Pelliccia A, Di Paolo FM, Quattrini FM. Aortic root dilatation in athletic population. Prog Cardiovasc Dis. 2012;54(5):432-7.
Kinoshita N, Mimura J, Obayashi C, Katsukawa F, Onishi S, Yamazaki H. Aortic root dilatation among young competitive athletes: echocardiographic screening of 1929 athletes between 15 and 34 years of age. Am Heart J. 2000;139(4):723-8.
Stephen Hedley J, Phelan D. Athletes and the Aorta: Normal Adaptations and the Diagnosis and Management of Pathology. Curr Treat Options Cardiovasc Med. 2017;19(11):88.
Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2398-405.
Chubb H, Simpson JM. The use of Z-scores in paediatric cardiology. Ann Pediatr Cardiol. 2012;5(2):179-84.
Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2398-2405. doi: 10.1016/j.jacc.2015.09.039. Epub 2015 Nov 2. PMID: 26542664.
Referanslar
De Mozzi P, Longo UG, Galanti G, Maffulli N. Bicuspid aortic valve: a literature review and its impact on sport activity. Br Med Bull. 2008;85:63-85.
Mordi I, Tzemos N. Bicuspid aortic valve disease: a comprehensive review. Cardiol Res Pract. 2012;2012:196037.
Basso C, Boschello M, Perrone C, Mecenero A, Cera A, Bicego D, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol. 2004;93(5):661-3.
Nistri S, Basso C, Marzari C, Mormino P, Thiene G. Frequency of bicuspid aortic valve in young male conscripts by echocardiogram. Am J Cardiol. 2005;96(5):718-21.
Spaziani G, Girolami F, Arcieri L, Calabri GB, Porcedda G, Di Filippo C, et al. Bicuspid Aortic Valve in Children and Adolescents: A Comprehensive Review. Diagnostics (Basel). 2022;12(7).
Niaz T, Fernandes SM, Sanders SP, Michelena H, Hagler DJ. Clinical history and management of bicuspid aortic valve in children and adolescents. Prog Cardiovasc Dis. 2020;63(4):425-33.
Fernandes SM, Sanders SP, Khairy P, Jenkins KJ, Gauvreau K, Lang P, et al. Morphology of bicuspid aortic valve in children and adolescents. J Am Coll Cardiol. 2004;44(8):1648-51.
Michelena HI, Desjardins VA, Avierinos JF, Russo A, Nkomo VT, Sundt TM, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation. 2008;117(21):2776-84.
Yim ES. Aortic root disease in athletes: aortic root dilation, anomalous coronary artery, bicuspid aortic valve, and Marfan's syndrome. Sports Med. 2013;43(8):721-32.
Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol. 2005;45(8):1318-21.
Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372-92.
Isselbacher EM, Preventza O, Hamilton Black J, 3rd, Augoustides JG, Beck AW, Bolen MA, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482.
Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(14):1422-45.
Jensen T, Tran P, Kjaer M. Marfan Syndrome and Exercise: A literature review. Translational Sports Medicine. 2020;3.
Maron BJ, Chaitman BR, Ackerman MJ, Bayes de Luna A, Corrado D, Crosson JE, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109(22):2807-16.
Pelliccia A, Di Paolo FM, Quattrini FM. Aortic root dilatation in athletic population. Prog Cardiovasc Dis. 2012;54(5):432-7.
Kinoshita N, Mimura J, Obayashi C, Katsukawa F, Onishi S, Yamazaki H. Aortic root dilatation among young competitive athletes: echocardiographic screening of 1929 athletes between 15 and 34 years of age. Am Heart J. 2000;139(4):723-8.
Stephen Hedley J, Phelan D. Athletes and the Aorta: Normal Adaptations and the Diagnosis and Management of Pathology. Curr Treat Options Cardiovasc Med. 2017;19(11):88.
Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2398-405.
Chubb H, Simpson JM. The use of Z-scores in paediatric cardiology. Ann Pediatr Cardiol. 2012;5(2):179-84.
Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2398-2405. doi: 10.1016/j.jacc.2015.09.039. Epub 2015 Nov 2. PMID: 26542664.
