CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: ASD, VSD, PDA

ASD, unrepaired
ASD, unrepaired
Need to know:
- Pulmonary hypertension?
⬋

⬊

No pulmonary hypertension

"It is recommended that athletes with small defects (< 6 mm), normal right-sided heart volume, and no pulmonary hypertension should be allowed to participate in all sports (Class I Recommendation; Level of Evidence C)."

"It is recommended that athletes with a large ASD and no pulmonary hypertension should be allowed to participate in all sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Pulmonary hypertension

"Athletes with an ASD and pulmonary hypertension may be considered for participation in low-intensity class IA sports."

"Athletes with associated pulmonary vascular obstructive disease who have cyanosis and a large right-to-left shunt should be restricted from participation in all competitive sports, with the possible exception of class IA sports (Class III Recommendation; Level of Evidence C)."

May consider Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga

(Class I Recommendation; Level of Evidence C)
ASD, s/p closure
ASD, s/p surgical or cath closure
Need to know:
- How long since repair
- Pulmonary hypertension?
- Myocardial dysfunction?
- Arrhythmias?
⬋

⬊

Repair 3-6 months ago and none of above issues

"Three to 6 months after operation or intervention, athletes without pulmonary hypertension, myocardial dysfunction, or arrhythmias may participate in all sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Pulmonary hypertension, arrhythmia, or myocardial dysfunction

"After operation or intervention, patients with pulmonary hypertension, arrhythmias, or myocardial dysfunction may be considered for participation in low-intensity class IA sports."

May consider Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga

(Class IIb Recommendation; Level of Evidence C)
VSD, unrepaired
VSD, unrepaired
Need to know:
- Size of VSD, hemodynamic significance
- Pulmonary hypertension?
⬋

⬊

Small VSD & no pulmonary hypertension

"An athlete with a small or restrictive VSD with normal heart size and no pulmonary hypertension can participate in all sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Large VSD and/or pulmonary hypertension

"An athlete with a large, hemodynamically significant VSD and pulmonary hypertension may consider participation in only low-intensity class IA sports."

May consider only Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga

(Class IIb Recommendation; Level of Evidence C)
VSD, s/p closure
VSD, s/p surgical or cath closure
Need to know:
- How long since repair
- Pulmonary hypertension?
- Myocardial dysfunction?
- Arrhythmias?
⇙

⇓

⇘

Repair 3-6 months ago and none of above issues

"At 3 to 6 months after repair, asymptomatic athletes with no or a small residual defect and no evidence of pulmonary hypertension, ventricular or atrial tachyarrhythmia, or myocardial dysfunction can participate in all competitive sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Pulmonary hypertension or myocardial dysfunction

"Athletes with persistent pulmonary hypertension should be allowed to participate in class IA sports only (Class I Recommendation; Level of Evidence B)."

"Athletes with mild to moderate pulmonary hypertension or ventricular dysfunction should not participate in competitive sports, with the possible exception of low-intensity class IA sports."

May consider Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga

(Class III Recommendation; Level of Evidence C)

Sympatomatic tachyarrhythmia, or 2nd/3rd degree AV block

"Athletes with symptomatic atrial or ventricular tachyarrhythmias or second- or third-degree atrioventricular block should not participate in competitive sports until further evaluation by an electrophysiologist."

No competitive sports until evaluation by EP

(Class III Recommendation; Level of Evidence C)
PDA, unrepaired
PDA, unrepaired
Need to know:
- PDA size
- Pulmonary hypertension?
- LV size
⇙

⇓

⇘

Small, no pulmonary hypertension, normal LV size

"Athletes with a small PDA, normal pulmonary artery pressure, and normal left-sided heart chamber dimension can participate in all competitive sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Moderate-large PDA and pulmonary hypertension

"Athletes with a moderate or large PDA and persistent pulmonary hypertension should be allowed to participate in class IA sports only."

May consider only Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga

(Class I Recommendation; Level of Evidence B)

Moderate-large PDA and LV enlargement

"Athletes with a moderate or large PDA that causes left ventricular (LV) enlargement should not participate in competitive sports until surgical or interventional catheterization closure."

No competitive sports until surgical or percutaneous closure

(Class III Recommendation; Level of Evidence C)
PDA, s/p closure
PDA, s/p surgical or cath closure
Need to know:
- Pulmonary hypertension?
⬋

⬊

No pulmonary hypertension

"After recovery from catheter or surgical PDA closure, athletes with no evidence of pulmonary hypertension can participate in all competitive sports."

All Sports = Acceptable

(Class I Recommendation; Level of Evidence C)

Pulmonary hypertension

"Athletes with residual pulmonary artery hypertension should be restricted from participation in all competitive sports, with the possible exception of class IA sports."

Class IA sports: Bowling, Cricket, Curling, Golf, Riflery, Yoga = Possibly ok

(Class I Recommendation; Level of Evidence B)

ASD, unrepaired

ASD, s/p surgical or cath closure

VSD, unrepaired

VSD, s/p surgical or cath closure

PDA, unrepaired

PDA, s/p surgical or cath closure