CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Familial Thoracic Aortic Aneurysm or Unexplained Thoracic Aortic Aneurysm

Unexplained thoracic aortic aneurysm (TAA) or familial TAA syndrome

Or known mutation leading to familial TAA syndrome (ACTA2, MYH11, FBN1, TGFBR1, TGFBR2, MLCK, SMAD3, TGFB2, and others)

Need to perform:

"Athletes with unexplained TAA, familial TAA syndrome, or known pathogenic mutation leading to a familial TAA syndrome (ACTA2, MYH11, FBN1, TGFBR1, TGFBR2, MLCK, SMAD3, TGFB2, and others) should undergo echocardiographic and (depending on the diagnosis) MRA or CT surveillance every 6 to 12 months to evaluate for progression of aortic or branch vessel disease."

(Class I Recommendation; Level of Evidence C)

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Participation criteria

"It is reasonable for athletes with an unexplained TAA, familial TAA syndrome, or known pathogenic mutation leading to familial TAA syndrome (ACTA2, MYH11, FBN1, TGFBR1, TGFBR2, MLCK, SMAD3, TGFB2, and others) to participate in low static, low dynamic competitive sports (class IA) if they do not have ≥1 of the following :

Aortic root dilatation (ie, score >2, or aortic diameter >40 mm, or >2 standard deviations from the mean relative to BSA for children and adolescents < 15 years old)
Moderate to severe mitral regurgitation
Family history of aortic dissection
Cerebrovascular disease
Branch vessel aneurysm or dissection"

Class IA = reasonable, if patient has none of the above findings.

(Class IIa Recommendation; Level of Evidence C)

"Athletes with Marfan syndrome, familial TAA syndrome, Loeys-Dietz syndrome, unexplained aortic aneurysm, vascular Ehlers-Danlos syndrome, or a related aortic aneurysm disorder should not participate in any competitive sports that involve intense physical exertion or the potential for bodily collision."

No sports that involve intense physical exertion or potential for bodily collision.

(Class III Recommendation; Level of Evidence C)

Reference: Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force . A Scientific Statement From the AHA and ACC. Circulation 2015

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