Working Diagnosis:
Bicuspid aortic valve, Aortic valve regurgitation

Treatment:
Patient was referred to a cardiothoracic surgeon where it was determined that he does not require surgical treatment.

Outcome:
Patient was given a full clearance for sports participation. Patient should undergo yearly history, physical examination and Doppler echocardiogram

Author's Comments:
Chronic aortic valve regurgitation is often undiagnosed until patients become symptomatic. Once symptoms develop, mortality rate increases up to 10-20% per year. Early detection of disease allows for close surveillance of a progression of valvular dysfunction and associated comorbidities, allowing earlier surgical intervention and likely greater patient health outcomes. Unfortunately, young adults rarely receive preventative care due to challenges encountered while transitioning from pediatric care to adult health systems. This case depicts the importance of preparticipation examination in screening for congenital valvular heart disease in a young adult population that may otherwise not seek preventative care. During preparticipation examination diseases and illnesses can be diagnosed early and provide patients the opportunity to take control of their health at an earlier age, leading to better health outcomes

Editor's Comments:
The common causes of chronic Aortic Regurgitation include bicuspid aortic valve disease, congenital connective tissues disorders such as Marfan syndrome, rheumatic heart disease, and idiopathic or hypertensive dilation of the ascending aorta. Chronic AR is usually asymptomatic and well tolerated for years, but when severe, it produces a gradual increase in LV dimensions. The diagnosis during the asymptomatic stages of AR (stages B and C) is suggested on physical examination by a wide arterial pulse pressure, a diastolic murmur heard along the sternal border, or a systolic outflow murmur related to the increased forward stroke volume. Doppler echocardiography is useful in confirming the diagnosis and grading the severity of AR. Athletes with AR should undergo a yearly history and physical examination with Doppler echocardiography. Exercise testing to at least the level of activity achieved in competition and the training regimen is helpful in confirming asymptomatic status and assessing blood pressure responses. Patients with AR often have underlying bicuspid aortic valves. It is important to also assess the morphology of the aortic root and ascending aorta to rule out associated aortopathy in these patients. Athletes with a bicuspid aortic valve can participate in all competitive athletics if the aortic root and ascending aorta are not dilated. The function of the bicuspid aortic valve (whether stenotic or regurgitant) is also important in determining recommendations for participation.

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