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eComment: Cardiovascular screening of the young competitive athletes before participating in sports

Bursa Yüksek Ihtisas Education and Research Hospital, Bursa 16330, Turkey

Acute aortic dissection occurring during the butterfly stroke in a 12-year-old boy

In the young competitive athletes, acute aortic dissection is a rare and catastrophic disorder. The intrinsic developmental abnormalities and secondary hemodynamic changes may lead to degeneration of the aortic wall resulting in aortic dissection. A complete cardiovascular screening may be necessary to reveal possible lethal abnormalities that may predispose the young children and adolescents to athletic field catastrophes. Individuals at high-risk for aortic dissection may show the physical features of the Marfan syndrome such as tall height and long extremities. As reported by Uchida et al. [1], however, acute aortic dissection may arise without any predisposing factors in a young child athlete.

The occurrence of an unexpected life-threatening event in studentathletes due to unsuspected cardiovascular disease has aroused concern of the public and medical community [2]. Therefore, pre-participation cardiovascular screening may play a role in stimulating considerable interest in such catastrophes. The aims of the pre-participation examination are to detect conditions that may predispose to injury, disability or death, meet legal and insurance requirements, establish the general health of the athlete, provide counsel on health-related issues, and assess the athlete's fitness for specific sports [3]. On the basis of the available evidence coming from the 25 years Italian experience, pre-participation cardiovascular screening consists of complete personal and family history, physical examination, and 12-lead electrocardiogram in the young competitive athletes [4].

Multiple disciplines including family physician, cardiologist, cardiovascular and orthopedic surgeons, ophthalmologist, and genetic and sports medicine specialists are in charge of care. Parents and athletes should be made aware that pre-participation cardiovascular screening cannot always prevent fatal incidents during sports activity.

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1. Uchida K, Imoto K, Yanagi H, Date K. Acute aortic dissection occurring during the butterfly stroke in a 12-year-old boy. Interact CardioVasc Thorac Surg 2009;9:366–368.[Abstract/Free Full Text]
2. Pfister GC, Puffer JC, Maron BJ. Preparticipation cardiovascular screening for US collegiate student-athletes. J Am Med Assoc 2000;283:1597–1599.[Abstract/Free Full Text]
3. Mick TM, Dimeff RJ. What kind of physical examination does a young athlete need before participating in sports? Cleve Clin J Med 2004;71:587–597.[Abstract/Free Full Text]
4. Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus statement of the study group of sport 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;26:516–524.[Abstract/Free Full Text]

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