English

D Bolognesi,M Bolognesi,P Barbier

doi:10.13172/2052-0077-2-3-553

Abstract

A 43-year-old man, who was an elite triathlete, was referred to our sports medical centre for pre-participation screening and abilitation in the triathlon competition. This athlete has been active in racing triathlon and long distance cycling competitions for the last 10 years. His family history revealed no known congenital or other cardiovascular disease and no known causes of premature sudden cardiac death among close relatives. He had no relevant past medical history and physical examination was unremarkable. Peripheral blood pressure was 110/70 mmHg. Resting 12-lead electrocardiogram showed a sinus bradycardia and incomplete right bundle block. The cycloergometre and treadmill maximal exercise test showed a good performance and absence of any electrocardiographic abnormality, with a peak cycling workload of 330 watt, 15 METS on the treadmill Astrand protocol and a maximal heart rate of 165–170 bpm. Twodimensional trans-thoracic echocardiogram demonstrated a left atrium divided into two compartments by an incomplete membrane appearing in an incomplete thin diaphragm in all echocardiographic windows (Figures 1, 2 and 3). The mitral valve appeared slightly dysplastic with mild regurgitation. Pulmonary artery pressure was estimated to be 25 mmHg. Hence, the filling pressure was not elevated and the athlete was asymptomatic. Suspected diagnosis of nonobstructive cor triatriatum sinister was performed. Subsequently, a two-dimensional echocardiogram

Highlights

The literature reports very few cases of cor triatriatum in the general population and very rare cases of cor triatriatum in competitive athletes
Twodimensional trans-thoracic echocardiogram demonstrated a left atrium divided into two compartments by an incomplete membrane appearing in an incomplete thin diaphragm in all echocardiographic windows (Figures 1, 2 and 3)
Cor triatriatum sinister can be characterised as follows: (1) asymptomatic, (2) an isolated finding with a large, non-restrictive communication between the superior and inferior left atrial chambers or (3) associated with minor congenital defects such as patent foramen ovale, atrial septal defect or persistent left superior vena cava[7]. This case demonstrates the increasingly frequent presence of adults with congenital heart disease that is compatible with competitive sports and signifies the importance of sports pre-participation screening

Summary

Conclusion

This case demonstrates the increasingly frequent presence of adults with congenital heart disease that is compatible with competitive sports and signifies the importance of sports pre-participation screening. The advent of the widespread use of cardiovascular imaging in the evaluation of cardiac disease may explain the rise in the frequency of cor triatriatum diagnosis. It follows that the open questions for further research are: (1) should echocardiography be considered as a second-level examination or should it be routinely performed in sports pre-participation screening?; (2) what further assessments must be conducted in this athlete?; and (3) should GUCH (an adult born with congenital heart disease) with no apparent signs of functional impair-. A copy of the written consent is available for review by the Editor-in-Chief of this journal

Introduction

Discussion