Cuándo hablamos de válvula aórtica bicúspide (VAB) nos estamos refiriendo al defecto cardíaco congénito más común en los adultos. Se calcula que afecta al 1,3% de la población mundial. Aunque la estenosis aórtica y la regurgitación son las complicaciones más comunes de la VAB, la dilatación de alguno o todos los segmentos de la aorta proximal desde la raíz aórtica hasta el arco aórtico (llamada aortopatía bicúspide) puede observarse con frecuencia en los pacientes con VAB.
Cuando valoramos a deportistas con este hallazgo, debemos saber qué decisión tenemos que afrontar de cara a su futuro deportivo. Para ello nos debemos apoyar en diferentes aspectos: presencia de síntomas, capacidad funcional, tipo y gravedad de la enfermedad valvular, las alteraciones en la estructura y función del miocardio, la presión de la arteria pulmonar y el riesgo de arritmias.
Tenemos que apoyarnos siempre en bases científicas, y en concreto la American College of Cardiology/American Heart Association (AHA/ACC) indica que los individuos sintomáticos no deben participar en deportes de competición, independientemente de la gravedad de la enfermedad valvular. Si estamos ante un deportista asintomático, es obligatoria una cuidadosa evaluación clínica y personal para determinar la elegibilidad o descalificación para practicar deportes, ya que se trata de una decisión muy importante para el deportista y su entorno.
En el seguimiento de un deportista con VAB deberemos incluir periódicamente una ecocardiografía para evaluar la función de la válvula aórtica, las dimensiones de la aorta (incluido el arco aórtico) y el origen de las arterias coronarias. Recientemente se publicó las guías sobre cardiología deportiva y ejercicio de la Sociedad Europea de Cardiología donde se afirma que, en ausencia de aortopatía, las recomendaciones de ejercicio para las personas con VAB son idénticas a las de las personas con disfunción de la válvula aórtica tricúspide, es decir, limita mucho las restricciones a la práctica deportiva. Dependiendo de las dimensiones de la raíz aórtica, el tipo de aortopatía y el tipo de deporte practicado, se clasifican los deportistas como de bajo, bajo-intermedio, intermedio y alto riesgo, considerándose las actividades deportivas de competición (excepto los deportes de fuerza) sólo en los individuos de bajo riesgo.
Las recomendaciones actuales sugieren que los atletas con VAB sin complicaciones son elegibles para las competiciones, mientras que los que tienen VAB con complicaciones deberían tener la restricción a las competiciones deportivas según el grado de disfunción/dilatación. A pesar de la elegibilidad para las competiciones, es obligatorio un seguimiento estricto para controlar la posible aparición de disfunción o dilatación de la válvula aórtica.
La progresión de la enfermedad valvular se produce principalmente de forma independiente de la práctica deportiva, aunque existen preocupaciones sobre el impacto del entrenamiento regular en los pacientes con VAB, por lo que se aconseja un periódico análisis de las características de la válvula aórtica y la anatomía de la aorta para diferenciar entre los atletas que pueden competir y los que no. Aquí es importante el papel de la angiografía por resonancia magnética para evaluación de estos deportistas.
Se recomienda la profilaxis con antibióticos para la endocarditis, particularmente en aquellos que practican deportes de contacto que puedan crear heridas infectadas.
Si finalmente los deportistas precisan de cirugía (habitualmente por disfunción valvular grave, deterioro de la función ventricular, hipertensión pulmonar y arritmias), se debe aconsejar que se abstengan de practicar deportes competitivos. Tras una cirugía exitosa los deportistas pueden considerarse de riesgo bajo-intermedio y la elegibilidad para realizar deportes sigue la clasificación de riesgo. Por el contrario, si tras la cirugía quedan secuelas, los deportes están contraindicados.
A aquellos deportistas a los que se les implanta una prótesis biológica, que tengan una función valvular y del ventrículo izquierdo normal y con ritmo sinusal estable, se les puede aconsejar la realización de deportes dinámicos y estáticos bajos-moderados; sin embargo, si están en fibrilación auricular y anticoagulados, no deberían practicar deportes con riesgo de colisión corporal.
Por último, aquellos deportistas en los que se les implanta una prótesis metálica sin complicaciones, pueden también realizar deportes dinámicos y estáticos de baja a moderada intensidad, pero no se permiten los deportes de contacto debido al riesgo de hemorragia por anticoagulación.
Os dejo aquí el enlace para lectura completa de este artículo de revisión de un importante grupo italiano de cardiología del deporte:
REFERENCIA
Bicuspid aortic valve and sports: From the echocardiographic evaluation to the eligibility for sports competition [published online ahead of print, 2020 Dec 1].
- D’Ascenzi F, Valentini F, Anselmi F, et al.
- Scand J Med Sci Sports. 2020;10.1111/sms.13895. doi:10.1111/sms.13895
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