[Korzun]

Task Force 4: Congenital Heart Disease

Atrial Septal Defect
ASD: Untreated
Recommendations
1. It is recommended that athletes with small defects (<6 mm), normal right-sided heart volume, and no pulmonary hypertension should be allowed to participate in all sports (Class I; Level of Evidence C).
2. It is recommended that athletes with a large ASD and no pulmonary hypertension should be allowed to participate in all sports (Class I; Level of Evidence C).
3. Athletes with an ASD and pulmonary hypertension may be considered for participation in low-intensity class IA sports (Class I; Level of Evidence C).
4. Athletes with associated pulmonary vascular obstructive disease who have cyanosis and a large right-to-left shunt should be restricted from participation in all competitive sports, with the possible exception of class IA sports (Class III; Level of Evidence C).
ASD: After Surgical Repair or Closure by Interventional Catheterization
Recommendations
1. Three to 6 months after operation or intervention, athletes without pulmonary hypertension, myocardial dysfunction, or arrhythmias may participate in all sports (Class I; Level of Evidence C).
2. After operation or intervention, patients with pulmonary hypertension, arrhythmias, or myocardial dysfunction may be considered for participation in low-intensity class IA sports (Class IIb; Level of Evidence C).

Ventricular Septal Defect
VSD: Untreated
Recommendations
1. An athlete with a small or restrictive VSD with normal heart size and no pulmonary hypertension can participate in all sports (Class I; Level of Evidence C).
2. An athlete with a large, hemodynamically significant VSD and pulmonary hypertension may consider participation in only low-intensity class IA sports (Class IIb; Level of Evidence C).
VSD: After Surgical Repair or Closure by Interventional Catheterization
Recommendations
1. At 3 to 6 months after repair, asymptomatic athletes with no or a small residual defect and no evidence of pulmonary hypertension, ventricular or atrial tachyarrhythmia, or myocardial dysfunction can participate in all competitive sports (Class I; Level of Evidence C).
2. Athletes with persistent pulmonary hypertension should be allowed to participate in class IA sports only (Class I; Level of Evidence B).
3. Athletes with symptomatic atrial or ventricular tachyarrhythmias or second- or third-degree atrioventricular block should not participate in competitive sports until further evaluation by an electrophysiologist (Class III; Level of Evidence C).
4. Athletes with mild to moderate pulmonary hypertension or ventricular dysfunction should not participate in competitive sports, with the possible exception of low-intensity class IA sports (Class III; Level of Evidence C).

Patent Ductus Arteriosus
PDA: Untreated
Recommendations
1. Athletes with a small PDA, normal pulmonary artery pressure, and normal left-sided heart chamber dimension can participate in all competitive sports (Class I; Level of Evidence C).
2. Athletes with a moderate or large PDA and persistent pulmonary hypertension should be allowed to participate in class IA sports only (Class I; Level of Evidence B).
3. Athletes with a moderate or large PDA that causes left ventricular (LV) enlargement should not participate in competitive sports until surgical or interventional catheterization closure (Class III; Level of Evidence C).
PDA: Treated (After Surgical Repair or Closure by Interventional Catheterization)
Recommendations
1. After recovery from catheter or surgical PDA closure, athletes with no evidence of pulmonary hypertension can participate in all competitive sports (Class I; Level of Evidence C).
2. Athletes with residual pulmonary artery hypertension should be restricted from participation in all competitive sports, with the possible exception of class IA sports (Class I; Level of Evidence B).

Pulmonary Valve Stenosis
Recommendations
1. Athletes with mild PS and normal RV function can participate in all competitive sports. Annual reevaluation is also recommended (Class I; Level of Evidence B).
2. Athletes treated by operation or balloon valvuloplasty who have achieved adequate relief of PS (gradient <40 mm Hg by Doppler) can participate in all competitive sports (Class I; Level of Evidence B).
3. Athletes with moderate or severe PS can consider participation only in low-intensity class IA and IB sports (Class IIb; Level of Evidence B).
4. Athletes with severe pulmonary insufficiency as demonstrated by marked RV enlargement can consider participation in low-intensity class IA and IB sports (Class IIb; Level of Evidence B).

Aortic Valve Stenosis
Recommendations
1. Athletes with mild AS can participate in all competitive sports (Class I; Level of Evidence B).
2. Athletes with severe AS can participate only in low-intensity class IA sports (Class I; Level of Evidence B).
3. Athletes with moderate AS may be considered for participation in low static or low to moderate dynamic sports (class IA, IB, and IIA) (Class IIb; Level of Evidence B).
4. Athletes with severe AS should be restricted from all competitive sports, with the possible exception of low-intensity (class IA) sports (Class III; Level of Evidence B).
AS After Surgery or Balloon Dilation
Recommendations
1. Athletes with residual AS may be considered for participation in sports according to the above recommendations based on severity (Class IIb; Level of Evidence C).
2. Athletes with significant (moderate or severe) aortic valve insufficiency may participate in sports according to the recommendation of Task Force 5 in this document (8).

Coarctation of the Aorta
Coarctation of the Aorta: Untreated
Recommendations
1. Athletes with coarctation and without significant ascending aortic dilation (z score ≤3.0; a score of 3.0 equals 3 standard deviations from the mean for patient size) with a normal exercise test and a resting systolic blood pressure gradient <20 mm Hg between the upper and lower limbs and a peak systolic blood pressure not exceeding the 95th percentile of predicted with exercise can participate in all competitive sports (Class I; Level of Evidence C).
2. Athletes with a systolic blood pressure arm/leg gradient >20 mm Hg or exercise-induced hypertension (a peak systolic blood pressure exceeding the 95th percentile of predicted with exercise) or with significant ascending aortic dilation (z score >3.0) may be considered for participation only in low-intensity class IA sports (Class IIb; Level of Evidence C).
Coarctation of the Aorta: Treated by Surgery or Balloon and Stent
Recommendations
1. Athletes who are >3 months past surgical repair or stent placement with <20 mm Hg arm/leg blood pressure gradient at rest, as well as (1) a normal exercise test with no significant dilation of the ascending aorta (z score <3.0), (2) no aneurysm at the site of coarctation intervention, and (3) no significant concomitant aortic valve disease, may be considered for participation in competitive sports, but with the exception of high-intensity static exercise (classes IIIA, IIIB, and IIIC), as well as sports that pose a danger of bodily collision (Class IIb; Level of Evidence C).
2. Athletes with evidence of significant aortic dilation or aneurysm formation (not yet at a size to need surgical repair) may be considered for participation only in low-intensity (classes IA and IB) sports (Class IIb; Level of Evidence C).

Elevated Pulmonary Vascular Resistance in CHD
Recommendations
1. Patients with mean pulmonary artery pressure of <25 mm Hg can participate in all competitive sports (Class I; Level of Evidence B).
2. Patients with moderate or severe pulmonary hypertension, with a mean pulmonary artery pressure >25 mm Hg, should be restricted from all competitive sports, with the possible exception of low-intensity (class IA) sports. Complete evaluation and exercise prescription (physician guidance on exercise training) should be obtained before athletic participation (Class III; Level of Evidence B).

Резюме.
Небольшие пороки (дефекты межпредсердной и межжелудочковой перегородок и открытый артериальный проток). Если маленькие и без симптомов и без нарушения функции, то можно во всех видах спорта. Если с нарушением функции и с симптомами, то спорт только класса низкой интенсивности 1A.
После операции через 3-6 месяцев, если нет симптомов и нарушения функции, то можно любым видом спорта. Если есть остаточные явления, то спорт только класса низкой интенсивности 1A.

Стеноз клапана легочной артерии. Если небольшой и без нарушения функции и если после операции или баллонирования с градиентом менее 40 мм рт.ст. то разрешены все виды спорта.
При средней и тяжелой степени можно рассмотреть возможность участия только в спортивных соревнованиях класса IA и IB с низкой интенсивностью.

Стеноз аортального клапана. Если легкая степень, то все виды, если тяжелая, то только 1А, если умеренная, то класс IA, IB и IIA. При тяжелой лучше без соревнований.
После операции/баллонирования в зависимости от тяжести остаточных явлений по принципу как без операции.

Коарктация аорты. При незначительной, если разница давления между руками и ногами менее 20 мм рт.ст и нормальный тест на нагрузку, то разрешены все виды. Если разница давления больше 20 мм рт.ст., при нагрузке гипертония и восходящая дилатация, то участие только в спортивных состязаниях класса низкой интенсивности IA.
После операции, если после 3 месяцев после операции разница давления рук и ног менее 20 мм рт.ст. и нормальный тест на нагрузку, то допустимы все виды. Если нет, то классы IA и IB.

Легочная гипертензия. При давлении в ЛА менее 25 мм рт.ст. допустимы любые виды, если давление выше, то нет.