Differentiating Cardiac (Mal)adaptation in 2 Athletes With Bicuspid Aortic Valves

Abstract

Background: Distinguishing left ventricular (LV) remodeling due to early decompensation from chronic aortic regurgitation (AR) from physiologic adaptation to intensive endurance training is challenging. Case Summary: Two elite endurance athletes (and best friends) presented with bicuspid aortic valves complicated by moderate AR and marked LV remodeling. Despite near-identical valvular findings, LV volumes, and exceptional cardiorespiratory fitness at baseline, their clinical courses diverged. One developed exertional symptoms and underwent a Ross procedure, followed by rapid and profound reverse remodeling. The other remained asymptomatic with stable LV dimensions and supranormal exercise ca..