Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
INTRODUCTION:
Ebstein’s anomaly (EA) is a rare congenital defect involving malformation of the heart’s tricuspid valve. EA is associated with other congenital heart defects as well as increased risk of cardiac arrhythmia. This makes its identification especially important in athletes, as it could lead to sudden cardiac death. In this case, a young professional soccer player was found to have EA with WPW. Our goal is to highlight the appropriate work-up and subsequent treatment and follow-up of a competitive athlete with Ebstein’s Anomaly.
CASE REPORT:
A 20-year-old male professional soccer player received a preparticipation EKG and physical and was noted to have a ⅙ holosystolic ejection murmur over the tricuspid listening post. EKG was consistent with changes of an athletic heart, but Echocardiogram was ordered to further evaluate the murmur. Echocardiogram showed findings highly suggestive of an ASD with a mildly enlarged right ventricle and mild tricuspid regurgitation. Given these findings, there was a high clinical suspicion for EA. Cardiac MRI, cardiopulmonary stress testing, and Holter monitor were ordered to further risk stratify the patient. Cardiac MRI noted a stretched PFO v. ASD with predominantly left to right shunting and apical displacement of the septal leaflet of the tricuspid valve. Cardiopulmonary stress testing and Holter monitor showed no evidence of arrhythmia. At that time, the player was allowed to participate without any restrictions. The following year, the player returned for pre-participation physical exam, at which time his EKG was noted to be abnormal with pre-excitation suggestive of WPW. He was referred to Electrophysiology for further evaluation. The player underwent EP mapping and was noted to have two low-risk accessory pathways, which were subsequently ablated. Post ablation, the player was held from any physical exertion for 72 hours to allow the catheterization site to heal. He was then slowly reintroduced to full team activities over a period of 4 weeks without any issues. EKG done one-month post ablation showed no further pre-excitation.
DISCUSSION:
Ebstein’s anomaly is described as abnormal tricuspid valve development in which the septal and posterior leaflets of the tricuspid valve are displaced inferiorly into the right ventricle, leading to “atrialization” of the right ventricle. Echocardiogram is commonly used to diagnose EA. Risk stratification is important with these patients as EA can be associated with other congenital cardiac malformations and arrhythmia. EKG, Holter monitor, cardiopulmonary stress testing, and more advanced imaging studies are commonly used to further risk stratify these patients. Return-to-play guidelines for EA are dependent on the severity of the condition. Patients with no right heart enlargement, cyanosis, or arrhythmia are usually allowed to fully participate in all sports without restrictions. If patients have moderate symptoms but no findings of arrhythmia on ambulatory EKG, they can participate in low-intensity competitive sports with minimal restrictions. Patients with severe tricuspid valve dysfunction or recurrent arrhythmias are to avoid competitive sports and may need surgical intervention or ablation.
CONCLUSION:
This case provides useful clinical information to aid physicians in diagnosing and managing patients, including professional athletes, with Ebstein’s Anomaly.
Embargo Period
6-25-2024
Included in
Ebstein’s Anomaly in a Professional Soccer Player: A Case Report
Suwanee, GA
INTRODUCTION:
Ebstein’s anomaly (EA) is a rare congenital defect involving malformation of the heart’s tricuspid valve. EA is associated with other congenital heart defects as well as increased risk of cardiac arrhythmia. This makes its identification especially important in athletes, as it could lead to sudden cardiac death. In this case, a young professional soccer player was found to have EA with WPW. Our goal is to highlight the appropriate work-up and subsequent treatment and follow-up of a competitive athlete with Ebstein’s Anomaly.
CASE REPORT:
A 20-year-old male professional soccer player received a preparticipation EKG and physical and was noted to have a ⅙ holosystolic ejection murmur over the tricuspid listening post. EKG was consistent with changes of an athletic heart, but Echocardiogram was ordered to further evaluate the murmur. Echocardiogram showed findings highly suggestive of an ASD with a mildly enlarged right ventricle and mild tricuspid regurgitation. Given these findings, there was a high clinical suspicion for EA. Cardiac MRI, cardiopulmonary stress testing, and Holter monitor were ordered to further risk stratify the patient. Cardiac MRI noted a stretched PFO v. ASD with predominantly left to right shunting and apical displacement of the septal leaflet of the tricuspid valve. Cardiopulmonary stress testing and Holter monitor showed no evidence of arrhythmia. At that time, the player was allowed to participate without any restrictions. The following year, the player returned for pre-participation physical exam, at which time his EKG was noted to be abnormal with pre-excitation suggestive of WPW. He was referred to Electrophysiology for further evaluation. The player underwent EP mapping and was noted to have two low-risk accessory pathways, which were subsequently ablated. Post ablation, the player was held from any physical exertion for 72 hours to allow the catheterization site to heal. He was then slowly reintroduced to full team activities over a period of 4 weeks without any issues. EKG done one-month post ablation showed no further pre-excitation.
DISCUSSION:
Ebstein’s anomaly is described as abnormal tricuspid valve development in which the septal and posterior leaflets of the tricuspid valve are displaced inferiorly into the right ventricle, leading to “atrialization” of the right ventricle. Echocardiogram is commonly used to diagnose EA. Risk stratification is important with these patients as EA can be associated with other congenital cardiac malformations and arrhythmia. EKG, Holter monitor, cardiopulmonary stress testing, and more advanced imaging studies are commonly used to further risk stratify these patients. Return-to-play guidelines for EA are dependent on the severity of the condition. Patients with no right heart enlargement, cyanosis, or arrhythmia are usually allowed to fully participate in all sports without restrictions. If patients have moderate symptoms but no findings of arrhythmia on ambulatory EKG, they can participate in low-intensity competitive sports with minimal restrictions. Patients with severe tricuspid valve dysfunction or recurrent arrhythmias are to avoid competitive sports and may need surgical intervention or ablation.
CONCLUSION:
This case provides useful clinical information to aid physicians in diagnosing and managing patients, including professional athletes, with Ebstein’s Anomaly.
Comments
Presented by Eldad Saler.