Aortic regurgitation in athletes. Pieces of the puzzle we have so far omitted

The prevalence of valvular heart disease (VHD) rises with age, reaching 11.7% in individuals older than 75 years.1 In young individuals, VHD is usually related to the presence of a congenital valve abnormality, as bicuspid aortic valve (BAV) or mitral valve prolapse. This is also the case for athletes, where in the presence of these abnormalities few restrictions exist in eligibility for competitive sports participation, even if a strict follow-up would be desirable. BAV is the most common congenital valve abnormality (1%) found in the general population and in athletes. BAV is more prevalent in males and it can lead to aortic regurgitation (AR), aortic stenosis and/or aortic root dilation. At present, no definitive studies have proved that intensive sports participation could worsen the progression of BAV and limited data are available on athletes.