Triathlete With Repaired D-Transposition of the Great Arteries and Anterior Left Anterior Descending Coronary Artery Takeoff.

BACKGROUND

Care for athletes with congenital heart disease (CHD) is challenging owing to limited evidence to guide participation decisions. We present a case regarding return-to-play recommendations in a triathlete with CHD.

CASE SUMMARY: A 22-year-old triathlete with repaired D-transposition of the great arteries and supravalvular pulmonary stenosis presented with dyspnea during competition. Imaging revealed moderate right ventricular enlargement, moderate pulmonic regurgitation, a dilated neo-aortic root, and a reimplanted left anterior descending coronary artery with high-risk anatomic features. Multidisciplinary review determined that the coronary and aortic abnormalities posed prohibitive risk for competitive triathlon participation. Through shared decision-making, the athlete elected to retire from triathlon.

DISCUSSION: Contemporary sports cardiology guidelines emphasize a multistep and multidisciplinary approach to participation assessment in athletes with CHD and encourage engaging in shared decision-making when providing recommendations.

TAKE-HOME MESSAGE: Care for athletes with CHD requires collaborative, patient-centered decision-making involving the patient, medical team, and relevant stakeholders.