CARDIAC ABNORMALITIES IN YOUNG MALE ELITE HOCKEY PLAYERS PRESELECTED BY THE NATIONAL HOCKEY LEAGUE (NHL) : DETECTION BY SCREENING TRANATHORACIC ECHOCARDIOGRAPHY

S158 BACKGROUND:

Bicuspid aortic valves (BAV) are commonly classified according to the absence (type 0), presence of 1 (type 1) or 2 (type 2) raphes1. Type 1, however, encompasses a wide spectrum of anatomically distinct patterns that are addressed by different repair techniques depending on the behaviour of the raphe, the commissural orientation, the quantity of leaflet tissue and the dimensions of the ventricular-arterial junction (VAJ), among other characteristics. PURPOSE: To establish whether transesophageal echocardiography (TEE) correlates with the surgical findings that modulate the repair approach in BAV patients. METHODS: Pre-operative TEEs of 78 consecutive patients who underwent BAV repair/sparing at our institution between June 2010 and January 2015 were reviewed by one echocardiographer blinded to the surgical findings and procedures. Two surgeons, blinded to TEE data, reviewed the operative videos to determine the anatomical features of the diseased valves and describe the surgical techniques. In our center, type 0 and type 1 BAV with a complete, prolapsing raphe (type 1A) and excess tissue are repaired with free margin plication triangular resection. In symmetrical (commissural orientation 150 ) restrictive type 1 BAV (type 1B), central plication for gap closure and maintenance of bicuspid configuration is usually performed, while asymmetrical (120 ) BAV are considered for tricuspidization with patch, depending on the quantity of tissue. Root-replacement valve-sparing with reimplantation is chosen to stabilize the VAJ when the root is dilated, and subcommissural annuloplasty is used when root dimensions are normal. RESULTS: TEE correctly identified the raphe presence and behaviour (ie. prolapsing vs restrictive) determined at surgical inspection in 84.6% of cases (table). Tricupidization with commissural patch was performed in 4 cases, which had all been appropriately categorized as type 1B with asymmetrical (z120 ) orientation at TEE. Bicuspid configuration was restored in 5 asymmetrical type 1B BAV patients, in whom relatively large VAJ (mean 14.4 1.5 mm/m2) and sinuses of Valsalva (18.8 1.3 mm/m2) allowed sufficient tissue for bicuspid restoration after aortic root remodelling. CONCLUSION: TEE has the potential to accurately classify BAV according to specific structural and functional patterns that guide the surgical repair approach and that the currently accepted anatomical classifications of BAV do not take into account. REFERENCES:

1.Sievers HH, Schmidtke C. The Journal of thoracic and cardiovascular surgery. 2007;133(5):1226-33.

Canadian Journal of Cardiology Volume 31 2015

299 CARDIAC ABNORMALITIES IN YOUNG MALE ELITE HOCKEY PLAYERS PRESELECTED BY THE NATIONAL HOCKEY LEAGUE (NHL) : DETECTION BY SCREENING TRANATHORACIC ECHOCARDIOGRAPHY G Ong, V Evangelista, K Connelly, K Chan, C Chow Toronto, Ontario BACKGROUND:

Sudden deaths in young athletes are uncommon but devastating events. Many have underlying cardiovascular disease not diagnosed until after the event. Cardiac screening of athletes may reduce the risk of sudden death but its role remains controversial. The purpose of this study was to screen for cardiac abnormalities in young elite male hockey players who were the top draft choices for the National Hockey League (NHL). METHOD: In this prospectice cohort study, we performed comprehensive assessment of the top 100 or so top draft picks selected by the NHL from 2009 to 2014. The athletes were young men with a media nage of 19 years. The assessment included a focus history, physical examination, electrocardiogram and transthoracic echocardigram (echo). None had a history of cardiac disease. RESULTS: In total, 627 athletes were assessed. Abnormalities were identified in 18 (2.9%) subjects. The findings included : bicuspid aortic valves in 10 (1.6%), patent ductus arteriosus in 2 (0.3%), mildly reduced left ventricular systolic function (LVEF <50% by Simpson’s biplane method) in 2 (0.3%), a moderate size circumferentiel pericardial effusion 1 (0.2%), and a posterior mitral valve prolapse associated with mild mitral regurgitation in 1 (0.2%). All the biscuspid valve were functionally normal with no significant stenosis or regurgitation. None were found to have hypertrophic cardiomyopathy. All the significant findings were reported to the players’ physicians. No players had cardiac symptoms. One subject with left ventricular dysfunction was excluded from the draft. The player with pericardial effusion underwent a pericardiocentesis procedure. The incidences of these cardiac abnormalities differ slightly from those in previous reports. The incidence of bicuspid aortic valve in this study was slightly higher than the reported 0.8% in a young adult population. The incidence of asymptomatic patent ductus arteriosus in athletes is not precisely known, and its detection in our study may be due to the improved imaging capability of the current echo systems. CONCLUSION: In young male elite hockey players, bicuspid aortic valve is the most common cardiac abnormalities, as in the general population of the same age. Although rare, significant cardiac abnormalites can be present in these elite athletes, and screening by echo appears indicated in this population. 300 COMPARISON OF A NOVEL FREE BREATHING STEADY STATE FREE PRECESSION (SSFP) SEQUENCE WITH TRADITIONAL BREATH HELD SSFP IN THE QUALITATIVE ASSESSMENT OF LEFT VENTRICULAR FUNCTION I Roifman, R Walcarius, L Biswas, KA Connelly, GA Wright Toronto, Ontario