Bicuspid Aortic Valve Aortopathy in an Athlete

BACKGROUND: Bicuspid aortic valve (BAV) is a common congenital condition associated with progressive aortopathy and remains a frequent justification for sporting restriction despite limited data on exercise-related aortic events. CASE SUMMARY: An asymptomatic 18-year-old athlete undergoing evaluation for military service was discovered to possess a type-1 BAV, accompanied by a dilated aortic root (4.2-4.3 cm), with trivial to mild aortic regurgitation. Serial imaging demonstrated rapid progression of aortic dilatation to 4.7 cm. Such findings posed significant implications for military eligibility and athletic participation. Consequently, given long-term aspirations for athletic and military participation, a valve-sparing aortic root replacement was performed. REVIEW SUMMARY: BAV-associated aortopathy in athletes requires a personalized risk assessment, careful surveillance, and shared decision-making. Despite conservative historical guidelines, the risk of exercise-related aortic dissection is low, and individualized management, including prompt surgical intervention, may allow safe return to athletic participation. TAKE-HOME MESSAGES: Bicuspid aortic valve aortopathy is a distinct pathological process that may be complicated by physiologic athletic remodeling. Decisions on participation should adhere to established dimensional thresholds and guidelines, while being personalized within a shared decision-making framework and risk stratification. Following surgical intervention, a gradual, supervised return-to-play strategy, guided by postoperative imaging stability and multidisciplinary input, is necessary to ensure the safe resumption of athletic participation.