Athlete’s Heart with a Systemic Right Ventricle?

Objective: High load of regularly vigorous exercise leads to multiple physiological adaptations. The major cardiovascular effects are hypertrophy and dilation, predominantly of the left ventricle, and bradycardia. However, there are no reports on an athlete’s heart in a systemic right ventricle.

Subject: We report on a 23 year old male endurance athlete (177cm, 69kg) with a systemic subaortic right ventricle after atrial redirection (Senning procedure) for simple transposition of the great arteries in infancy. Albeit medical doctors had imposed activity restriction to him, he has lead an active lifestyle from early childhood on, intensifying his sport activities over the years especially in cycling and running to a training volume of about 10 hours per week in winter and about 15 hours per week in summer. In 2009 he performed 1:50h on the half marathon distance. In 2013 he finished his first Marathon in 4:34h.

Results: Cardiopulmonary exercise testing revealed a maximum oxygen uptake of 52.3ml/min/kg and a peak work load of 353 Watt, corresponding to 5.1Watt per kilogram body mass. Cardiovascular Magnetic Resonance showed a cardiac index of 2.9ml/min/m², a tricuspid regurgitation fraction of 4%, and a systemic right ventricle end-diastolic volume of 109ml/m² with an ejection fraction of 53%.

Conclusions: With regular exercise training a systemic right ventricle can become very efficient comparable to healthy amateur athletes.