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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease

Cantinotti, Massimiliano, MD*,†; Giordano, Raffaele, MD*,‡; Assanta, Nadia, MD*; Murzi, Bruno, MD*; Melo, Manuel, MD*; Franchi, Eliana, MD*; Crocetti, Maura, MD*; Iervasi, Giorgio, MD*,†; Kutty, Shelby, MD§

Clinical Journal of Sport Medicine: November 2018 - Volume 28 - Issue 6 - p 540–560
doi: 10.1097/JSM.0000000000000474
General Review

Objective: Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk–benefit ratio of sport participation versus restriction.

Data source: A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria.

Main Results: Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated.

Conclusions: Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.

*Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy;

Institute of Clinical Physiology, Pisa, Italy;

Department of Advanced Biomedical Sciences, University of Naples Federico II; and

§University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, Nebraska.

Corresponding Author: Raffaele Giordano, MD, Fondazione Toscana Gabriele Monasterio, Massa 54100, Italy (

The authors report no conflicts of interest.

Received April 22, 2016

Accepted November 16, 2016

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