Aortic Root Dilation in a Masters Dressage Athlete With Familial TAAD

Familial thoracic aortic aneurysm and dissection is a genetic condition frequently presenting without syndromic features or early symptoms, and it often warrants restrictive sports advice.

A masters dressage rider presented with palpitations and atypical thoracic discomfort. Cardiac magnetic imaging revealed an aortic root of 47 mm. Genetic testing confirmed a pathogenic class V LTBP3 variant consistent with familial thoracic aortic aneurysm and dissection. Although prophylactic surgery was considered given subsequent growth to 49 mm, continued surveillance was chosen after shared decision-making, as the aortic root diameter did not reach the surgical threshold and remained stable during 5 years of follow-up. The patient competed in multiple international competitions, without evidence of accelerated root growth.

Dressage is unlikely to contribute to aortic root progression in genetically predisposed athletes.

In athletes, decisions about timing of intervention should consider sport-specific hemodynamic demands and force distribution, aortic dimensions and growth, symptom burden, and athlete ambitions and goals.