The Preparticipation Sports Examination of Healthy Children: When Should be Referred to Pediatric Cardiologist?

ABS TRACT Objective: Sudden cardiac death (SCD) that may occur during sports activation of young healthy athletes is a painful condition and impose responsibilities on both families and physicians. Although, there is not an established standard protocol in medical screening of sports preparticipation, any of the screening procedure cannot completely rule out the presence of cardiovascular disease and prevent from SCD. The aim of this study is to evaluate the frequency of cardiac anomalies in healthy children evaluated by electrocardiography (ECG) and transthoracic echocardiography before sports participation and to question the necessity of pediatric cardiologist evaluation in the light of the available data. Material and Methods: All children who were admitted to Pediatric Cardiology Department of Keçiören Training and Research Hospital to get certificate to conform sports activation and underwent cardiac examination, ECG and echocardiography between October 2018 and October 2019 were enrolled in the study and findings were evaluated retrospectively. Results: A total of 785 children and adolescents with median age of 12 (minumum 5-maximum 18) years were enrolled in the study in one year period. A total of 27 (3.4%) participants showed abnormal findings on physical examination. ECG abnormalities were detected in 48 (6.1%) participants. Structural cardiac anomalies were observed in 53 (6.7%) participants by echocardiography. None of the echocardiographic diagnoses were hemodynamically significant. Conclusion: Echocardiography allows to diagnose cardiomyopathies or hemodynamically significant structural heart diseases which lead to decision of sports disqualification. However, in such a case, symptoms and ECG abnormalities may occur earlier and may be a guide for physicians for further examination. Comprehensive cardiac evaluation by a pediatric cardiologist including echocardiography should be performed in patients with suspected personal and family history, pathological findings in physical examination and/or pathological ECG findings.