Abstract
BACKGROUND: Care for athletes with congenital heart disease (CHD) is challenging owing to limited evidence to guide participation decisions. We present a case regarding return-to-play recommendations in a triathlete with CHD. CASE SUMMARY: A 22-year-old triathlete with repaired D-transposition of the great arteries and supravalvular pulmonary stenosis presented with dyspnea during competition. Imaging revealed moderate right ventricular enlargement, moderate pulmonic regurgitation, a dilated neo-aortic root, and a reimplanted left anterior descending coronary artery with high-risk anatomic features. Multidisciplinary review determined that the coronary and aortic abnormalities posed prohibitive risk for competitive triathlon participation. Through shared decision-making, the athlete elected to retire from triathlon. DISCUSSION: Contemporary sports cardiology guidelines emphasize a multistep and multidisciplinary approach to participation assessment in athletes with CHD and encourage engaging in shared decision-making when providing recommendations. TAKE-HOME MESSAGE: Care for athletes with CHD requires collaborative, patient-centered decision-making involving the patient, medical team, and relevant stakeholders.