Abstract
BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: Dressage is unlikely to contribute to aortic root progression in genetically predisposed athletes. TAKE-HOME MESSAGE: 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.