Noncritical Aortic Stenosis in Two Men Unable to Quit Running Marathons—Well, One Quit

To the Editor.  —Jogging has become part of a way of life thought to promote health.¹ We describe unfavorable outcomes in two patients with noncritical aortic valve stenosis who did not give up their endurance exercise despite warnings from their physicians.

Report of Cases.—Case 1.  —As an 11-year-old boy, the patient had a successful commissurotomy for congenital aortic valve stenosis, after which he was told to avoid severe exertion. At age 18 years, his clinical signs and echocardiography suggested only insignificant residual stenosis and regurgitation of the aortic valve. Electrocardiogram was normal. At age 20 years, he started jogging daily, running between 120 and 210 km a week. One year later he completed a marathon race without symptoms.At 22 years of age, he was still asymptomatic. The electrocardiogram showed gross left ventricular hypertrophy. Ultrasonography revealed a fibrotic aortic valve with a peak systolic gradient of 29 mm Hg