DEAR MAY CLINIC: I consider myself in good health. I exercise several times a week, but I recently started experiencing episodes of shortness of breath after going up and down the stairs in my house. After running on the treadmill a few weeks ago, I got dizzy and fainted. I went to my doctor who told me I have a bicuspid aortic valve. Can you share more information on what this is and if it can be fixed? Also, I have children. Are they at risk for this disease?
ANSWER: It may be a shock to receive a diagnosis that you have color condition. The good news is that you should be able to live a healthy and active lifestyle with proper care.
As a reminder, the heart has four main valves. The two valves on the left side of the heart are the aortic valve and the mitral valve, and the two valves on the right side are pulmonary valve and the tricuspid valve. The aortic valve is the main “gate” of the heart. Blood flows through the aortic valve to leave the heart and supplies oxygen and nutrients to the rest of the body.
The normal aortic valve has three leaflets, also known as cusps. Some people may be born with one, two, or even four cusps of the aortic valve. The most common of these abnormalities is an aortic valve with two cusps, hence a bicuspid aortic valve.
A bicuspid aortic valve is a common cardiovascular condition that affects approximately 1% of the general population. Bicuspid aortic valves are more common in men, but also affect women. A bicuspid aortic valve is a congenital condition, meaning people are born with two cusps instead of the normal three cusps of their aortic valve. Although bicuspid aortic valves can occur sporadically without a pattern of inheritance, the condition can also work in families. Many people can live with a bicuspid aortic valve for the rest of their lives, but there are people who may need their valve to be replaced or surgically repaired.
When people are born with a bicuspid aortic valve, the bicuspid valve usually works well throughout childhood and early adulthood. When people reach middle age, bicuspid aortic valves can begin to degenerate. Degeneration is normal for aortic valves as people age, but occurs at a younger age in bicuspid aortic valves compared to normal aortic valves.
Degeneration occurs in two forms: constipation, also known as stenosis; or filtration, also known as regurgitation. People do not feel any symptoms of bicuspid aortic valves until the narrowing or leakage becomes severe enough to affect cardiac function. At this time, people with bicuspid aortic valves may notice difficulty breathing, difficulty exercising, dizziness, or chest pain. Looks like what happened in your situation.
If heart function deteriorates significantly, people may develop heart failure, the symptoms of which are fluid retention, weight gain, inflammation of the legs, substantial breathing difficulty, and potentially even syncope, which means to pass.
Healthcare providers often diagnose bicuspid aortic valves with an ultrasound of the heart called an echocardiogram. Computed tomography and magnetic resonance imaging can also detect bicuspid aortic valves. Bicuspid aortic valves usually produce characteristic sounds when health care providers listen to the hearts.
In addition to early degeneration of the valves, people with bicuspid aortic valves have a risk of enlargement or development of aneurysm of the ascending aorta, which is the main blood vessel that carries blood out of the heart. People with bicuspid aortic valves can rarely have aortic narrowing or coarctation. Echocardiogram, computed tomography, and magnetic resonance imaging can detect aneurysms and aortic coarctations. Your healthcare provider may want to monitor you with scans at different intervals.
Bicuspid aortic valves are more prone to infection than normal aortic valves. Infection of a heart valve is called infectious endocarditis. It can have devastating consequences. Infectious endocarditis can occur from bacteria that are a normal part of the human mouth. People with bicuspid aortic valves, in addition to dental abscesses or other oral infections, are at increased risk for infectious endocarditis. It is very important that people with bicuspid aortic valves undergo regular dental cleanings and maintain excellent oral hygiene.
People with bicuspid aortic valves should get their doctor examined and tested to check the valve and aorta periodically. Echocardiograms are the most common tests to monitor people with bicuspid aortic valves, but CT and MRI scans can also be used for this purpose. The frequency of follow-up depends on the degree of stenosis or valve insufficiency, enlargement of the ascending aorta, and a person’s family history. Tests may be needed as often as every six months or as rarely as every five years. Because bicuspid aortic valves can work in families, all first-degree relatives (i.e., children, siblings, and parents) of people with bicuspid aortic valves should have an echocardiogram to check for a bicuspid aortic valve and a ascending aortic aneurysm.
There are no medications to treat a bicuspid aortic valve. The only treatment is surgery to repair or replace the aortic valve if the stenosis or insufficiency is bad enough or if the ascending aorta becomes too large.
Not all patients with bicuspid aortic valves will need heart surgery. Studies suggest that up to 75% of people with bicuspid aortic valves will need intervention at some point in their lives. If people with bicuspid aortic valves have regular follow-up and prompt treatment, their lifespan is similar to that of the general population.
People diagnosed with bicuspid aortic valve should understand that they will need periodic monitoring and may eventually require valve replacement or repair. Otherwise, they should live an active, healthy and normal lifestyle.
―Dr. Michael Cullen, Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Citation: Q and R: What is a bicuspid aortic valve? (2021, May 27), retrieved May 27, 2021 from https://medicalxpress.com/news/2021-05-bicuspid-aortic-valve.html
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