Living with Bicuspid Aortic Valve: What to Know and Expect
Learn how bicuspid aortic valve affects daily life, treatment choices, and how to manage this common congenital heart condition for better health.
A bicuspid aortic valve (BAV) is the most common congenital heart defect, affecting up to about 2% of the population. While many people live healthy lives with this condition, it can pose challenges and risks, especially if left unmanaged. This article explores the core aspects of living with a bicuspid aortic valve, from understanding the anatomy and symptoms to managing complications, treatments, and lifestyle choices that help ensure long-term health.
Understanding Bicuspid Aortic Valve
The aortic valve is responsible for controlling blood flow from the left ventricle of your heart into the aorta, which supplies oxygen-rich blood to your body. Normally, the aortic valve has three flaps (also called leaflets or cusps), but a bicuspid aortic valve has only two flaps. This seemingly small difference can have important effects on heart function over time.
- Bicuspid aortic valve: 2 flaps
- Normal (tricuspid) aortic valve: 3 flaps
A BAV may operate normally for many years, but it is structurally more prone to disorders such as stenosis (narrowing) or regurgitation (leakage), and can increase the risk of an enlarged aorta and other complications later in life.
How Common Is Bicuspid Aortic Valve?
Experts estimate that 0.5%–1.4% of people are born with a BAV, making it the most frequent congenital heart defect. It is twice as common in males as in females.
How Does the Aortic Valve Work?
Each time the heart contracts, the aortic valve flaps open, allowing blood to be ejected into the aorta. When the heart relaxes, the flaps close tightly, preventing blood from flowing backward. In a bicuspid valve, these flaps may be thicker or stiffer, potentially impeding their ability to open and close efficiently.
- Tricuspid valve: Usually opens and closes easily
- Bicuspid valve: More likely to become stiff (stenotic), or not close fully (regurgitant)
Symptoms of Bicuspid Aortic Valve
Most children and young adults with a BAV have no symptoms, and many discover the condition incidentally during routine exams or imaging. However, as the valve ages, it may lose function, leading to symptoms that typically arise in adulthood—often between ages 50 and 70.
- Chest pain or tightness
- Fatigue
- Lightheadedness or fainting
- Shortness of breath, especially during exertion
- Swelling in the legs or ankles
Sometimes, a physician may hear a heart murmur on auscultation, which is often a clue to the presence of an abnormal valve.
Potential Complications
- Aortic stenosis: The valve becomes narrowed and stiff, making it more difficult for blood to leave the heart. This increases the workload on the heart and can lead to symptoms and, over time, heart failure.
- Aortic regurgitation: The valve may leak, allowing blood to flow backward from the aorta into the heart. This too can stress the heart and, if significant, cause it to enlarge or weaken.
- Enlarged aorta (aortopathy): The section of the aorta closest to the heart may become enlarged, raising the risk of dangerous complications such as an aortic aneurysm or, rarely, aortic dissection.
- Infective endocarditis: The abnormal valve is more susceptible to infection from circulating bacteria.
What others are reading
| Complication | Description |
|---|---|
| Aortic Stenosis | Thickened or stiffened valve restricts blood flow out of the heart |
| Aortic Regurgitation | Valve leakage allows blood to flow backward into the heart |
| Aortopathy | Enlargement or weakening of the aorta raises the risk of aneurysm or rupture |
| Endocarditis | Infection of the valve or heart lining, more likely in abnormal valves |
Causes and Risk Factors
Bicuspid aortic valve is a congenital condition, meaning it is present from birth. The exact cause is not fully understood. However, genetics play a role: if you have a family member with BAV, your own risk is higher, and screening of first-degree relatives is generally advised.
- Congenital heart defect
- Often inherited or runs in families
- Associated with connective tissue disorders in rare cases
Diagnosis
Bicuspid aortic valve is commonly detected by:
- Physical exam: A heart murmur may be the first sign of an abnormal valve.
- Echocardiogram (ultrasound): The most important tool for visualization of valve structure and function.
- CT or MRI scans: Used to assess the aorta and look for enlargement or dissection risk.
- Electrocardiogram (ECG) and chest X-ray: Often done to assess heart size and function.
Routine screening is not required for everyone, but is often recommended for close family members of someone diagnosed with BAV.
Treatment Options
Treatment is highly individualized, based on the valve’s function, the presence or absence of symptoms, and the state of the aorta. Many people with a bicuspid aortic valve require only regular monitoring, while others may need medication or surgery.
Monitoring and Lifestyle Management
- Regular cardiology follow-up (every 1–3 years or as recommended)
- Intermittent echocardiograms to track valve and aorta structure/function
- Blood pressure control
Medications
Medications may be prescribed to help manage blood pressure, control risk factors, and ease the heart’s workload. Common drug classes include:
- Beta-blockers
- ACE inhibitors or ARBs
- Statins for cholesterol (if appropriate)
Surgical Treatment
Surgery is considered when BAV causes severe symptoms, the valve dysfunction becomes significant, or the aorta becomes dangerously enlarged.
- Aortic valve repair or replacement: Damaged valves may be surgically repaired or replaced. Options include mechanical or biological (tissue) replacement valves.
- Aorta repair or replacement: If the aorta is enlarged, surgery may be needed to replace the affected segment.
These operations are common and often lead to excellent long-term results.
Endocarditis Prevention
- Antibiotic prophylaxis may be recommended before certain dental or surgical procedures to reduce the risk of endocarditis, especially in those with prior valve replacement.
Living Well with a Bicuspid Aortic Valve
Most people with bicuspid aortic valve live normal or near-normal lives—especially with good medical care and healthy lifestyle choices. Here’s what you can do:
- Stay active: Engage in regular exercise as advised by your cardiologist. Most noncompetitive, moderate-intensity activities are safe unless severe valve dysfunction occurs.
- Avoid illicit drug use: Drugs that increase heart rate or blood pressure can pose dangers.
- Control blood pressure: High blood pressure increases strain on the valve and aorta.
- Monitor cholesterol and treat as needed.
- Eat a heart-healthy diet: Emphasize vegetables, fruits, whole grains, lean protein, and healthy fats.
- Keep dental hygiene a priority: Healthy teeth and gums lower the risk of infective endocarditis.
- Don’t smoke: Smoking worsens heart and vessel health.
- Manage stress: Chronic stress can contribute to high blood pressure.
- Attend all prescribed medical visits and imaging.
Special Considerations
- People with BAV should consult with a specialist before pregnancy or participating in strenuous sports.
- Screening for aortic enlargement is especially important if there is a family history of aneurysm or aortic dissection.
Frequently Asked Questions (FAQs)
How serious is a bicuspid aortic valve?
It is the most common congenital heart defect. In many cases, it remains asymptomatic and does not cause problems. However, for some, especially as they age, it increases the risk of valve stenosis, regurgitation, heart failure, and aortic aneurysm. Early detection and regular follow-up are key.
Is a bicuspid aortic valve hereditary?
Yes, BAV tends to run in families. Close relatives of someone with a bicuspid aortic valve should consider screening, even if they have no symptoms.
Can I live a normal life with a bicuspid aortic valve?
Most people with BAV live normal or near-normal lives, provided they follow recommended monitoring, medical management, and lifestyle changes.
When does surgery become necessary?
Surgery is necessary when valve dysfunction becomes moderate to severe, symptoms occur, the aorta enlarges beyond a certain threshold, or if there are other major complications. Decisions are made in close consultation with a cardiologist and cardiac surgeon.
What activities should I avoid with BAV?
Unless there is significant aortic enlargement or severe valve dysfunction, most people can participate in regular exercise. High-contact sports, extreme weight training, and activities that sharply raise blood pressure may require special discussion with your doctor.
Resources and Support
- Talk to your cardiologist for the latest advances in management and screening for your specific situation.
- Connect with national heart health organizations, such as the American Heart Association, for guidance and patient support groups.
- If a family member is diagnosed, ask about screening and counseling for you or your children as appropriate.
Key Takeaways
- Bicuspid aortic valve is common and often manageable.
- Many people remain symptom-free, but complications may arise with age.
- Regular medical care and imaging are vital for early detection and management of risks.
- Lifestyle adjustments, attention to blood pressure, dental hygiene, and, when necessary, surgery, can lead to excellent outcomes.
If you or a loved one has been diagnosed with a bicuspid aortic valve, remember that with ongoing care, education, and appropriate treatment, you can continue to lead a full and active life.
References
- https://www.healthline.com/health/heart-disease/bicuspid-aortic-valve
- https://marfan.org/conditions/bicuspid-aortic-valve/
- https://www.mayoclinic.org/diseases-conditions/bicuspid-aortic-valve/cdc-20385577
- https://www.healthline.com/health/heart/living-with-bicuspid-aortic-valve
- https://my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease
- https://www.medicalnewstoday.com/articles/bicuspid-aortic-valve
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6363677/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3368178/
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