How to Manage Adult Bicuspid Aortic Valve

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Bicuspid aortic valve (BAV) disease is a simple, yet common congenital (born with) heart defect affecting nearly 2 percent of the population, or 1 in 50 people. A child is born with BAV every seven minutes in the U.S. The aortic valve has three flaps or leaflets, and is normally called tricuspid. When there is abnormal development of the valve, it can have two cusps (bicuspid) or one cusp (unicuspid).

Here are some common questions congenital heart patients may have about BAV.

  1. How is BAV disease diagnosed?
    A doctor can hear an abnormal heart sound which then requires additional heart imaging such as echocardiography imaging. BAV can be associated with other heart abnormalities, most commonly aneursyms.
  2. Is it possible to be an adult and just be diagnosed with BAV disease?
    Yes, some severe forms are diagnosed in infancy, but it is common to be diagnosed for the first time in adulthood.
  3. What are some symptoms of BAV disease?
    In adults, initially and commonly there are no symptoms. Symptoms are related to the valve dysfunction, dilation and tear of aorta, or infection. If the valve begins to leak (aortic regurgitation/insufficiency) or becomes narrow (stenosis), symptoms are generally shortness of breath or chest pains. If the aorta tears (dissection), this can become life threatening and a medical emergency; symptoms can include chest and mid-back pain. There is a risk of infection of the heart valve and symptoms can include fever, chills and fatigue.
  4. How is BAV treated?
    Surveillance with heart imaging is very important for the identification of significant valve abnormality or enlargement of the aorta. It is important to consider the size of the aorta in reference to the person’s size. Good dental hygiene, blood pressure control and appropriate cholesterol control are important. Because the risk of heart valve infection (endocarditis) is extremely low and there is a high prevalence of antibiotic resistance, the American College of Cardiology (ACC) and American Heart Association (AHA) no longer recommend antibiotics prior to procedures for BAV.
  5. Will I need surgery to correct this?
    Yes, you may need aortic valve replacement and/or replacement of the aorta at some point in your life.
  6. How does BAV affect my family?
    There is a 9 percent prevalence within immediate family members; therefore, theACC and AHA recommend echocardiographic screenings for immediate family members.
  7. Are there any limitations to exercise?
    If there is no significant or only mild valve disease and normal size aorta, there is no restriction for exercise or sports. If there is severe valve disease, aerobic exercise can be performed after evaluation by a physician. If there is significant abnormality to the aorta, aerobic exercises are well tolerated, but there are limitations that need to be discussed with your doctor about competitive sports and weight training.
    ***Wendy Bradley, Ochsner employee and wife of a patient with CHD, also contributed to this article.

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