Bicuspid Aortic Valve (BAV): What You Need to Know

Introduction

The aortic valve is one of the heart's four valves, responsible for ensuring blood flows from the heart into the aorta and then to the rest of the body. Normally, the aortic valve has three leaflets (tricuspid), but in some individuals, it has only two leaflets—this is called a bicuspid aortic valve (BAV).

Causes and Risk Factors

BAV is a congenital condition, meaning it is present from birth. The exact cause is not entirely understood, but genetic factors play a significant role. If a family member has BAV, there is a higher chance of other relatives having it too.

Symptoms

Many people with BAV have no symptoms for many years. However, some may develop:

• Shortness of breath
• Chest pain
• Fatigue
• Dizziness or fainting
• Heart murmur (an abnormal heart sound heard with a stethoscope)

Potential Complications

Even if someone has a bicuspid valve but no symptoms, complications can develop over time. These include:

1. Aortic Stenosis (Valve Narrowing):

• The valve may become stiff and narrow, restricting blood flow.
• Symptoms include chest pain, dizziness, and shortness of breath.

2. Aortic Regurgitation (Valve Leakage):

• Blood can leak backward into the heart instead of moving forward.
• Can lead to heart enlargement and eventually heart failure.

3. Aortic Aneurysm (Widening of the Aorta):

• The aorta may become abnormally large and could rupture if severe.

Diagnosis

BAV can often be detected through:

• Echocardiogram (Ultrasound of the heart)
• Cardiac MRI (For more detailed images)
• CT scan (To check the aorta for enlargement)

Treatment Options

1. Regular Monitoring

If no symptoms or complications exist, routine check-ups (echocardiograms) are essential.

2. Medications

While no medications can correct the valve, blood pressure control can reduce stress on the aorta and the heart.

3. Surgery

• If the valve becomes severely narrowed (stenotic) or leaky (regurgitant), a valve replacement or repair may be necessary.
• If the aorta becomes too enlarged, surgery may be required to prevent rupture.

Lifestyle Recommendations

• Regular Follow-ups: Ensure periodic heart evaluations.
• Blood Pressure Control: Keep hypertension under control to prevent aortic complications.
• Exercise: Avoid extreme weightlifting or high-intensity sports if the aorta is enlarged.
• Heart-Healthy Diet: Includes fruits, vegetables, whole grains, and lean proteins.

Conclusion

Bicuspid aortic valve is a common congenital heart condition that requires lifelong monitoring. While many individuals live normal lives without complications, some may develop problems requiring medical attention. Regular evaluation and a heart-healthy lifestyle are essential for maintaining good cardiovascular health.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines on the Management of Valvular Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/21/58/2020-ACC-AHA-VHD-GL-Pt-1-GL-VHD
3. https://pubmed.ncbi.nlm.nih.gov/9809971/
4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/03/13/18/13/2024-acc-aha-clinical-performance-valvular
5. https://pubmed.ncbi.nlm.nih.gov/33332149/

2. European Society of Cardiology Guidelines on Valvular Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Valvular-Heart-Disease-Guidelines
2. https://academic.oup.com/eurheartj/article/43/7/561/6358470
3. https://pubmed.ncbi.nlm.nih.gov/34453165/
4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
5. https://pubmed.ncbi.nlm.nih.gov/17259184/