Treating a heart valve defect
Q: I am a 29-year-old active military service member without any significant health issues. Yet during my most recent routine physical examination, it was discovered that I have a heart murmur. I was referred for an echocardiogram and evaluation with a cardiologist who said I have a bicuspid aortic valve. What are the consequences of having a bicuspid aortic valve? When should it be treated, and what is the treatment? A:
The aortic valve sits at the base of heart, and it separates the heart’s main pumping chamber (the left ventricle) and the main artery (the aorta), which carries oxygen-rich blood to your body. It functions as a one-way valve, opening and closing with each heartbeat, which keeps blood flowing in the correct direction. It usually consists of three flaps of tissue, or valve cusps. This makes the aortic valve a tricuspid valve.
Approximately 1% to 2% of the population are born with an aortic valve that only has two cusps. This is called a bicuspid aortic valve. Most people with a bicuspid heart valve do not have any signs and symptoms until adulthood, but it occasionally can cause symptoms in childhood. It commonly is diagnosed as an incidental heart murmur during physical examination in otherwise healthy adults.
A diagnosis of a bicuspid aortic valve usually does not need immediate intervention or have significant effects in the short or mid term. It may cause heart problems in the long term. Over half of patients will need aortic valve repair or replacement within 25 years after a bicuspid aortic valve diagnosis.
Commonly, the bicuspid aortic valve results in early narrowing of the aortic
valve, called aortic stenosis. This causes reduced blood flow from the heart, which creates excessive work on the heart. Sometimes the valve does not close tightly enough, allowing backward flow of the blood into the heart and causing leakiness, or aortic regurgitation.
A narrow or leaky valve can lead to heart failure, causing chest pain, shortness of breath and difficulty exercising. Some people with bicuspid aortic valve also may develop enlargement of the aorta. The enlargement of the aorta can lead to a rupture or tear of the aorta, which is life-threatening if not treated in a timely manner.
The initial test, as in your case, is an echocardiogram. This test uses sound waves to image the heart chambers, its valves, blood flow through the valves and aorta size. It is an excellent initial screening tool. An echocardiogram can reliably diagnose a leaky or narrow valve or enlargement of the aorta.
Treatment of the bicuspid aortic valve depends on the extent of the valve’s disease, the patient’s symptoms and the size of the aorta. Open-heart surgery may be needed.
The most commonly performed procedure is
aortic valve replacement, with either an artificial mechanical valve or a biological tissue valve. In certain cases of a leaky valve, repair of the aortic valve may be more feasible than replacement.
During open-heart surgery, the surgeon may remove the enlarged section of aorta, if necessary, and replace it with a synthetic tube, or graft. Patients with bicuspid aortic valve are at increased risk for developing infection of the lining of the heart and the valves. Regular dental care can lower this risk.
Once the diagnosis of bicuspid aortic valve is established, you will require lifelong care and surveillance by a cardiologist using an echocardiogram. Since the bicuspid aortic valve can be passed down in families, your health care provider also will recommend a screening for your parents, siblings and children.