Bicuspid Aortic Valve Disease – All You Need To Know

Health disorders, especially those related to the heart, can cause long-lasting complications for the patient. These may be congenital or can develop throughout life. Irrespective of when one contracts a cardiovascular disorder, it should be attended to it immediately. A later diagnosis can result in complicated surgeries that may have life-long effects on the patient's health. One such cardiovascular disorder is the Bicuspid Aortic Valve Disease or BAVD. Let's understand what it is, its symptoms and treatment.

What is Bicuspid Aortic Valve Disease?

Bicuspid aortic valve disease is essentially a kind of irregularity in the aortic valve in the heart. It is generally a congenital condition.

In the heart, the ventricles are the two lower chambers. The left ventricle connects to the aorta, i.e. the main blood vessel and pumps oxygenated blood to the human body. The aortic valve, which is one of the four valves of the heart, is located between the aorta and the left ventricle. The four valves assist with the flow of blood through the four chambers of the heart and into the lungs or out to the body.

Normally, the aortic valve has three small parts, also known as leaflets. However, in the heart of a patient suffering from BAVD, the valve has only two small leaflets instead of the usual three. Typically, the third leaflet fails to develop correctly, and the two leaflets are fused together. The bicuspid valve opens and closes abnormally and may sometimes result in the valve leaking. The leakage allows the blood to flow back into the heart instead of the normal function of flowing forward into the body. This process, known as aortic regurgitation, makes the heart work harder.

Bicuspid Aortic Valve – Symptoms and Diagnosis

Despite being a congenital disease, BAVD symptoms may not be apparent until it is diagnosed in adulthood. Over time, the valve becomes harder to open and may start leaking, resulting in patients developing symptoms like chest pain, shortness of breath, lightheadedness, loss of stamina, fatigue, etc. Once the patient reports these symptoms, the healthcare provider may run various tests to diagnose the condition, such as

• Echocardiography to show blood movement through the valve
• Transesophageal echocardiography, a heart ultrasound done from the oesophagus
• Electrocardiogram to check the electrical rhythm of the heart
• Chest X-ray to assess the heart's anatomy and lungs
• Cardiac CT or MRI to get more details about the heart, valve, or aorta

Bicuspid Aortic Valve Treatment

When it comes to bicuspid aortic valve treatment, several options are available. BAVD treatment depends on whether the aortic root is enlarged and how well the valve is working. If the valve function worsens, the patient may need to undergo a procedure, which could be:

Balloon aortic valvuloplasty via a heart

In this procedure, the surgeon guides a catheter to the heart via the big blood vessels to collect blood and measure blood pressure. A picture of the heart is taken using a special dye to determine the next steps. The doctor inserts a catheter with an uninflated balloon into the narrowed valve opening. The balloon is first inflated, then deflated, and then removed, thus relieving the aortic valve's narrowing or constriction.

Aortic valve repair/replacement without enlarging aortic root, which includes

• Valve repair or tightening with stitches to reduce leaking
• Mechanical valve replacement wherein the bicuspid valve is removed, and a mechanical valve is replaced
• Tissue valve replacement wherein the bicuspid valve is removed and replaced with animal tissue valve
• Ross Procedure wherein the doctor removes the patient's pulmonary valve and uses it to replace the bicuspid valve

Aortic valve repair with aortic root enlargement

• Valve-Sparing Aortic Root Replacement wherein the doctor removes the ascending aorta above the valve and replaces it with a vascular graft by attaching coronary arteries to the graft.
• Aortic Root and Valve Replacement wherein the doctor removes the ascending aorta and valve and places a vascular graft with an artificial one by attaching coronary arteries to the graft.

Depending on the patient's condition, the doctor may also suggest trans-catheter aortic valve replacement or TAVR, also known as trans-catheter aortic valve implantation or TAVI, a minimally invasive procedure to replace the narrowed aortic valve if it fails to open properly.

Final Note: Bicuspid aortic valve disease can be prevented or cured with an early diagnosis. If you notice any symptoms, you should immediately schedule a routine checkup and keep following up with your doctor. Undergoing a physical examination might reveal any underlying problems. Cardiac MRIs, CT scans and echocardiograms can help identify aortic aneurysm and aortic root enlargement. Consult your doctor if you experience chronic chest or back pain, racing heartbeats, shortness of breath, or unexplained and persistent fevers.