It’s Medical Monday!

Welcome back, everyone! Today we’ll be discussing one of the most common myths regarding bicuspid aortic valves. Being told that you have a bicuspid aortic valve (BAV) can understandably raise a lot of questions. One of the most common is: “If my valve is abnormal, does that mean I’ll eventually need surgery?”

The short answer is no.

A bicuspid aortic valve can sometimes cause significant problems, but many people with BAV never need their valve replaced. Understanding what a bicuspid valve is and what doctors are actually watching for can help make the diagnosis much less intimidating.

What is a bicuspid aortic valve?

The aortic valve sits between the heart and the aorta. Its job is to open when the heart pumps and close afterward to keep blood from flowing backward.

Most people are born with an aortic valve that has three leaflets, or cusps (a tricuspid aortic valve). In people with a bicuspid aortic valve, the valve has two leaflets instead of three. BAV is one of the most common congenital heart conditions. Some people are born with it and go their entire lives without significant symptoms.

Sometime during development, two of the three leaflets of the aortic valve can fuse, creating a valve with only two functional leaflets instead of three. Source: https://my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease

Why can a bicuspid valve cause problems?

A bicuspid valve can function normally for many years. However, because its structure is different than the standard anatomy, it has a higher risk of developing problems over time. The two most common are:

• Aortic stenosis: The valve becomes stiff or narrowed, making it harder for blood to leave the heart.

• Aortic regurgitation: The valve does not close completely, allowing blood to leak backward from the aorta into the heart.

  
  

BAV is also associated with changes in the ascending aorta, including enlargement or aneurysm formation. This is why people with BAV often need periodic imaging of both the valve and the aorta.

So, does a bicuspid valve have to be replaced?

Not necessarily.

If the valve is working well and you don't have significant symptoms or evidence of severe valve disease, treatment may simply involve regular monitoring.

The most important thing for someone with BAV is knowing what is happening with the valve and aorta over time. Your doctor may use echocardiograms to follow how well the valve is opening and closing and to check the size of the aorta. The goal is to identify changes early and operate only if any intervention is necessary.

When might surgery become necessary?

Valve replacement may eventually be recommended if the valve develops severe stenosis or regurgitation, especially when it is symptomatic or begins to affect the heart's function.

In some patients, surgery may also be recommended when the ascending aorta becomes significantly enlarged. In those situations, the valve and aorta can sometimes be addressed during the same operation. Importantly, the decision to operate is based on the condition of the valve, the size and growth of the aorta, symptoms, and the overall health of the heart, rather than whether the valve is bicuspid or not.

Bottom line

A bicuspid aortic valve does not automatically need repair or replacement. Some people with BAV eventually develop significant valve disease or aortic enlargement and require surgery, while others have a normally functioning valve for decades and never need an operation. Regular follow-up with your healthcare team can help ensure that treatment is recommended when it is actually needed.

That's all for this one, folks. Keep thinking aorta!

Signing off,

Anirudh Karla