Bicuspid Aortic Valve

What is a bicuspid aortic valve?


Your heart has four valves which direct the flow of blood through the heart. Your aortic valve is located between the left ventricle and the aorta (the large blood vessel that carries blood to the rest of the body). When your ventricle contracts, blood is forced through the aortic valve, into the aorta, and out to the rest of your body. Your valve then closes as the ventricle relaxes and fills with blood. This prevents blood from moving backward into the left ventricle.


Your aortic valve normally has three flaps or leaflets. A bicuspid aortic valve only has two leaflets.


Learn more about how blood flows through your heart  


How do you get a bicuspid aortic valve?


Having a bicuspid aortic valve is a congenital abnormality, meaning you were born with this condition. You are at a higher risk if you have a family history of bicuspid aortic valve. It is one of the most common congenital abnormalities of the heart. It is caused by a fusion of the original valve leaflets. Approximately 1 percent of the population has a bicuspid aortic valve and it is more common in males. 


Is having a bicuspid aortic valve a problem?


In many cases, a bicuspid aortic valve will not cause any problems. The valve can function for years without causing any symptoms. Diagnosis usually comes later in life when a person develops symptoms of heart valve disease (aortic valve diseasse or aortic valve regurgitation). Patients with a bicuspid aortic valve are also at increased risk of aortic aneurysm and aortic dissection. 


What are the symptoms of a bicuspid aortic valve?


Symptoms are generally related to aortic valve stenosis or aortic valve regurgitation.


These symptoms can include:

  • Chest pain or tightness
  • Feeling lightheaded or fainting with physical exertion
  • Increased fatigue, especially with increased activity
  • Shortness of breath
  • Heart palpitations
  • Swollen ankles and feet 

Initial symptoms may also be from an aortic aneurysm or aortic dissectionwhich can be related to a bicuspid aortic valve. This is a potentially life threatening condition and you should seek immediate medical attention. Symptoms include:

  • Chest pain or tightness, and may radiate to the back
  • Shortness of breath
  • Difficulty swallowing or hoarseness
  • Lightheadedness
  • Dizziness
  • Sharp stabbing or ripping sensation under chest bone (with dissection)

How is a bicuspid aortic valve diagnosed?


Valve disease may be detected by your doctor during a routine medical exam. They may notice a heart murmur, which is the sound of blood flowing across an abnormal heart valve. A murmur may be the first clinical sign of valve disease if you have no symptoms. Your doctor may order an echocardiogram (an external ultrasound of your heart) to look at your heart valves. A bicuspid aortic valve may also be found incidentally while doing an echocardiogram for another heart problem. 

  • EchocardiogramAn echocardiogram, or "echo," uses sound waves to create a picture of your heart. It shows the different structures of the heart and can show any abnormalities in your valves. There are two kinds of echocardiograms. Your doctors will determine which test is needed to get the best view of your heart valves. Learn more about echocardiograms
  • Transthoracic echocardiograms (TTE): A TTE is done using an ultrasound probe held against the chest and is noninvasive.
  • Transesophageal echocardiograms (TEE): A TEE is done by passing an ultrasound probe down the esophagus to get a close up view of your heart. This test is more invasive. 

What is the treatment for a bicuspid aortic valve?

  • Non-Surgical: Medical Management - Depending on the severity, treatment with medications may be successful in managing your valve disease. Medications can be helpful in treating your symptoms, however they will not prevent or reverse the disease. Various medications may be used for blood pressure control if you have high blood pressure. It is important to keep close follow up with your heart doctor. This includes regular appointments, living a healthy lifestyle, and taking the medications to help your heart. You will likely have routine echocardiograms to monitor your valve.

  • Surgical: Open Heart Surgery - If your aortic valve disease becomes severe and medications alone are no longer effective, aortic valve surgery may be necessary. This is a surgical procedure during which your aortic valve is repaired or replaced by a properly functioning valve. It is the most common surgical intervention for aortic valve disease.