Bicuspid Aortic Valve

A bicuspid aortic valve is a congenital heart defect in which the aortic valve has only two leaflets (“cusps”) instead of the usual three. This abnormal structure can affect how blood flows from the heart to the rest of the body.

While some people with bicuspid aortic valves may never experience symptoms, others may develop complications over time such as valve narrowing (aortic stenosis), valve leakage (aortic regurgitation), or enlargement of the aorta (aortopathy). As a result, this condition may require medical or surgical care.

Bicuspid aortic valve can lead to several complications or overlapping conditions, including:

• Aortic Stenosis – The valve opening can become narrowed, limiting blood flow from exiting the heart to the rest of the body.
• Aortic Regurgitation – The valve may not close completely, allowing blood to leak backward into the heart.
• Aortic Aneurysm – The aorta may enlarge or bulge, increasing risk of serious complications like dissection or rupture.
• Endocarditis Risk – The abnormal valve structure increases the risk of infection of the heart valve.

A bicuspid aortic valve is a congenital condition—present at birth—and may be associated with:

• Congenital condition – Defect that occurs during fetal development and is present at birth.
• Genetic Factors – Often runs in families.
• Connective Tissue Disorders – Like Marfan syndrome.
• Male Gender – More common in men than women.

Many people with bicuspid aortic valve are asymptomatic for years. Symptoms may not appear until adulthood, especially if the valve begins to narrow or leak. These can include:

• Chest pain or tightness
• Shortness of breath, especially during activity
• Fatigue
• Dizziness or fainting
• Heart murmur (Often picked up during a routine physical exam)

If aortic stenosis or regurgitation develops, symptoms can worsen over time.

Diagnosis typically includes:

• Physical exam – A heart murmur is often picked up on routine physical exam, prompting further investigation.
• Echocardiogram – Primary tool to visualize valve structure and function.
• Electrocardiogram (EKG) – Assesses rhythm and signs of heart strain.
• Cardiac MRI or CT – Provides detailed images of the valve and aorta.
• Genetic Screening – May be recommended if there’s a family history.

Treatment depends on symptoms and the extent of valve dysfunction:

• Regular Monitoring – Asymptomatic patients may require only annual imaging.
• Medications – To manage blood pressure and reduce heart strain.
• Aortic Valve Replacement (SAVR or TAVR) – For severe stenosis or regurgitation.
• Surgery for Aortic Aneurysm – If the aorta is dangerously enlarged.
• Endocarditis Prevention – Antibiotics before certain procedures.

If untreated or unmonitored, bicuspid aortic valve can lead to:

• Heart Failure
• Arrhythmias
• Aortic Dissection or Rupture
• Stroke or Blood Clots
• Infective Endocarditis

While the condition itself isn't preventable, complications can be minimized by:

• Keeping blood pressure well controlled
• Attending regular cardiology follow-ups
• Informing providers before dental or surgical procedures
• Reporting new symptoms like shortness of breath or chest pain early