Bicuspid Aortic Valve (BAV)
Bicuspid Aortic Valve (BAV): A Complete Guide
A bicuspid aortic valve (BAV) is the most common congenital heart defect, affecting approximately 1–2% of the population worldwide. In this condition, the aortic valve, which normally has three cusps (tricuspid), develops with only two cusps. These cusps are responsible for regulating the flow of oxygen-rich blood from the left ventricle into the aorta — the body’s largest artery.
In a healthy valve, the three cusps open and close efficiently to ensure blood flows forward without leakage or obstruction. With a bicuspid valve, however, the altered anatomy places stress on the valve tissue and surrounding aorta. Over time, this can lead to complications such as:
Aortic stenosis (narrowing of the valve, restricting blood flow).
Aortic regurgitation (leakage of blood backwards into the heart).
Aortic dilation, aneurysm, or dissection (widening or tearing of the aorta).
Not everyone with BAV develops symptoms or complications — some live a normal lifespan without major issues. However, for others, the condition can progress silently and lead to serious cardiovascular problems. Regular monitoring, early diagnosis, and appropriate treatment are essential.
One of the challenges with BAV is that it may not cause obvious symptoms until later in life. Many people are diagnosed incidentally, either during a routine physical examination or imaging performed for another reason.
Early Stage (Often Asymptomatic)
Many individuals feel entirely well in childhood and early adulthood.
The only sign may be a heart murmur, a “whooshing” sound heard through a stethoscope.
Progressive Disease, Symptoms of bicuspid aortic valve:
As the valve degenerates or the aorta dilates, symptoms may develop:
Chest pain or discomfort (angina)
Often appears during exertion, when the heart needs to pump harder.
Shortness of breath
Can worsen during physical activity or when lying flat.
Fatigue and reduced exercise tolerance
Early sign that the heart is struggling to cope with increased workload.
Palpitations
Feeling of skipped or irregular heartbeats.
Dizziness or fainting (syncope)
Strongly associated with severe aortic stenosis.
Can be a warning sign of imminent complications.
Heart failure signs
Swollen ankles, rapid weight gain, or fluid buildup in lungs.
Even if you have no symptoms, it’s important to know when to seek medical advice.
If you’ve been told you have a heart murmur.
If you have a family history of bicuspid aortic valve, aortic aneurysm, or sudden cardiac death.
If you experience fainting, chest pain, or breathlessness.
If you have palpitations or irregular heartbeat.
If you have already been diagnosed with BAV — regular check-ups are essential, even if you feel well.
Diagnosis of bicuspid aortic valve usually begins with a physical examination where a doctor may detect a characteristic murmur. Diagnosing bicuspid aortic valve involves a combination of clinical assessment and imaging studies.
2. Echocardiogram (Echo)
Can show valve structure (two cusps instead of three).
Assesses severity of stenosis or regurgitation.
Measures size of the ascending aorta.
May require transoesophageal echocardiography (TOE) for more detailed imaging.
3. Cardiac MRI / CT Scan
Provides precise measurements of the aorta.
Essential in patients with suspected aortic aneurysm.
Often used in surgical planning.
4. Exercise Stress Test
Evaluates functional capacity and symptoms under exertion.
Treatment depends on symptoms, severity of valve dysfunction, and aortic involvement.
1. Monitoring and Lifestyle
Regular echocardiographic surveillance.
Blood pressure control to reduce aortic complications.
Avoidance of heavy weightlifting and extreme exertion if the aorta is enlarged.
2. Medical Therapy
Medications may control associated conditions like hypertension or heart failure but cannot cure Bicuspid Aortic Valve.
3. Surgical and Interventional Options
Aortic valve replacement (SAVR) – traditional open-heart surgery.
Transcatheter aortic valve implantation (TAVI) – less invasive, suitable for selected patients.
Valve repair – in some cases of regurgitation.
Aortic surgery – repair or replacement if the ascending aorta is dilated.
Treatment decisions are personalised, made by a multidisciplinary heart team.
Lifestyle for bicuspid aortic valve
Regular cardiology follow-ups are non-negotiable.
Maintain a healthy weight and exercise sensibly.
Avoid extreme weightlifting if the aorta is dilated.
Monitor blood pressure closely.
Oral hygiene is important to reduce risk of infective endocarditis.
Family Screening for bicuspid aortic valve
Close relatives (parents, siblings, children) may also have BAV.
Echocardiographic screening is often advised.
Special Considerations with bicuspid aortic valve
Pregnancy: women with BAV need careful assessment before and during pregnancy, as the cardiovascular system is under increased stress.
Sports participation: depends on severity of valve disease and aortic dilation. Competitive or high-intensity sports may be restricted.
The outlook for patients with bicuspid aortic valve varies.
Mild cases: Many people live normal lives with little or no intervention.
Progressive cases: Risk increases with age, especially after 40–50 years.
Complications:
Aortic stenosis or regurgitation often require surgery in adulthood.
Aortic aneurysms may require surgical repair to prevent rupture.
Post-surgery: Survival and quality of life are excellent, with modern surgical techniques offering long-term solutions.
Overall, prognosis is good with timely diagnosis, monitoring, and appropriate treatment.
- BAV is present in 1–2% of the general population.
- It is twice as common in men than women.
- It results from a congenital developmental abnormality.
- Many patients are asymptomatic for years.
- BAV is linked to aortic aneurysm and dissection.
- Family members may also be affected — screening is advised.
- Aortic stenosis and regurgitation are common complications.
- Surgery (valve or aortic repair) has excellent success rates.
- Endocarditis prevention is particularly important.
- Lifelong cardiology follow-up is required.
- How severe is my bicuspid aortic valve condition?
- Do I need surgery now or in the future?
- How often should I have follow-up scans?
- What activities or exercises are safe for me?
- Should my family members be screened?
- Am I at risk of developing an aortic aneurysm?
- What symptoms should I watch out for and report immediately?
- What are the treatment options available for me (surgical vs TAVI)?
- Do I need antibiotics before dental or surgical procedures?
- What lifestyle changes will help protect my heart and aorta?
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