What is a Bicuspid Aortic Valve?
The heart pumps blood out in to a large vessel called the aorta that supplies the body with blood. The aortic valve sits in between the heart and the aorta and is there to stop blood leaking backward in to the heart after is has been pumped out.
At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD
Usually the aortic valve has three leaflets; hence it’s called a tricuspid aortic valve. When there are two leaflets only, it is called a bicuspid aortic valve. The two leaflets are typically a result of fusion between two of the original three leaflets. Unfortunately patients with bicuspid valve are predisposed to developing tight valves (aortic stenosis), leaky valves (aortic regurgitation) and dilation of the aorta in the chest (thoracic aortic aneurysm).
Diagnosis
An ultrasound scan of the heart known as echocardiography is typically used to diagnose bicuspid aortic valve. This will allow assessment of the valve structure, and look for associated valve tightening (aortic stenosis) or leakiness (aortic regurgitation). Importantly this will also allow assessment of the aorta and to assess widening of the aorta in the chest (aortic aneurysm).
Sometimes standard echocardiography isn’t able to accurately assess the valve and so it can be difficult to differentiate between a normal tricuspid, and a bicuspid valve. Transesophageal echocardiography is much more accurate, however that involves passing a small camera in to the stomach to take close pictures of the heart and is therefore not done routinely.
In some patients, the aorta as it comes of the heart cannot be fully visualized using transthoracic echocardiography. As mentioned earlier, dilation of the aorta with aneurysm is more common in those with bicuspid aortic valve and therefore its important to make sure this is well characterized. Therefore CT or MRI imaging is recommended in those patients who do not have adequate echo pictures. MRI is generally preferred as it avoids the need for radiation exposure; particularly in those who need repeated follow up studies for surveillance.
Relation to Aortic Aneurysm
Bicuspid aortic valve is a condition that doesn’t just affect the valve, rather it affects the valve and the aorta, the main vessel that leaves the heart and supplies the body with blood. It is therefore known as a valvulo-aortopathy. A significant number of patients with bicuspid valve have associated development of dilation of the aorta known as an aortic aneurysm. The area of the aorta affected is in the chest and is known as a thoracic aortic aneurysm.
Signs and Symptoms
The way in which the diagnosis of bicuspid aortic valve presents itself is very variable. In some people, the diagnosis is made because family members are found to have it, and it is picked up on a screening heart scan. The majority of people sent for a heart scan and found to have bicuspid aortic valve are sent for the scan due to the presence of a heart murmur. Patients may be sent for a heart scan due to some unrelated reason and found to have a bicuspid valve. Therefore many of those in whom a bicuspid aortic valve is diagnosed are healthy and without symptoms.
In others however, the diagnosis may be made due to a complication associated with the bicuspid valve. Most patients with a bicuspid aortic valve will develop tightening (known as aortic stenosis) or leakiness (known as aortic regurgitation) at some point in their lifetime. Some of these may present with symptoms of heart failure due to an overly tight, or leaky valve. Others may be found to have a bicuspid valve as part of a work up for aortic aneurysm, which is an associated complication. Occasionally a diagnosis may be made under life threatening circumstances as part of a work up for the associated complications of aortic dissection, or an infection of the aortic valve known as endocarditis.
Do Family Members Need to be Screened For Diagnosis?
About 20-30% of patients with bicuspid aortic valve will have other family members affected. There is no exact genetic cause known, and the inheritance pattern can be very variable although there certainly appears to be a genetic component. In patients with bicuspid aortic valve with a known family history of valve disease or aortic disease, it is definitely recommended to screen all first-degree relatives with echocardiography. Most experts would recommend that echocardiographic screening be performed in all first-degree relatives of patients with bicuspid aortic valve.
How Often Should Follow Up Studies Be Performed?
1) The size of the aorta
2) The rate of changes of size of the aorta
3) The function of the valve.
Rate of progression of aortic dilation has been documented in several studies.
- The reported average rate of progression is between 1-2mm per year. Those with more rapid progression in between studies, i.e. >0.5cm may need closer monitoring.
- Patients with a bicuspid valve and an aorta that has a diameter of >4cm should have regular repeat studies to document the size and the stability of the aorta.
- In patients with aorta diameter >4.5cm imaging should be performed on a yearly basis. In some patients there is a more rapid rate of progression of aorta dilation, and it is reasonable to perform imaging more frequently if deemed necessary.
- In patients with aorta <4.5cm who have documented slow progression and no family history of bicuspid or aortic disease, imaging can be left even longer than yearly.
Finally, follow up will depend on the extent of the valve disease. Those with severe tightening or leakiness of the valve will require follow up as per guidelines for valvular disease. Typically at least yearly and sometimes more frequent.
Should You Undergo Operation?
This depends on a few things. 1) The valve condition. 2) The size of the aorta.
As mentioned above, the bicuspid aortic valve is a valvulo-aortopathy diagnosis, which means it affects the valve and the aorta. If the valve becomes severely leaky or severely tight, then operation is performed as per usual guidelines. These are basically if symptoms develop, or there is evidence of heart failure or heart muscle dysfunction. However many patients with bicuspid aortic valve will have aortic disease without significant valve disease and may need to undergo operation of the aorta aneurysm. Some patients will require both are done.
- Operation for aortic aneurysm in patients with bicuspid aortic valve is recommended in those who have ascending aorta diameter >5.5cm.
Studies have shown that the rate of aortic dissection in patients with bicuspid aortic valves is reassuringly low. The old guidelines used to recommend aortic surgery when the aorta size was >5cm. The newer guidelines take in to account the low risk of complications and therefore recommend surgery when aorta size is >5.5cm.
- Importantly an individualized approach should be taken and surgery recommended on an aorta size of 5.1 – 5.5 cm in patients who have shown rapid progression of aorta size (> 0.5cm per year), or in those with a family history of aortic dissection.
Some patients with bicuspid aortic valve will have only a mild to moderately dilated aorta, however they will have a severely dysfunctional aortic valve that requires surgery.
- In those patients who are therefore already undergoing valve replacement surgery, replacement of the ascending aorta is recommended if the size of the aorta is >4.5cm.
There is no medicine that is proven to slow down or prevent dilation of the aorta in patients with bicuspid aortic valve. In patients with elevated blood pressure, control of blood pressure is of course recommended. Typically medicines known as beta-blockers or angiotensin receptor blockers are used.
Actionable Steps for Patients
- Ensure that you take an active part in your treatment and know how often your follow up is and also at what stage your disease is at
- Make sure attention is paid to treating blood pressure
- Keep good dental hygiene to avoid a valve infection. Antibiotics are not routinely needed for dental procedures unless there is a history of valve infection
- Ask your Dr if family members require screening
- Pay attention to cardiovascular risk factors that include diet, cholesterol,
excellently explained
Doctor plz can you tell me how much money is needed in pakistan for the operation of bicuspid aortic valve plz send details on my this number plz
03006153882
Thank you
Im sorry, I have no idea, I am based in the US.
What about in the US?
Hi, my son has BAV, he is 16 years old and was diagnosed 9 months ago when a step infection attacked his heart.
For the past few days he has been experiencing more forceful heartbeats (Feeels them more). Do I need to take him to hospital, he says it comes and goes and otherwise he feels perfect.
Thanks for any information you can provide.
Unfortunately without seeing and examining him and taking a story its not safe for me to answer that. If you are worried get him checked out by a general dr at least, and an EKG would be reasonable.
Sir is it safe to fly with bicuspid valve?
In the absence of significant degenerative valve disease and stable symptoms the bicuspid valve itself is not an issue.
you can follow our twitter at @MustafaAhmedMD
Im 37 yrs old, my son has a bicuspid ventricular valve. It was diagnosed at age 5, among other defects. I have never thought about going to a cardiologist at all. And I wasnt suggested to do so.
He is 15 yrs old now and healthy. Biyearly check ups and all.
Last nite i had chest pains and shortness of breath that woke me from my sleep. Lasted about 5-10 mins.
I just for over a cold so i first thought it was related to that… maybe cold when to my chest…
But now i wonder.
Will make an appointment asap.
Agree you need to get this checked out promptly.
Hi Dr. Ahmed . I am a 61 years old man with bicuspid aortic valve. My BP is between 14.5-13/6.
The aorta diameter is around 4.2 .Do you advise :1) having the valve changed since the echo is showing some tiredness in the heart muscle ? 2) is it advisable to change the aorta at this stage ?
Do you have more details of the echo report.
Hi Dr. My son is detected BAV ,
He is 1 year n 2 month old,
His severe valvular aortic stenosis with Gr 70/30 mmHg,
Aortic annulus 12mm, Transsinus
14mm, Stj 11mm, Ascending Aorta 16mm
Please tell me is their need to any treatment on it.
And when we have take action for treatment.
His weight is growing ( now 9.5kg) and activities are normal
Please give us information
Hi, we have a pediatric cardiologist joining myheart.net soon, we will direct this question their way.
In general balloon aortic valvuloplasty is performed to palliate a bicuspid aortic valve for the following indications:
Severe gradient measured in cathaterizaiton lab – peak to peak > 50-60 mmHg. Echo mean gradient correlates best with this.
EKG evidence of left ventricular hypertrophy with strain
Left ventricular hypertrophy by echocardiography with upper moderate gradients.
Young children tend to tolerate moderate gradients very well. Many times, even severe gradients are tolerated, outside of the newborn period and before adolescence.
It is important to wait for the above indications prior to balloon valvuloplasty as the procedure can result in aortic insufficiency. With our current medical technology, the goal is to preserve valve function and allow for growth of the child prior to valve replacement.
…is it really possible to tell how severe aortic stenosis is just by listening to the murmur? My primary doctor at 3 month check up reports a significant “worsening” of aortic stenosis based on change in murmur from previous check up. It was already at the upper limits of moderate. I feel good. Do things normally progress that quickly? My cardiologist says ok to wait until next check up as long as I am asymptomatic.
The asymptomatic part is good as long as you are truly asymptomatic. The character of murmur can suggest severity but is not reliable enough to make management decisions from. If truly asymptomatic you need at least yearly echo.
Thank you sir. I take this condition very seriously and would not hesitate to report any symptoms. My cardiologists are watching closely as there was concern that it had gone from mild to moderate rather quickly. Not completely sure yet how fast things are moving.
Is orthostatic hypotension a sign of increasing valve disease? Diagnosed by a friend who is doctor that witnessed an event i had over the holiday weekend. This has been going on for 5 days. I keep waiting for this to improve, but it’s not. I am 45 and my friend says my heart/severe aortic stenosis is to blame and I should see my cardiologist asap. I had TEE 3 months ago and was told I could wait a year for the next one. I don’t want to run to the cardiologist every time I feel a little twitch.
It depends on the severity of the valve disease. If the valve is known to be severely diseased, for example severe aortic stenosis then the symptoms should be taken seriously if there is no clear alternative cause.
Thank you for your response. It is severely diseased, I think I knew your response before I asked. I agree considering 6 weeks ago was having mostly good days and it has flip flopped. So many articles on this website have been informative and beneficial.
Sir
I am 51, Male and have Bicuspid Valve. My Blood pressure fluctuates (130/80 to 180/80)
This problem was detected around 8-9 yrs ago
Does bicuspid valve raises Blood Pressure ?
My lipid profile is good. I take a healthy diet, lot of Veg and Fruits. Go for Cardio and Resistance Exercises 5 days per week. I also go for Half Marathon. I do not smoke.
I do not have any problem when the BP rises.
I have got checked with Doctors, they are unable to provide any detail of my High BP, they just prescribe medicines.
Can you please help me what could be the problem, a few guidance or suggestions from you will help me a lot
Thanks
Sanjeev
Bicuspid valve alone without significant stenosis is not known to have an effect on blood pressure. It should be treated as any other case of high blood pressure which of course is extremely common. Do you have any significant stenosis of the valve?
Can you please give your opinion about the possible negative effects of ‘g’ force when flying in high speed jets on an undiagnosed bicuspid heart valve with aortic stenosis. Also the effect of strenuous exercise on this and the symptoms that may have arisen. Thank you.
There is no data regarding these issues. They are interesting questions.
19 year old son, severe dizziness, fainting or near fainting on exertion of any type, chest pains. Passed out and came round within 8 minutes on tilt test, diagnosed orthostatic hypertension. Now on fludrocortisone and bp now regulating however symptons are not. Has mild regurgitation and bicuspid valve . Now unable to work , drive or play football . Is this related to his bicuspid valve?
A bicuspid valve by itself without evidence of tightening would not typically be related to such symptoms.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I am a small framed 5 ft. 6in. woman with an ascending aortic aneurysm of 4.7 cm and a bicuspid aortic valve ( moderate stenosis and regurg.). Does the size of the individual have any bearing on when to go in for surgery for an aneurysm? Is the >5.5 cm a standard for everyone regardless of stature?
Great question.
The relative aortic index is important and can predict complication, and could theoretically be justified to intervene at an earlier stage although prospective studies validating such an approach are required. Various methods have been suggested to calculate index however the cut-offs are not well established. 5.5 is not necessarily standard, 5 is used for example in situations where the rate of growth is prominent, in cases with chest pain / aortic symptoms an earlier approach may be taken, and in cases where aortic surgery is required for symptomatic aortic valve disease then a cut off as low as 45 may be used to prevent the need for repeat surgery.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
I am 35 year old female was diagnosed last year with the bicuspid valve they found it when I was having chest pain I still get a lot of chest pain and stay tired is this something I need to talk to my cardiologists about he did a heart cath two months ago and said everything looked good but I don’t seem to be feeling any better is this a problem and do I need to find a new cardiologist
The bicuspid aortic valve will not be associated with chest pain and so is not the cause for the symptoms. The exception is if you were known to have a severe tightening of the valve known as stenosis. The normal heart cath is reassuring in that your arteries are not to blame. It may be wise to look for other causes of the symptoms.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
How do you know the difference between worsening symptoms and that need surgery due to symptom progression? I am 36, have always know about my BAV, and recently was told that there my ascending aorata is enlarged. My doctor has given me the choice to monitor closely with 3 month follow-up or to begin discussions with a surgeon. His decision is based on the fact that my valve has not changed much in over 15 years and in the past 3, it has double in mesurements. (My current condition is graded as moderate BAV with mild to moderate stenosis). The doctor said that he while he is surprised I am experiencing symptoms, the symptoms drive the decision to discuss surgery at this point. I am still young and very active. How does a patient know the difference between a pulled muscle versus chest tightness, etc.?
Mild to moderate stenosis of the valve will not cause symptoms. What are the measurements that you are referring to? In this case i am assuming the decision to initiate surgical discussion is the size of the aorta. Bicuspid aortic valve is associated with enlargement of the aorta known as aortic aneurysm. In general patients with a bicuspid aortic valve and aortic aneurysm should undergo operation for the aneurysm if the aortic size is ≥ 55mm. In patients with risk factors for complications such as those with rapid size increase, high blood pressures, family history of complications and others, surgery at an aortic size of >50mm is considered reasonable. In patients already requiring surgery on the aortic valve for severe aortic valve disease, lower thresholds for aortic surgery may be used, such as 45mm. Decisions are regarding the need for and the type of operation should be made on a case by case basis by a specialist team and take all these factors in to account. For this reason we have a dedicated aortic clinic that addresses these issues. Read this too https://myheart.net/articles/aortic-aneurysm-what-you-need-to-know/
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD
Hi Doctor,
I have been diagnosed with BAV some 6 years ago, but after that I have not followed up. I did EchoCardioGram thrice, before being diagnosed, within 3 years of span, but on that periods the reports were normal. But just after 2 years when i had the normal Echo, I was told to have BAV.
Can it just be the fault of the doctor, last time when i did echo and my heart is still normal ?
Please let me know.
BAV is something you have had your whole life and were born with. Every echo you have ever had should have shown BAV and I suspect on review would show that if you indeed have BAV.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Hi. I am 59 years old male. I recently had an echocardiogram. My EF is 73% and the findings are Concentric LVH i preserved LV function, Normal SWMA, bicuspid aortic v (No gradient) and CF slm MR+ AR+2.. And I’m a hypertension patient
Can you please give your opinion about my condition?
Thanks.
The heart pumping function is normal. The heart muscle is thick because of uncontrolled blood pressure over time and the most important thing at this time is to meticulously control it. The valve has been reported bicuspid however there is no tightening of the valve which is good, have someone listen periodically and obtain an echocardiogram periodically to ensure no development of a worsening of murmur or development of symptoms. There is a leak of the aortic valve reported as 2/4 in severity, this is not likely significant at this point but needs to be monitored over time. I recommend a cardiologist follow this.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Thank you.
Hi, Dr. Ahmed,
My son was diagnosed yesterday with BAV and non rheumatic aortic valve insufficiency (Dr. said it was mild). He is 12 yrs. old. At his appointment, his BP was 114/80. The doctor we saw ( first time to see her), put him on Losartan 25mg twice a day. My question is what is the exact purpose of a BP medicine for this condition? Also, I worry that it will lower his BP too much, since it is the normal range. Is this a common medication that is given for this condition?
Was the aorta dilated? Fort the BAV itself i have never heard of losartan being used as a primary treatment, i suspect it is being used to great something else.
Hello
I just had an echo from my pcp he said there is a 50/50 chance I have BAV. I’m having a follow up echo with my cardiologist this week. This is my 3rd echo in 10 years no one has ever said I have this. I’m 42. What are the chances this was misread?
I see things read wrong all the time. Nowadays most good sonographers should be able to differentiate between bicuspid and tricuspid aortic valve. Its not uncommon for it to have been missed prior.
………………………………………………………………………………………………………….
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed. I am 61 years old male. I recently had an echo. 1. Normal left ventricular size and systolic function. Estimated EF is 60-65%. Borderline concentric LV hypertrophy. 2. Moderately calcified aortic valve. Probable bicuspid aortic valve. No hemodynamically significant aortic stenosis. The mean pressure gradient is 12.0 mmHg. The peak velocity is 223.3 cm/sec. There is no hemodynamically significant valvular aortic stenosis. No aortic regurgitation is present. 3. Mildly dilated aortic root. Mildly dilated ascending aorta (42 mm).
I’m controlling BP and weight. My Mom passed away at 84 years old and had severe aortic stenosis, BAV.
Can you please give your opinion about my condition and opinion whether I need further imaging to determine bicuspid or not and potential next steps?
I don’t think at this stage further testing to clarify the issue would help. It is surprising to me that this couldn’t be determined from review of the echo already performed, maybe they can review. You have a mildly dilated aorta and mild gradient across the aortic valve only. The bicuspid valve is associated with aortic dilation so it is a reasonable contention. It looks like you are taking the right steps with control of traditional cardiac risk factors. At this point, even the diagnosis of bicuspid valve would not likely change your management in any way. I would suggest regular follow up of the aorta and the bicuspid valve to ensure stability over time even though currently there is no real cause for concern.
you can follow my twitter at @MustafaAhmedMD
Hello Doctor,
I am 35, was diagnosed with BAV at 20. I have not had any symptoms since then (used to have incidents of atrial fibrillation), but in the last month have two episodes of increased heart rate (above 200) that both lasted for about 3 minutes, and made me feel like I was going to faint. I have hesitated going to the doctor because I am without health insurance until January. Is this related to BAV? Can I wait another month to go to the doctor? Thank you for your time!
Unfortunately its not safe on an internet platform to advise you not to seek help, with a heart rate of 200 and feeling faint, you absolutely need to go be evaluated or at least speak with a healthcare provider familiar with your history. With regards to the BAV, how was your valve function at the last check?
When one get tightness in heart due to biscupid valve and cant breath and the pain is not bearable what can be done.
It is important to see whether the valve itself is contributing to the symptoms. It would only likely do so if it was sufficiently tight or sufficiently leaky. Echocardiogram should be able to answer these questions fairly easily. It sounds like obtaining a diagnosis is the first step here.
you can follow my twitter at @MustafaAhmedMD
Dr.
I”m a 58 year old male in very good health with BAV insufficiency moving into the severe category (40’s) and a growing abdominal aortic root (4.7mm at the moment). Although asymptomatic so far, it looks as if surgery will be likely in the not too distant future. I’m hopeful both the placement of the stent for the aortic aneurysm and the replacement valve for BAV can be done endoscopically. I think it might be more efficient for the surgeon to open my chest but I think the recovery would be better if they were both done using minimally invasive techniques.
What do you think?
Thanks so much for your opinion.
I will have our new expert surgical aortic valve repair specialist answer this question.
I have Bicuspid Aortic Valve with mild regurgitattion. I also have mild blood pressure which is being treated and in the 120s/70s. My root is at 1.4
My question is regarding tachycardia/ palpitations. Had them since I was a diagnosed but we haven’t been able to diagnose them offficially as they are infrequent and random and dont often last beyond a couple mins. Usually have a couple episodes a week(often occur in bed at night, laying down, when stressed, or sudden changes in posture.) heart rate is steady and rapid 120-130 bpm.
My doctor said she isn’t worried about them at all as long as they go away quickly and don’t happen too often. We did a echo, ekg and stress test and she detected zero p wave activity. So she doesn’t think it’s AFib(said very small chance). In all my 27 years of having these conditions they have never found pwave or Afib activity during testing. Though I’ve never had an episode while being tested. My cardiologist said even without being in episode we would likely have seen some activity that points to Afib.
Is she correct that all the info makes it unlikely to be Afib?
Given my description, what do you think it likely is? Plain tachycardia or palpitations? Is there a chance these won’t progress to more frequent and intense?
With just BAV and mild regurgitation my mortality rate doesn’t change from the regular population, correct?
If it were Afib would that change my diagnosis or affect my mortality rate?
My doctor said that since I’m 27 and my root is only 1.4 size and I’m still mild regurgitation that I likely won’t need surgery till 50s or 60s. Does that sound logical to you?
Just trying to see if I needn’t to prioritize an event monitor for health reasons. Not worried about peace of mind. I can wait till my 2yr appt.
Did you mean 1.4 or 4.4?
What did you mean by 0 p wave activity?
No, she said it was 1.4–which she classified as normal ?
And I’m not sure exactly about pwave, maybe I used it wrong, but she said it was highly unlikely to be AFib based on zero signs of it during so much testing. She didn’t even think we needed event monitor
Correction: my root is 3.6 and my regurgitation is mild to moderate. Am I at risk for dissection? Is this classified as an anuyerism yet?
Its mild dilatation at this point. not anything concerning.
I am 39 year old male, recently by chance diagnosed with BAV. I am presently not feeling any problem.
Does every person having BAV need valve replacement later in life?
As because I have BAV, I am bound to have valve replacement surgery at one time or the other in my life
Those with bicuspid aortic valve will have a higher risk of needing intervention on the aortic valve. Not every patient will require it. In general it depends on development of degeneration of the valve with leak or tightening that determines this. Its important to watch the aorta also.
you can follow my twitter at @MustafaAhmedMD
Hi Dr.
I am 39 and just ,ve been diagnosed with bicuspid aortic valve, mild sclerotic and mild to moderate regug.and
with aortic root 3,3 , a bit fibrotic , asc. aorta is 4,1 . What are your suggestions regarding my limitations ? Aerobics, squats? Lifting till what weight?
Thank you,
Ramona
This depends on the stability of the disease. Its not appropriate to give medical advice directly on this forum since only very few details overall are known. In general for uncomplicated cases with mild dilation only of the aorta there are not activity restrictions.
you can follow my twitter at @MustafaAhmedMD
Wonderful website with much useful information. Thank you! My husband’s latest echo indicates a .61 valve opening and severe stenosis and calcification. His ascending aorta dilation is now at 4.5. up from 3.5 at the same time last year. Has had annual echoes for the past five years and every year things have progressed. He has a bicuspid valve, as do several of his family members. He denies symptoms. (I personally think he is having them, such as SOB.). His cardiologist said come back in a year or call if symptoms develop. At the very least, wouldn’t 3 or 6 month echoes be warranted? How much tighter can the valve get before something catastrophic happens?
What are the symptoms in terms of progression of slowing down / shortness of breath over time? How old is he? Also important is the rate of progression. I would need to know more information to answer you accurately. The valve is very tight at 0.61 and i’m not sure of the reason for waiting a year, i agree thats long.
you can follow my twitter at @MustafaAhmedMD
Thank you for your response. He is 59 years old. As mentioned, he denies symptoms, but I have noticed SOB and definitely fatigue, especially the last six months. He also seems to move his left arm a lot and squeezes his left hand – like it is going numb. When I point that out to him, he dismisses it, saying it’s nothing. He has also been hoarse for quite some time and I understand that may be due to compression of a nerve. I had planned on contacting the doctor’s office before his exam with my concerns over perceived symptoms. However, when I saw his latest echo results (he wants nothing to do with seeing test results), I thought for sure that the doctor would recommend consulting a surgeon. Following is from his last report. I am assuming that since there is no regurgitation, that perhaps that is why his doctor isn’t overly concerned. His coronary arteries are clear also. EF is 60%
Moderate concentric LV hypertrophy
left atrium is mildly dilated
mild mitral valve regurgitation is present
Severe calcific aortic stenosis is present. There is no aortic valve regurgitation
Mild tricuspid regurgitation is present RVSP 26 mmHg
Dilation of the aorta 4.5
Compared to prior study, the severity of the aortic stenosis has worsened (prior peak AV velocity 03.80 m/sec
mean gradient 35 mmHG
peak gradient 58 mmHG
I certainly understand that without seeing him in person, that you really can’t lay out a thorough response, but I thank you for your thoughts in general. I just like to get as much information as I possibly can and, while doing so, came across your website.
Hallo Dr.
I have Bicuspid Aortic Valve and high blood pressure, I have no therapies for the heart, have 36 Years.What would be a good therapy for my situation?
Is the valve functioning well? what is the aortic size?
you can follow my twitter at @MustafaAhmedMD
Hello,
I am 50 years old and was dx with BAV in 2015, diagnosed via routine Echo. Repeat ECHO late 2017 unchanged.
I have no other medical problems except elevated TC which I take Vytorin with now LDL<80
I also did an MRI of heart and it showed very similiar to ECHO: EF 60-70%, no LVH, no regurgitate, no stenosis, mild sclerosis of the valve. Aortic valve 3.9cm (mri) and 4.2 via (echo), Proximal aorta 3.2cm, AVA 2cm square.
My question what are my chances of needing a replacement in the future, does every one with BAV eventually need surgery. I can’t find a solid answer re BAV and replacement in a lifetime. How often do I need next MRI/Echo? If things get worse what are typically first symptoms that I should pay attention to?
After googling more about BAV I sometimes now experience ( maybe somatization) fatigue, dizziness but no CP, no DOE, or palpitations my my VS 120-30/70-80, pulse 50-60, 165#, 5-11.5 height
Thank you in advance,
Very informative web site.
As with any clinical variable, aortic size over time is hard to generalize and thats why its almost impossible to give individual answers. What we know in this case is that the aorta is dilated and the valve is BAV and therefore there is a reasonable chance that intervention at some point may be required although by no means a certainty. Key in this setting is the change over time. The size as things stand here (about 40) is not at all in the range where intervention would be needed nor within a range where complications are expected. What is key is to see in between time points if there is enlargement. Use of gated ct/mri technique is important in reproducibility. Symptoms at this stage are unexpected, of course chest pains should be taken seriously. When i see aortic patients, usually 6 mths is the first interval then the rest spaced out depending on various factors
you can follow my twitter at @MustafaAhmedMD
Hi,
I’m a 25 year old male, active (did a 7 mile hike just yesterday), and eats well and cleanly, who has been referred for an echo by a consultant cardiologist. My purpose for my initial visit was strange ‘spasm’ like heartbeats I have mostly when I lay down (completely painless, no lightheadedness, just a strange feeling which lasts the length of a heartbeat). The cardiologist found a murmur which she said sounded innocent and was “nothing to worry about”. However, she has sent me for an echo (why, if she thought it was innocent?).
Only, having done my research and having had a second opinion from a friend with a medical background (he listened to my murmur and as did I), he suggested that if anything, it sounded like aortic stenosis. Obviously, being young and quite fit, he suggested this would more likely be as a result of BAV. The murmur was loudest when supine and after increasing slightly when standing up, after 10-15 seconds, it seemed to disappear. He said diastole was completely silent with normal splitting of second heart sound on breathing in. Also, both heart sounds were clear.
All my life I have been able to feel my heartbeat quite clearly in my chest. I also seem to have a strong pulse (definitely not slow rising). Though, I am thin and only have a small frame. I was wondering whether this could be linked to stenosis? All I can say is, I do not feel any different at 25 that say I did when I was 15 or younger. I remember having an obsession as a child thinking I could make my heart skip a beat as I breathed in (still freaks me out today..)
Also, if I do have BAV, is aortic valve replacement a certainty? Or does a bicuspid valve have to be calcified heavily for surgery to be suggested?
I have a history of anxiety and depression and this is the last thing I need!
I also have to add that I have had 2 ECGs in my life (one around 7 years ago and one 4 weeks ago) both came back completely normal.
See what the echo shows, chances are its normal.
im 18 i have been diagnosed with ascending aorta aneurysm (39-40mm) i have a bicuspid aortic valve with mild leakiness and mild stenosis. i found out i had these problems less than a year ago and about 4 days ago i was talking to my fiance and out of no where my chest tightened up and i had a pain of someone stabbing me in my chest and it was bad enough it brought me to my knees while grabbing my chest. it lasted maybe 5 mins or so and afterwards i had cold sweats and dizziness what is your opinion on what could be the cause of this
If you haven’t already you need to seek emergent medical evaluation.
Hello Doctor
I had my bicuspid valve replaced 8 years back. I am 31 yrs of age. I had repeated echo’s and i can see
before valve replacement in 2010 my Asc Aorta was 3.9cm
In 2013 Asc Aorta was 4.3cm
In 2015 Asc Aorta was 4.7cm
In 2017 Asc Aorta was 5.1cm (CT Scan shows as 5.2cm)
I have just started beta blockers. What you suggest surgery at this point of time or can i wait till 5.5cm.
Hello Dr.
I have BAV, 4.1cm asc Aorta,
Mild to moderate valve insufficiency, no stenosis. 54yrs old. Good BP 114/72
My Dr. has given the ok to use viagra/sildenafil, but I have heard mixed opinions especially with BAV related issues. Your thoughts?
Thank you
Hello Dr.
I am 55, diagnosed 8 yrs ago with BAV, no stenosis, mild to moderate regurgitation/insufficiency, aortic size originally at about 3.7cm, slowly growing over 8yrs to 4.1cm. With bi-annual ultra sounds have seen things remain relatively unchanged, but have read that aortic size grows a little naturally as we age correct?
My Dr.s (general and cardiologist) have prescribed sildinafil and I have been using it routinely this year in particular. I have read some studies suggesting sildinafil may or may not be good (or at least not fully understood) for various affects on other vessels, the aorta in particular.
I’m wondering, could using this make things worse faster, are there studies on this or talk in the medical community??
Your opinions?
What is the sildenafil for?
you can follow our twitter at @MustafaAhmedMD
It’s viagra, for ED problems.
Hi,
I am 34 I had a murmur was referred to cardio, the cardio said I have a BAV but everything else is healthy without any problems, the murmur is very light. He said to have a next year check ,and then may be 50 or 60 needs a stent . Does this mean you need a operation at 50 or 60, how will it be decided,does everyone with BAV needs stent, or some do not how does this depend.
The procedure is not a stent, but rather aortic valve replacement. In patients with BAV the chance of getting valve degeneration is higher.
you can follow our twitter at @MustafaAhmedMD
I have dizzy spells and low blood pressure. I have just been diagnosed with BAV. Had a sonogram and dr said it was fine right now. Could this be part of the dizziness and tired feeling?
Is it safe to have a cardiac MRI with stress with a bicuspid aortic valve? I am extremely anxious about the stress part of the MRI. My hr is not supposed to go over 131 bpm.
Typically safe.
Please follow our Twitter at @MustafaAhmedMD
My father, my uncle, and my grandfather (all on my fathers side of the family) have had BAV. Statistically, how likely is it that my brother and I will have this same issue?
I would recommend screening for sure,
Studies have found a 15% rate of familial clustering. In a study of 142 patients with bicuspid aortic valve, 20% of first-degree relatives had some cardiac abnormality found by screening, of whom 68% had bicuspid aortic valve. Of these, 71% were newly detected abnormalities.
follow our twitter at @MustafaAhmedMD
I for over a year had foggy spells, this year I have had dizzy spells to which have progressed, couple weeks ago I fainted at work bad chest neck pressure sweaty, was taken to emergency room then exhausted and couldn’t function ended up next 2 days back to a different emergency room ,chest pressure, fire running down left arm, pouring sweat severe nausea. Did not last real long but severe fatigue. Very short of air even with inhalers. Test dobutamine stress, could not do tred mill be used if nausea and Short of air. Labs okay, chest Dr at and brain Ct all okay. Only thing notes was could not rule out anterior infarct. Finally got appt in 2 weeks for a cardiologist. Scared . My brother has NAV, pacemaker and open heart, my mom had aortic aneurysm. Any advise. I have to sit up to sleep, some minor pitting edema in ankles .