Bicuspid Aortic Valve: Diagnosis, Follow-up and Treatment

What is a bicuspid aortic valve?

The aortic valve lies between the left ventricle and the aorta, the main artery carrying blood to the body. A normal aortic valve has three leaflets. A bicuspid aortic valve is a congenital condition in which the valve has two functional leaflets instead of three.

It may function normally for many years. Over time, however, narrowing or leakage can develop. Some patients also have enlargement of the aortic root or ascending aorta.

What symptoms can occur?

Many people have no symptoms and are diagnosed after a heart murmur is heard or during echocardiography. When significant valve disease develops, symptoms may include exertional breathlessness, fatigue, chest discomfort, dizziness, fainting or palpitations.

What problems can it cause?

Aortic stenosis

Thickening and calcification can reduce valve opening, making it more difficult for the left ventricle to eject blood.

Aortic regurgitation

If the leaflets do not close fully, blood flows back into the left ventricle. Significant leakage can gradually enlarge the ventricle and affect its function.

Aortic enlargement

The aortic root or ascending aorta may enlarge. The risk and need for intervention depend on aortic size, growth rate, family history and other clinical features. Valve function and aortic dimensions must both be followed.

Infective endocarditis

Infection of the valve is a possible complication. Good oral hygiene and appropriate dental care are important. A bicuspid valve alone does not automatically mean antibiotic prophylaxis is required before every dental procedure.

How is it diagnosed?

Echocardiography identifies valve morphology, measures stenosis or regurgitation and assesses ventricular function and visible aortic dimensions.

CT or MRI may be needed when the ascending aorta cannot be assessed adequately by ultrasound or when more precise measurements are required. Other tests are selected according to symptoms and treatment planning.

How often should it be followed?

There is no single follow-up interval for everyone. Timing depends on valve function, aortic diameter, previous measurements and symptoms. More frequent imaging may be needed with significant valve disease or aortic enlargement.

How is it treated?

A normally functioning bicuspid valve does not require intervention solely because it has two leaflets. Treatment includes risk factor management and appropriate blood pressure control.

Significant stenosis or regurgitation may require valve intervention. Surgical or catheter-based options are considered according to age, anatomy, aortic disease and other clinical factors. Aortic enlargement may require surgery, sometimes together with valve surgery. Decisions are individualised rather than based on one measurement alone.

Should relatives be screened?

Because bicuspid aortic valve and associated aortic disease can occur in families, first-degree relatives may benefit from echocardiographic screening.

Can patients exercise?

Exercise recommendations depend on valve severity, aortic dimensions, symptoms and blood pressure. Heavy straining and high-intensity activities may need restriction in some patients, especially with significant aortic enlargement.

When is urgent care needed?

Sudden severe chest or back pain, fainting or acute breathlessness requires emergency assessment. Call 112. New exertional symptoms should also prompt a cardiology review.

Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist

This information is educational. Follow-up and treatment are tailored to the individual.

Türkçe: Biküspit Aort Kapağı