A bicuspid aortic valve (BAV) is an aortic valve that only has two leaflets, instead of three.
The aortic valve regulates blood flow from the heart into the aorta. The aorta is the major blood vessel that brings oxygen-rich blood to the body.
Bicommissural aortic valve; Valvular disease - bicuspid aortic valve; BAV
The aortic valve allows oxygen-rich blood to flow from the heart to the aorta. It prevents the blood from flowing back from the aorta into the heart when the pumping chamber relaxes.
BAV is present at birth (congenital). An abnormal aortic valve develops during the early weeks of pregnancy, when the baby's heart is developing. The cause of this problem is unclear, but it is the most common congenital heart defect. BAV often runs in families.
A BAV may not be completely effective at stopping blood from leaking back into the heart. This leakage is called aortic regurgitation. The aortic valve may also become stiff and not open up. This is called aortic stenosis, which causes the heart to pump harder than usual to get blood through the valve. The aorta may become enlarged with this condition.
BAV is more common among males than females.
A BAV often exists in babies with coarctation of the aorta (narrowing of the aorta). BAV is also seen in diseases in which there is a blockage to blood flow on the left side of the heart.
Most of the time, BAV is not diagnosed in infants or children because it causes no symptoms. However, the abnormal valve can leak or become narrow over time.
Symptoms of such complications may include:
If a baby has other congenital heart problems, they may cause symptoms that will lead to the discovery of a BAV.
The infant or child may need surgery to repair or replace a leaky or narrowed valve, if complications are severe.
A narrowed valve can also be opened through cardiac catheterization. A fine tube (catheter) is directed to the heart and into the narrow opening of the aortic valve. A balloon attached to the end of the tube is inflated to make the opening of the valve larger.
In adults, when a bicuspid valve becomes very leaky or very narrowed, it may need to be replaced.
Sometimes the aorta may also need to be repaired if it has become too wide or is too narrow.
Medicine may be needed to relieve symptoms or prevent complications. Medicines may include:
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How well the baby does depends on the presence and severity of complications of BAV.
The presence of other physical problems at birth also can affect how well a baby does.
Most babies with this condition have no symptoms, and the problem is not diagnosed until they are adults. Some people never find out that they have this problem.
Complications of BAV include:
Call your child's provider if your baby:
BAV runs in families. If you know of this condition in your family, speak to your provider before becoming pregnant. There is no known way to prevent the condition.
Borger MA, Fedak PWM, Stephens EH, et al. AATS consensus guidelines on bicuspid aortic valve-related aortopathy: full online only version. J Thorac Cardiovasc Surg. 2018;156(2):e41-74. doi: 10.1016/j.jtcvs.2018.02.115. PMID: 30011777 pubmed.ncbi.nlm.nih.gov/30011777/.
Braverman AC, Cheng A. The bicuspid aortic valve and associated aortic disease. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald's Heart Disease. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 11.
Fraser CD, Cameron DE, McMillan KN, Vricella LA. Heart disease and connective tissue disorders. In: Ungerleider RM, Meliones JN, McMillian KN, Cooper DS, Jacobs JP, eds. Critical Heart Disease in Infants and Children. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 53.
Lindman BR, Bonow RO, Otto CM. Aortic valve disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 68.