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Signs & Symptoms of a Bicuspid Aortic Valve

The human heart has four chambers, each with a valve that lets blood out of the heart, and acts as a flap that prevents back flow into the heart. A bicuspid aortic valve affects the aortic valve located between the right ventricle and aorta. The aortic valve develops only two leaflets (i.e., cusps) instead of three, resulting in Bicuspid Aortic Valve Disease (BAV). The Journal of Current Problems in Cardiology reports that BAV affects one to two percent of the population. But the numbers are not believed to be exact because they're based on autopsies and don't account for undiagnosed cases in the living population. BAV is a congenital and hereditary condition. Eighty-five percent of children diagnosed with a heart problem have BAV.

  1. BAV Structure

    • A normal aortic valve has three cusps, divided by three commissures, or distinct grooves that outline the individual cusps, attached to the aortic wall. In BAV cases, the grooves may be indistinct or fused together (Raphe), resulting in one large cusp and one normal-sized cusp. With most BAV cases being diagnosed during the fourth decade of life, the Raphe may have become calcified and impossible to differentiate from a true commissure. The only difference is that Raphe do not attach to the aortic wall. The presence of only two cusps, however, will confirm the diagnosis.

    Resulting Conditions

    • With age, the BAV may weaken and fail to close or open properly, indicating a valve failure. When the valve fails to open properly, calcium deposits begin to form on the cusps, resulting in a condition called stenosis (i.e., blockage). Stenosis requires the heart to work harder to pump blood through a narrow opening and eventually stresses the heart, hardening the muscles around the left ventricles.

      BAV can also cause regurgitation, or BAV insufficiency. The valves fail to close completely, allowing leakage and back flow into the ventricle. This condition places extra strain on the heart by requiring extra pumps to empty out the ventricle, and can result in stretched heart muscles in the left ventricle and diminished pumping strength.

    Medical Signs of BAV

    • BAV will almost always enlarge the aorta. Medical tests are ordered when a routine examination uncovers irregular heart conditions. Some examples are a heart murmur heard through a stethoscope, arrhythmia detected through an electrocardiogram (EKG), or an X-ray showing enlargement of the heart. A magnetic resonance imaging (MRI) will help confirm the diagnosis.

    Symptoms of BAV

    • Common signs of BAV are chest pain (angina), shortness of breath, fatigue, persistent cough at nighttime when lying down, or dizziness due to irregular blood flow. Heart palpitations can also be a symptom. BAV symptoms can mimic heart failure.

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