What is Bicuspid AORTA (BAC)? Symptoms, Causes and Treatment

What is Bicuspid Aortic Valve (BAV)?

The aortic valve is one of four valves in the heart and helps move blood from the left ventricle to the aorta, the artery that distributes blood to most of the body. Generally, the aortic valve has three leaflets, or flaps, that open and close with the heartbeat, allowing blood flow from the heart to the aortic vessel. Each time the heart contracts, these valves in the aorta open and close. Bicuspid disease occurs when the aortic heart valve is congenitally divided into two leaves. This situation causes cardiac complications, causing the heart to not work efficiently. The tricuspid aortic valve, which is a 3-leaf valve, generally opens and closes easily and safely. However, abnormally congenitally bicuspid aortic valve leaflets may be thicker than normal, making it difficult for the leaflets to open and close properly.

This condition, one of the most common causes of aortic valve stenosis, causes the heart to work harder than normal to pump blood into the aorta. Sometimes, in the early stages of bicuspid aortic disease, the heart may function normally. However, the valves can thicken over time due to blood flow that is not distributed evenly throughout the valve. This may lead to deterioration of heart function in people with bicuspid aortic disease, which may be normal at first, later on. In some bicuspid aortic patients, the valve does not close tightly and blood may leak. When the blood that needs to be pumped to the body flows back towards the heart, this can lead to aortic valve insufficiency disease, which causes the heart to work harder.

Bicuspid Aorta Symptoms

In the initial stages of bicuspid aortic valve disease, the disease may not cause any symptoms for a long time because the heart valve is able to function properly. In some cases, symptoms may not manifest until adulthood. However, if the aortic valve in a newborn baby is very narrow or there are serious problems with the valve, symptoms may appear immediately after birth. Symptoms that may occur due to bicuspid aortic disease can be listed as follows:

• Pain  and discomfort in the chest
• dizziness
• Inability to exercise due to fatigue
• Severe  shortness of breath
• burnout
• Fainting
• heart palpitations
• pale skin
• having difficulty breathing
• Problems with feeding or weight gain

Unless bicuspid valve disease is treated, the heart may have difficulty pumping the blood the body needs. This may cause various complications in the body. These complications can be listed as follows:

• Aortic valve insufficiency
• Aortic Valve stenosis
• Heart failure
• aortic aneurysm
• Endocarditis: Inflammation of the inner layer of the heart and heart valves.
• Arrhythmias

How is Bicuspid Aorta Diagnosed?

Because the symptoms of bicuspid aortic valve syndrome are similar to those of many diseases, doctors may have difficulty diagnosing the disease. Therefore, special tests may be required to diagnose the disease. The doctor first performs a general examination of the patient and reviews the patient’s medical history. Then he listens carefully to the patient’s heart with the help of a stethoscope. If he detects any heart murmur (a different additional sound) during the listening, he will order more detailed tests to understand the situation more clearly. Methods used to diagnose bicuspid aortic disease can be listed as follows:

• Echocardiography (ECHO) : Echocardiography device; It reflects the heart’s movements, internal structure and function on the computer screen using sound waves. Thanks to this test, problems in the heart vessels and heart valves can be detected by examining the flow of blood in the heart.
• Electrocardiography (ECG) : Electrocardiography, which allows detailed examination of the electrical energy created by the heart; It reflects this energy to the computer screen thanks to electrodes placed on the chest area, wrists and ankles. The computer converts this electrical energy into a graph that the doctor can read.
• Chest x-ray: This x-ray, which allows the heart and blood vessels in the heart to be examined, provides images using X-rays.
• Cardiac  Computed Tomography (CT) : Computed tomography provides detailed examination of the heart and vessels using X-rays. It takes images of the chest area from different angles and combines them to obtain a three-dimensional image.
• Magnetic Resonance Imaging (MRI) : The magnetic resonance imaging device, which has large magnets inside, creates a large magnetic field with the help of these magnets. Thanks to this magnetic field, it allows detailed examination of the heart and cardiac vessels.

Bicuspid Aorta Treatment

In order to treat bicuspid aorta, the severity of the condition and which treatment will be appropriate must first be determined. Bicuspid aortic valve treatment can be achieved by more than one method. When there are no symptoms, doctors call the patient at regular intervals to evaluate the heart. Thus, in a potentially risky situation, the situation can be taken under control with early intervention. When symptoms occur, it may be necessary to replace or repair the heart valves. Bicuspid aortic valve surgery may often be required for this procedure. This surgery can be performed as open heart surgery. In some cases, angiography can also be used. In general, bicuspid aortic valve surgery can be performed in the following ways:

• Aortic valve surgery: In this procedure, the rib cage is cut in half vertically and the heart is exposed. In this way, operations can be performed on the heart.
• Minimally invasive aortic valve surgery: In this procedure, which is performed with a smaller incision, the incision is made over the chest and ribs. Bicuspid valve surgery, performed minimally, can allow surgery on the heart without opening the entire chest. It is also possible to perform aortic valve replacement via catheter, which is another minimally invasive method, in suitable patients   . In this way, blood loss is reduced and a faster recovery process can occur.

Methods used to repair or replace the aortic valve can be listed as follows:

• Aortic valve repair: In this procedure, the valve can be repaired without replacement. This method, which is used especially to treat aortic insufficiency, is usually performed with a minimally invasive procedure. The surgeon reshapes the aortic valves to make them tighter.
• Aortic valve replacement: When repair of the valves is not possible, the valves may need to be replaced completely. This procedure can be performed with open heart surgery or  TAVI , a minimally invasive surgical procedure  . There are two options for new covers to be installed. 

These options can be listed as follows:

• Biological valve: These valves, made from pig or cow tissue, can be used for many years; However, it has a shorter lifespan than mechanical valves.
• Mechanical valve: People who use these valves use blood thinners regularly to ensure that blood spreads throughout the body regularly. In this way, blood clot formation is prevented.

Your doctor may prescribe medication to keep bicuspid aortic disease under control and to make treatments more effective. You may also need to make changes in your lifestyle. Being more careful, especially in situations such as sleep patterns, exercise and nutrition, can improve your quality of life by positively affecting heart health. In addition, avoiding harmful habits that will negatively affect your heart health can make the treatment more efficient. Participating in a  cardiac rehabilitation  program can help you with these issues. If you think you have symptoms of bicuspid aortic valve disease, do not forget to consult your doctor or the nearest health institution for early diagnosis and treatment.