The aortic valve is the valve between the main pumping chamber (the left ventricle) and the aorta, which carries oxygenated blood to the brain and body. The aortic valve normally has three leaflets which serve as a one-way valve to allow blood through to the aorta and prevent it from leaking back into the pumping chamber.
Bicuspid aortic valve refers to aortic valves that have only two leaflets. Over time, the valve can become stenotic, resulting in varying degrees of obstruction across the valve. Additionally, the valve may begin to leak. The left ventricular function may be impaired with deterioration of valve function. The ascending portion of the aorta may also dilate. Usually, the diagnosis of a bicuspid aortic valve is made secondary to the presence of a cardiac murmur or in combination with other defects such as coarctation of the aorta. Patients with Turner syndrome (a congenital syndrome affecting females that often includes major heart defects) have an increased incidence of bicuspid aortic valve. Bicuspid aortic valves are also seen in increased incidence in patients with coarctation of the aorta.
Treatment of mild to moderate stenosis includes medical management of blood pressure, heart failure, if present, and observation and serial evaluation of the pressure gradient across the stenotic valve. If moderate to severe stenosis, balloon angioplasty versus replacement may be considered.
If only regurgitant lesions are present, (aortic insufficiency) serial follow-ups of left ventricular function and dimensions with aortic valvuloplasty and/or replacement as possible options.
Aortic root dilatation can occur with bicuspid aortic valves. This would be followed serially with aortic root/ascending aorta replacement as a surgical option when over 5 cm.