Bicuspid aortic valve: what it is, why it happens and how to treat it

The bicuspid aortic valve is a congenital heart disease, which arises when the aortic valve has 2 leaflets, instead of 3, as it should, a situation that is relatively common, as it is present in about 1 to 2% of the population.

The bicuspid aortic valve may not cause symptoms or any type of alteration, however, in some people it can evolve with complications over time, such as aortic stenosis, aortic insufficiency, aneurysm or infective endocarditis, which can cause dizziness, palpitations or lack of air, for example.

These complications happen because the bicuspid valve is more affected by the passage of blood flow, which can lead to injuries. Therefore, it is important that the treatment is done as soon as it is identified, with guidance from the cardiologist, who can indicate annual exams, use of medications or surgery to replace the valve.

What are the causes

Anyone can be born with the bicuspid aortic valve, as its exact causes have not yet been clarified. This is a defect developed during the development of the embryo in the maternal uterus, a period in which there is a fusion of 2 of the valves, forming one. This is probably due to genetic causes, with some cases being transmitted hereditarily from parents to children.

In addition, the bicuspid aortic valve may appear in isolation or associated with other cardiovascular malformations, such as coarctation and dilation of the aorta, interruption of the aortic arch, interventricular septal defect, Maritime syndrome or Turner syndrome, for example.

The heart contains 4 valves, which control the flow of blood so that the heart can pump both to the lungs and the rest of the body, so that it follows a single direction and does not return in the opposite direction during the heartbeat, however, these valves may be defective during the formation of this organ. Valve defects are the main causes of heart murmur, understand what it is, the causes and how to treat this problem.

How to identify

A bicuspid aortic valve can function normally, not necessarily evolving into a disease, so a large proportion of people who have this disorder do not have any symptoms. Generally, in these cases, the doctor can detect an alteration during the routine physical examination, in which a murmur with a characteristic sound can be heard along the heartbeat, called a systolic ejection click.

However, in about 1/3 of the cases, it is possible for the bicuspid valve to show changes in its function, usually in adulthood, which alters the blood flow and can cause symptoms such as:

• Fatigue; Shortness of breath; Dizziness; Palpitation; Fainting.

These symptoms can happen to a greater or lesser extent, depending on the severity of the change caused and its influences on the functioning of the heart.

To confirm the diagnosis of the bicuspid aortic valve, the cardiologist will request an echocardiogram, which is an exam capable of identifying both the shape of the heart valves and the functioning of the heart. Understand how the echocardiogram is done and when it is necessary.

Possible complications

The complications that a person with bicuspid aortic valve can present are:

• Aortic stenosis; Aortic insufficiency; Aortic dilation or dissection; Infectious endocarditis.

Despite appearing in only a few cases, these changes can happen in anyone with this condition, since the mechanical stress during the passage of blood is greater in those who have the bicuspid valve. The possibility of complications is greater over the years, and it is greater in people over 40 years.

How the treatment is done

Generally, a person with a bicuspid aortic valve can lead a normal life, as this change does not usually cause symptoms or repercussions on the person's physical capacity. In these cases, an annual follow-up with the cardiologist is required, who will request an echocardiogram, chest X-ray, ECG, holter and other tests capable of identifying changes or worsening of the condition, if any.

The definitive treatment is done with surgery, and procedures that involve dilation, minor corrections or, even, valve replacement surgery may be indicated, for which a rigorous analysis of the valve shape, its changes and its compromise is necessary. functioning of the heart, very important to determine the ideal type of surgery, which must be individualized, with assessment of the risks and diseases that each person has.

The valve can be changed by a mechanical or biological valve, which is indicated by the cardiologist and cardiac surgeon. Recovery from surgery takes time, requiring a hospitalization period of about 1 to 2 weeks, in addition to rest and a balanced diet. Check out what recovery is like after aortic valve replacement surgery.

In some cases, the doctor may also recommend the use of medications, such as antihypertensive drugs, beta-blockers or ACE inhibitors, or statins, for example, as a way to reduce symptoms or delay the worsening of cardiac changes, being smoking cessation, blood pressure and cholesterol control are also recommended.

In addition, people with the bicuspid valve may need antibiotic prophylaxis, using periodic antibiotics to prevent infection by bacteria that cause infectious endocarditis. Understand what it is and how to treat endocarditis.

Is it possible to practice physical activities?

In most cases, a person with a bicuspid aortic valve can practice physical activities and lead a normal life, and there may be restrictions only in cases where the patient progresses with complications, such as a dilation or narrowing of the valve, or with changes in the functioning of the heart..

However, it is very important that a practitioner of physical exercises with this alteration makes periodic evaluations with the cardiologist and echocardiogram exams, in order to monitor the functionality of the valve and if there is an evolution to any complications.

In addition, high-performance athletes, due to the high efforts made, can develop the "athlete's heart", in which the person has physiological adaptive changes in the heart, with the possibility of enlarging the ventricle cavity and thickening of the heart wall. These changes do not usually progress to heart disease, and are usually reversible with the suspension of exercise. However, there must be strict attention to these changes in periodic evaluations by the cardiologist.