Bicuspid Aortic Valve Treatment
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Bicuspid aortic valve disease can sneak up on you, making you short of breath and tired. You might have chest pain or dizzy spells, leaving you worried about your heart health. If you have a bicuspid aortic valve, it means one of the valves in your heart isn’t the ideal shape. This can make it harder for your heart to do its job.
At UVA Health, our aortic experts can get right to the root of your symptoms. And we can fix your bicuspid valve if your symptoms are getting serious. In fact, 5 of our heart, vein, and artery treatments got the highest possible rating from U.S. News & World Report, including aortic valve surgery and TAVR.
Bicuspid Aortic Valve Treatment at UVA Health
Your aortic valve lets oxygen-rich blood flow from your heart into your aorta, your body's largest blood vessel. The aorta carries blood away from your heart to your body. The aortic valve usually has 3 flaps (called cusps) that keep blood flow from moving backward. A bicuspid valve only has 2 cusps.
How we treat your bicuspid aortic valve disease depends on your symptoms. In mild cases, you may not need treatment. If you do need treatment, it might include:
- Medicine to manage symptoms and other heart issues
- Surgery or a procedure to repair or replace the valve
Medicines can't repair your bicuspid aortic valve. But they can help with symptoms.
Bicuspid Aortic Valve Surgery & Procedures
When medicines aren’t working, you may need a procedure or surgery to fix your aortic valve. The best way to fix your aortic valve depends on lots of factors. We'll go over with you the best choice for your condition. Options include:
- A procedure called transcatheter aortic valve replacement (TAVR)
- Open valve surgery
Transcatheter aortic valve replacement (TAVR) uses only very small cuts on your body (called incisions) so that we can get to your aortic valve. Through the incisions, we thread a small tube (called a catheter) to reach your aortic valve and replace it.
TAVR isn't the right choice for everyone. If we can't use TAVR, we can still repair or replace your bicuspid valve with a traditional open surgery.
When Doctor Becomes Patient: Mark's Bicuspid Valve Journey
As a primary care physician, Mark Lepsch, MD, guides countless patients through diagnoses and decisions. But when his bicuspid heart valve caught up with him, he found himself facing open-heart valve surgery.
Mark Lepsch:
My name is Mark Lepsch. I turned 55 years old this past year. I've been a primary care physician at Northridge Internal Medicine for the last 21 years. I was a patient of the cardiovascular surgery service where I was given a second chance at life. I was born with a bicuspid aortic valve, two leaflets instead of three, and they tend to wear out often in your 50s and mine was done.
Dr Beller:
So for Mark, he's known about this for some time, the bicuspid valve, and it's been monitored over the years. In the last year, he started to notice that he was developing some more shortness of breath when he was doing activities that he used to be able to do.
Mark Lepsch:
It was just before I turned 55, about nine months ago, where I suddenly noticed things were different. I was out of reserve. If I got a little bit sick, it would last for weeks and I would be exhausted. But then around two months ago, the wheels really came off the train. And at that point, I had actually started to go into early heart failure.
Dr Beller:
Mark is younger than most of the patients that we treat with aortic stenosis, and along with that, he had some concerns about surgery at such a young age and what that might mean for the future. And so obviously, Mark was very knowledgeable about the subject and had a lot of ideas and thoughts about what that might look like. Together, we were able to come to a conclusion and a decision about when to have surgery and what type of surgery to have.
Mark Lepsch:
These days, probably a significant majority are done through catheters. They're no longer open heart procedures. My evaluation proceeded. It became clear that I was going to have to have open heart surgery, and quite frankly, that was terrifying. It was either do this surgery or slowly decline and die in the next few years. The one consistent and constant was that I never had anything but the utmost confidence in the cardiovascular surgery teams at UVA.
Dr Beller:
The procedure itself went really well. Mark did great during the operation and recovered very nicely afterwards. Like all patients, go through some ups and downs during the recovery period, but overall, he did great.
Mark Lepsch:
The team was as responsive, as comforting as possible. So I'm getting better and better and actually ahead of the curve and going back to work, not even six weeks after I had the surgery. I've been fortunate because I am emblematic of, you know, it takes a village. There has not been anyone from the entire cardiovascular surgery team to my family, to my friends, who has been anything other than wonderful. It's been really an honor and a great pleasure to heal and then be able to share with them that I'm healing, that I lived.
Why Did I Get Bicuspid Aortic Valve Disease?
A bicuspid aortic valve is something you're born with (called congenital heart disease). We don’t yet know why the aortic valve only forms 2 cusps instead of 3 in some people.
You’re more likely to have it if you:
- Have family members with a bicuspid aortic valve (passed on in family genes)
- Have a genetic disease, like Marfan syndrome
- Are male (it’s more common in men)
Don't Ignore Bicuspid Valve Symptoms: See an Expert
Many people never feel any symptoms or even learn that they have a bicuspid aortic valve. Others show symptoms at birth or while they’re still babies.
You might feel:
- Chest pain or tightness
- Trouble beathing or feeling like you’re not getting enough air
- Fatigue
- Dizziness or fainting
- Heart murmur
If you're having bicuspid valve symptoms, it's important to see an aortic valve expert. A bicuspid valve can make it harder for your heart to pump blood around your body.
Most commonly, the valve leaks or becomes stiff over time, leading to heart disease that shows up when you’re an adult. And with a bicuspid aortic valve, you may be more likely to get other heart or artery conditions, like:
- Aortic stenosis (the valve becomes narrow and limits blood flow)
- Regurgitation (blood flows back into the heart)
- Aortic aneurysm (pressure causes your aorta to get bigger, which puts it at risk for tearing)
Without treatment, your body doesn’t get the right amount of oxygen, and you may develop heart failure.