Bicuspid Aortic Valve Treatment & Management

  • Author: Edward J Bayne, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Sep 27, 2011
 

Medical Care

No specific medical care is required for individuals with bicuspid aortic valve unless they have progressive deterioration or infection. Serial follow-up evaluations are important for early recognition of potential complications (valve insufficiency, valve stenosis, progressive aortic root dilation) and the prevention of possible bacterial endocarditis.

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Surgical Care

Surgery specifically for bicuspid aortic valve is not necessary unless progressive complications ensue (valve insufficiency, valve stenosis, progressive aortic root dilatation, possible bacterial endocarditis).

The patient with known bicuspid aortic valve no longer requires antibiotic prophylaxis for invasive dental or noncardiac surgical procedures.[32] If endocarditis has occurred on a bicuspid aortic valve, antibiotic prophylaxis is recommended.

For noncardiac procedures, preoperative cardiac evaluation may be appropriate, particularly for patients with aortic stenosis or insufficiency. The patient with simple, uncomplicated bicuspid aortic valve should not require special anesthetic precautions, other than bacterial endocarditis prophylaxis, when appropriate.

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Diet

Because hypercholesterolemia and other coronary artery disease risk factors may accelerate the sclerosis and deterioration of a congenitally bicuspid aortic valve, a heart-healthy diet is recommended for all patients, not only those with recognized risk factors. This diet should limit fat calories to no more than 30% of total calories. Calories from saturated fats should be limited to no more than 10% of total.

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Activity

Patients with normally functioning bicuspid aortic valves (ie, no stenosis or insufficiency) do not require activity restrictions. They may participate in organized competitive sports activities after echocardiography or MRI to assess for dilated aorta.[33]

Patients who develop valve insufficiency or stenosis from a congenitally bicuspid aortic valve may require restrictions from strenuous competitive sports.[34]

Patients with aortic valve insufficiency should avoid strenuous isometric activity, such as weight lifting, rope climbing, and pull-ups.

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Contributor Information and Disclosures
Author

Edward J Bayne, MD  Assistant Professor, Division of Pediatric Cardiology, Emory University School of Medicine; Consulting Staff, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta

Edward J Bayne, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul M Seib, MD  Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

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Bicuspid aortic valve with unequal cusp size. Note eccentric commissure and raphe.
Parasternal long-axis echocardiogram showing doming of a bicuspid aortic valve.
Parasternal short-axis echocardiographic view in diastole, showing bicuspid aortic valve with nearly equal cusp size and right-left orientation of the commissure. Note the 2 color signals showing minimal aortic insufficiency.
Two-dimensional echocardiogram of typical bicuspid aortic valve in diastole and systole. Valve margins are thin and pliable and open widely, creating the fishmouth appearance.
Long-axis and short-axis transthoracic echocardiograms showing a bicuspid aortic valve. In diastole, hammocking (prolapse) of the valve cusps occurs. The short-axis view shows the irregular sclerotic margins. This type of bicuspid valve is the most commonly replaced, typically because of insufficiency.
Basilar oblique transesophageal image showing congenitally bicuspid aortic valve with vegetation (due to Streptococcus viridans endocarditis).
 
 
 
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