Bicuspid Aortic Valve Treatment & Management

Updated: Jan 15, 2019
  • Author: Duraisamy Balaguru, MBBS, MRCP, FACC, FAAP, FSCAI; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Treatment

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 regurgitation, valve stenosis, progressive aortic root dilation) and the prevention of possible bacterial endocarditis by emphasizing importance of maintaining good oral and dental hygiene with regular dental visits (two times each year). Endocarditis prophylaxis is not indicated unless there is prior history of endocarditis, prosthetic valve replacement has been performed or within 6-months from heart surgery complete repair of aortic valvar or other associated congenital heart conditions. [39]

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Surgical Care

Surgery specifically for bicuspid aortic valve is not necessary unless progressive complications ensue (valve regurgitation, valve stenosis, progressive aortic root dilatation, bacterial endocarditis). Surgical options include aortic valve repair, aortic valve replacement using bioprosthesis or mechanical prosthesis, Ross procedure for aortic valve defects and aortic root surgeries for aortic root dilatations. See Guidelines for surgical indications.

Bicuspid aortic valve without significant stenosis or insufficiency does not require any intervention; however, significant stenosis should be addressed. The treatment of congenital aortic valve stenosis was by surgical valvotomy in the past, but with the advent of balloon aortic valvuloplasty, it has become the initial option in the management of congenital aortic stenosis. [40] Balloon aortic valvuloplasty is as good a treatment option for adolescents and adults with congenital aortic valve stenosis as for neonates, infants and children. Given the recent enthusiasm for transcatheter aortic valve replacement (TAVR), it should be emphasized that the TAVR should be reserved for severe calcific stenosis of the elderly. [40]

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

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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 regurgitation) do not require activity restrictions. They may participate in organized competitive sports activities after echocardiography or MRI to assess for dilated aorta. [41]

Patients who develop valve regurgitation or stenosis from a congenitally bicuspid aortic valve may require restrictions from strenuous competitive sports. [42]

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

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