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Bicuspid Aortic Valve
Open BAV
The opening of a BAV
resembles the open mouth
of a fish, leading to the
term “fish mouth” valve.
BAV and the Aorta
Aortic Aneurysm and Dissection
At one time it was thought that the abnormal blood flow
from a bicuspid aortic valve was the main cause of
enlargement of the ascending aorta. However,
development of an ascending aortic aneurysm has been
observed in the presence of a normally functioning
bicuspid aortic valve. Also, the aneurysmal progression of
the ascending aorta following replacement of the bicuspid
aortic valve indicates the intrinsic aortic wall abnormality
present in this syndrome. In addition, family members
with normal-appearing tricuspid aortic valves may
also experience aortic aneurysm and dissection.
Bicuspid aortic disease is increasingly being understood
as degeneration of the medial layer of the aorta, resulting
in an aortic wall that gradually loses its strength. This
condition causes the aorta to over stretch with each beat
of the heart, eventually leading to formation of an
aneurysm. Secondary to the anatomical nature of the
ascending aorta (which is relatively free inside the
pericardium), and its exposure to maximal blood flow from
the heart, the aortic root and ascending aorta are the most
common sites of aneurysm formation.
This weak aortic tissue is prone to dissection and rupture.
Given that many also develop labile hypertension, this
combination of high pressure and weak aortic tissue
potentially can result in a life-threatening situation.
Bicuspid Aortic Valve
Closed BAV
When closed, it may be
difficult to distinguish a
BAV from an aortic valve
with all three leaflets.
Tricuspid Aortic Valve
Closed TAV
A normal aortic valve has
three leaflets or cusps.
Pictured here is a TAV with
the leaflets closed. The
opening of a TAV is shaped
like a triangle.
Aortic Aneurysm
The aorta in those from BAV
families may be enlarged
and balloon out, which is
called an aneurysm.