Open BAV

The opening of a BAV resembles the open mouth of a fish, leading to the term “fish mouth” valve.

Bicuspid Aortic Valve Overview The bicuspid aortic valve (BAV) may seem to be a very simple birth defect of the heart. Perhaps this is because it frequently does not require surgical treatment early in life. There is no real way to predict if or when a bicuspid aortic valve will fail due to stenosis and/or aortic insufficiency. A bicuspid aortic valve may develop problems at different stages of life, including infancy. Some BAVs may continue to work well for an entire lifetime, but most will require treatment at some point. The valves of the heart are like one-way doors or gates. They open and close to direct the flow of blood into and out of the heart and between the chambers inside the heart. The aortic valve is the gate between the main pumping chamber of the heart, the left ventricle, and the main artery of the body, the aorta. The aortic valve is able to open and close because it has leaflets (cusps). In a normal aortic valve there are three leaflets, and because of this it is called trileaflet. The word bicuspid is used to describe an aortic valve that is not normal; it has only two cusps or leaflets. The highest pressure in the circulatory system is experienced by the left ventricle, aortic valve, and ascending aorta. When the heart muscle of the left ventricle contracts, the aortic valve leaflets separate, making an opening and allowing blood to flow from the heart into the aorta. When the heart muscle relaxes, the leaflets fold back together, closing the opening so that blood cannot flow back into the heart again. For proper blood flow, it is important for the valve leaflets to open widely and then close tightly. The bicuspid aortic valve may not function as perfectly as a trileaflet valve, but it could open and close well enough to support normal life and activity for some time. As the drawings show, a bicuspid aortic valve generally looks different than a trileaflet aortic valve. However, in reality the malformation can be very subtle and may not be found by routine echocardiography. With time, a bicuspid aortic valve may begin to leak (insufficiency, regurgitation), become narrowed (stenosis), or do both of these. Calcification of the leaflets may occur. It is also prone to bacterial infection, which is called endocarditis. These valve-related complications are the part of bicuspid aortic disease that is most well known. It should be remembered that while the diseased aortic valve is very important, it is only one part of this condition. Repairing or replacing a bicuspid aortic valve addresses the valve issue but not a diseased aorta.

Tricuspid Aortic Valve A closed trileaflet aortic valve and a closed BAV may be difficult to tell apart.

BAV is Common It is very likely that you know someone with BAV. It could even exist in your family or extended family without you knowing about it.