Aortic Valve Insufficiency

  I am a 43 year old male and learned for the first time in July of this year that I had a heart murmur.  An echocardiogram showed that I have leakage of the aortic valve and that my left ventricle is dilated.  I think the numbers quoted to me were 5.3 when the muscle is contracted and 7.1 relaxed.  I have never been told the quantity of regurgitation.  A TEE showed that I have a bicuspid aortic valve.  Prior to this diagnosis I had no syptoms (symptoms) that I was aware of.  In fact, 5 months earlier, I had started an exercise training program and was doing a cardio routine at 140-150 heart beats per minute and a strength training program where I was gradually increasing weights in a full body workout.  I have been feeling better than I have in years.  I am being advised that I need valve replacement surgery.  I have several questions.
  1.  Is there any reason to believe that the exercise routine I started caused or exacerbated the leakage in the valve or the dilation of the ventricle?
  2.  If question 1 is yes, is there any chance that a reduced program will result in the size of my ventricle returning to a more normal size.
  3.  Is repair of the valve an option, rather than replacement?
  4.  How do I find out if I would be a candidate for the minimally invasive techniques that are being used now?

[Cleveland Clinic, MD]

Dear  Darwin,
The aortic valve is the valve that separates the left ventricle from the aorta.  It is made of 3 leaflets or flaps that look like an peace symbol when the valve is closed.  A bicuspid aortic valve means that there are 2 leaflets instead of the usual 3.  A unicuspid valve means there is only one leaflet.   Bicuspid aortic valve is the most common congenital anomaly of the heart.  These valves are functional at birth and remain so throughout a normal life span.  There is a increased predisposition to progress to stenosis (narrowing) as an older adult (60-70