BICUSPID HEART VALVE

Dear Doctor,

My daughter, aged 19 now, was examined immediately on birth by a cardiologist, since she was born following foetal distress experienced by her mother. The doctor said it was a minor heart valve problem which would be alright with passage of time. A few years ago, a primary physician could hear a murmur during a routine exam and advised an echo. The echo was performed under supervision of the same cardiologist, who had seen her at birth. The cardilogist said that there was no infection, no endocarditis or any other abnormality, but advised regular monitoring.

We have shown her to primary physician again, following little complaints of exhaustion. He could not find anything wrong but we are going for an echo next week.

Please tell us what are the normal precautions that we have to take, even if the Echo Report, hopefully, is fine. Can she go about her daily routine normally? She is in College and intends to pursue with her studies for another 5 years, before settling down in a job. Can she have a normal married life, with children? She is little short (5 feet), other wise has had no other apparent health issues so far. At what stage would the valve condition likely to give a patient any problem? Please relieve our anxiety, with your clarifications.

Regards,

Murty
  

[MidLifeinCA]

My son age 17, was diagnosed with Biscuspid Valve Aeortic Stenosis at the age of 4.
His gradient varied between 12 and 17%, which is considered mild.  My son sees a cardiologist twice a year from Lucille Packard/Stanford to monitor.  By watching his diet, no caffeine, smoking ect, he is doing great.  I do not know from your comment if the valve is stenotic.  On my sons last visit Feb 08, his echo was completed using the new 3D/4D machine which was amazing to see. Due to the fuzzy grainy picutres of the old echo machines they were unable to determine my sons Bicusp was in fact a Tricusp!!!  His chance of ever having surgery just dropped to 1%,  If your daughters confition is mild and she easts right, plenty of rest exercise ect, they told me my son could go his whole life without ever having surgery, which was my goal, now that we have found out through modern technology that his valve is a tricusp, according to his cariologist, no meds and he will live to be 120!!! :):)  Have a 3D echo done, to make sure it is in fact a bicusp.  Which is a two instead of a 3 chamber. I would start there. Even when they thought my son was a bicusp, we did not have to refrain from exercise and no meds were prescribed, becasue he was not overweight and ate healthy.  The key is to live healthy and stay in the mild zone.  That is what his Doctor always advised.  Also, very important you are comfortable with her cardiologist, that he or she goes the extra mile and answers any and all questions you may have, if not get another one.

[kenkeith]

The bicuspid aortic valve has been recognized as a common congenital abnormality for centuries. It is a common abnormality, bicuspid aortic valve is mentioned only briefly in many pediatric and cardiology textbooks.

For some insight: The abnormal configuration determines the outlook or prognosis. The bicuspid valve is composed of 2 leaflets or cusps (rather than three) and usually of unequal size. The larger leaflet is referred to as the conjoined leaflet. Two commissures (or hinge points) are present; usually neither is partially fused. The presence of a partially fused commissure, which has also been called a high raphe, probably predisposes toward eventual stenosis. At least half of all congenitally bicuspid valves have a low raphe, which never attains the plane of the attachments of the two commissures and which never extends to the free margin of the conjoined cusp. Redundancy of a conjoined leaflet may lead to prolapse and insufficiency.  

Your cardiologist with an echo test is able to determine viability and apparently the condition is not considered a problem.  A problem would be a prolapse (leaflets would not completely close when the internal pressure is created in the left ventricle during the pumping phase...some back flow of blood into the receiving chamber and not into circulation).  It is not uncommon to have some leakage with the general public.  So the degree of backflow (insufficiency) should be monitored to verify there is no progression.  It is very probable there will be no limitations and a normal life.