stenosis

[Ted-Cotrel]

  I have a bicuspid Aortic valve and am 52 yrs old in excellent condition otherwise..
  I have no symptoms other than slight shortness of breath  upon heavy exertion
  The valve is getting pretty tight ..I think under 2cm.. maybe 1.5?
  WHat is the best valve to use as in this circumstance when it needs to be replaced which they think
  is in the next couple of yrs
  
  I know this is a stupid question and there is no one answer but I wanted to see what kind of response
  I might get
  Thank you
  Ted

[Cleveland Clinic, MD]

Dear  Ted,
I don't think this is a stupid question at all.  The type of valve to use (if necessary) is not a straightforward choice and depends upon multiple factors.  First, let me provide some review for those readers who may not be familiar with bicuspid aortic valve.
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’s) and surgical repair may be required at that time.  Replacement is not generally required until the valve has an area of less than 1 cm2.  There is also some increase in the incidence of infective endocarditis (infection of the valve).
There are no physical restrictions for individuals with bicuspid aortic valve.  
There are no special diet restrictions.
Q: Are there some people who have had bicuspid aortic valve who will never have to have a valve replacement or will everyone with this problem eventually have to get their valve replaced?
A: Only a small percentage of people with this condition will eventually need surgery.
Q: What type of replacement valve is best should surgery be required?
A: The choices are a bioprosthetic valve (from an animal), a mechanical valve, or a homograft (from a human cadaver).  Each has benefits and risks.  The benefit of the bioprosthetic and homograft are that anticoagulation with a blood thinner is not required.  This may be useful in women of child-bearing age who desire to become pregnant and older persons with a high risk of falling.  The disadvantage of these valves is that their life-span is only about 10 years.  The advantage of the mechanical valve is that the life-span is much longer (usually longer than the patients) but requires taking an anticoagulant.  
It is a highly individualized choice as to which valve and will depend upon the patient's preference, the practice of the hospital where the surgery takes place and the co-existing medical problems.  The final decision as to which valve to use will be made by the surgeon in the OR once the valve is exposed and clearly seen.

More information about congenital valve abnormalities can be found in  the web sites below.
http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/conghd.html
http://155.37.5.42/eAtlas/CV/579b.htm
http://www.mamc.amedd.army.mil/WILLIAMS/CHEST/Cardiac/Congenital/Bicuspid/Bicuspid.htm
http://www.cachnet.org/messages2/3292.html
http://www.mch.com/pihc5-06.htm
Hope this helps.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.

Bicuspid Aortic Valve