Pediatric Heart Expert Forum
Bicuspid aortic valve insufficiency
About This Forum:

Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Bicuspid aortic valve insufficiency

My 6 year old son starting seeing a pediatric cardiologist when he was 3 for a heart murmur at which time we were told he has a bicuspid aoritc valve insufficiency.  His heart was on the upper side of normal and had minimal to moderate leakage.  He has been seeing his cardiologist each year for the last 3 years and up until his last appointment 2 weeks ago he had remained stable with no changes, he has also been asymptomatic.  When we went for our appointment 2 weeks ago his the leakage had increased to moderate and his heart size had gone past normal for his size and age (she said he should be at 42 and it was at 45). His cardiologist sent his echo to the board of surgeons who thought it would be best to do a repair of this valve but then decided to put him on enalapril for 6 month and then do another echo to see if the enalapril is helping.  Is it likely that these changes will continue to increase or will the enalapril keep his heart functioning well enough that he will not need surgery?  Also he wants to do wrestling in a month or so (not much contact as it is for kindergarden - 2nd grade kids) is this something he should be limited in?
Related Discussions
773655_tn?1340656399
The natural history of bicuspid aortic valves is variable during childhood.  Aortic valve leakage can be progressive even at young ages.  It is appropriate to start after-load reducing medication (like enalapril) when the left ventricular size increases above normal. This medication tries to make it "easier" for the blood to move forward, instead of backward, across the aortic valve.  It does not directly affect the valve (no medication can) but if the left ventricular size stabilizes, then surgery may be able to be deferred for a while.  Sometimes surgeons can perform a "plasty" procedure on the native aortic valve, to tighten it up, and decrease the leakage.  It may not be perfect, but many times a valve replacement can be avoided for some period of time.  Since aortic valve replacement is always a possibility, it is preferrable (when safe to do so) to hold off on surgery until a patient is physically larger, as the options for valve replacement are less optimal and have need for on-going replacement, in younger children as they grow. Do not expect any drastic changes in the echo in 6 months time.  Your doctor will be follwing the size and function of the left ventricle as your child grows.  Finally, isometric sports, like weight lifting, wrestling and football are NOT to be encouraged in this situation, as it can worsen valve leakage.
2 Comments
Blank
Avatar_f_tn
Thank you so much for your response - it was very helpful in understanding how the medicine works and also understanding my son's condition a little better.  I really apprieciate your help!
Blank
Continue discussion Blank
This Forum's Experts
773655_tn?1340656399
Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
Blank
Request an Appointment
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
How to Silence Your Inner Critic an...
Apr 16 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eaters: How to Silence Yo...
Mar 26 by Roger Gould, M.D.Blank
1344197_tn?1392822771
Blank
Vaginal vs. Laparoscopic Hysterecto...
Feb 19 by J. Kyle Mathews, MD, DVMBlank