Thank you for your response. My son does have moderate regurgitation. I have noticed that he has had the most complaints since he has started to grow in the last 2 years and that is when we have noticed the most change with his heart. Thanks for your time and I will discuss his exercise issues more with his cardiologist when I see her in November.
Shel
Dear Shel,
Bicuspid aortic valve is associated with several changes in the aorta that can be progressive. The aortic valve can have stenosis (obstruction), of which your son’s appears to be mild. It can also have regurgitation, or leakage. With the diastolic murmur, this suggests that there may be aortic regurgitation, although you do not discuss this here. Finally, the aorta itself can dilate and rupture over time. At this time, we do not have a known treatment to prevent this, although there are some providers who are using medications, such as beta blockers, ACE inhibitors (such as enalapril), and angiotensin receptor blockers. These have not been proven to prevent or to slow aortic dilation. As well, ACE inhibitors and angiotensin receptor blockers have been used in the therapy of aortic insufficiency. However, there is some question as to whether that demonstrates benefit, as well.
Without evaluating your son, I cannot say what the reason of his symptoms while on enalapril is. As well, without seeing his studies, I cannot say what the best plan for him is. I can say that his measurements suggest that, based on his body surface area, he has mild dilation of his left ventricle and has as much as moderate dilation of his ascending aorta. Therefore, at minimum, it would be a good idea to consider some sort of an exercise stress protocol, since he has chest pain with exertion. You need to further discuss his athletic participation and his treatment with your cardiologist, who knows him best. If you feel that you are not getting the information that you need to make an informed decision, you can certainly consider a second opinion.