What is Bicuspid Aortic Valve

The aortic valve sits inside the aorta. The valve has three cusps that open to let blood out and come together to close the valve off. It's supposed to be a one way valve allowing oxygen rich blood to flow out to the body. It should then close tightly when the heart relaxes and refills. Think of it like a door. It should open wide to let everyone out, but then close tightly preventing anything from coming in. The bicuspid valve only has two cusps, often times the three cusps are present but two are fused together.

With bicuspid valves, one of two things can happen (or sometimes both simultaneously). The valve can become narrow and calcified as the disease process advances, or it can become progressively leakier. Mine is very leaky. The blood goes out fine, but then leaks back in to the left ventricle causing the heart to work very hard. This results in the heart chamber getting really big and thick due to the extra work to pump a large volume of blood forward. Eventually this can lead to irreversible damage and ultimately heart failure.

This is technically a diseased aorta and is usually formed in utero. It can be congenital, but can also be caused by things like Rheumatic Fever, endocarditis, or radiation therapy. As this is a disease of the aorta and tied to certain connective tissue disorders, it's very common to have the gift of an aortic aneurysm, too. Lucky for me, we haven't found any aneurysms. Hopefully it stays this way. It's very common for aneurysm repairs and valve repair/replacements to occur together.

As the disease progresses, symptoms may present. Common symptoms are shortness of breath, dizziness, syncope (passing out), fatigue, chest pain/palpitations, and full on heart failure. When symptoms present themselves it's usually time for surgery.

Some people never have symptoms, but need surgery based on other factors, such as, heart chamber enlargement and thickening, level of leakage or stenosis, ejection fraction (how well the heart is able to pump blood out to the body), or need of aneurysm repair. The idea is to wait as long as safely possible to have this invasive surgery, but yet not so long that permanent damage is done to the heart. With appropriately timed surgery, the heart should remodel itself to normal ranges.  In my case its a combination of anatomical markers and vague symptoms putting me in line for surgery.

Warning: this video is pretty educational, but not exciting. Watch at your own risk. For those of you FD friends that suffered through this whole post, make sure and log some training...you earned it!

Thanks for checking in. The next post will probably be an explanation of the surgery itself. I promise this educational stuff will end soon and we'll resume with the self deprecation and exposure of all my vulnerabilities.