The bicuspid aortic valve is the most common heart disease congenital , ie present from birth, which affects about 1-2% of the population, and which, however, is often diagnosed and treated in adulthood. It is a mild malformation of the aortic valve ( bicuspid valve ). In this defect, the aortic valve, which regulates blood flow from the heart to the rest of the body, presents itself with only two flaps (or cusps) instead of three as in normal, in most cases due to the “fusion” of two flaps in one, causing the valve to fail to open or close completely as it should.
WHAT ARE THE CAUSES?
The origin of the bicuspid aortic valve is associated with genetic factors. It is estimated that 10 to 20% of first-degree relatives of people with bicuspid valves have the same cardiac anomaly.
WHAT ARE THE SYMPTOMS?
There are no specific symptoms or alarm bells: a child born with a bicuspid aortic valve may not show symptoms even up to adulthood. Over time, however, this malformation can lead to a degeneration of the aortic valve, with the onset of aortic stenosis (narrowing of the valve that no longer opens well) or, less frequently, an aortic insufficiency (the valve does not close as it should causing a reflux of blood in the left ventricle). It should be emphasized that bicuspidiait is associated with the development of significant aortic stenosis earlier, usually between the ages of 40 and 60, compared to the calcific aortic stenosis of the elderly, which usually occurs between the ages of 60 and 70. Bicuspidia is also often accompanied by dilatation of the ascending aorta , and for this reason patients suffering from this pathology must be followed with particular attention (see Aortic Aneurysm in Pathologies).
Bicuspidia aortica is diagnosed by echocardiography or echocolordoppler , which allows to evaluate the valvular and cardiac function and to confirm the presence of aortic stenosis or other pathologies related to the bicuspid valve. If deemed necessary, it may be followed by one of the thoracic study by TAC and / or Resonance Magnetic .
HOW DO YOU CARE?
There is no specific medical cure for aortic bicuspidia, precisely because the problem is an anatomical anomaly of the valve with which it can coexist until the defect evolves into a disease. In the case of stenosis or aortic insufficiency, drugs can initially be administered to limit the damage of obstruction or insufficiency, such as ace-inhibitors or beta-blockers. In any case, if the bicuspid valve evolves into an important pathology, the only possibility is that of the intervention, which can be:
- Valve replacement surgery: the bicuspid native valve is removed and replaced with a prosthesis, biological or mechanical. The surgical approach can be traditional open or minimally invasive. The choice between biological or mechanical prosthesis must be carefully discussed with the cardiac surgeon and depends on the patient. The mechanical prosthesis has the undoubted advantage of lasting forever. If the patient is young and with a long life expectancy, it is therefore the choice for which one generally opts. The disadvantage is that you have to take anticoagulants throughout your life, which you need to keep under control with blood samples every 10-15 days. The biological prosthesis, on the other hand, does not require the taking of drugs, but has the disadvantage of having a duration that goes from 10 to about 15 years, after which another intervention is necessary to replace the prosthesis. Surgery is the option chosen in most cases.
- TAVI: A transcatheter valve prosthesis is placed inside the native bicuspid valve, which therefore is not removed but only “excluded”. We generally rely on this procedure when the patient is elderly or particularly at risk to be subjected to a traditional cardiac surgery.
BICUSPIDIA IN CHILDREN: As mentioned above, there is no need to be alarmed! In most cases, bicuspidia aortica does not cause worrying consequences. The child can therefore carry out his normal life, also doing physical activity and sport . It is important, however, to keep yourself regularly under control to monitor the possible onset of stenosis or aortic insufficiency. Your trusted cardiologist will certainly recommend echocardiographic checks every one or two years.