​A normal aortic valve has three leaflets, while a bicuspid aortic valve only has two. The aortic valve allows oxygen-rich blood to flow from the heart to the aorta, the main blood vessel that brings blood to the body. Bicuspid aortic valve is present at birth (congenital) and it is one of the most common congenital heart defects. This defect may occur in 1-2% of the population, predominantly in males. The bicuspid valve may be entirely undetected during childhood or even during adolescence. The bicuspid aortic valve defects are sometimes associated with other defects of the aorta and other left side heart abnormalities.

Bicuspid aortic valve may not be diagnosed early in most cases as it causes no symptoms. However, over time this valve may begin to leak (regurgitation), become narrowed (stenosed), or has both of these. Calcification of the leaflets may happen. The narrowing of the valve causes the heart to pump harder. A leaky valve allows blood flow back into the heart after it has been pumped out, hence needing the heart to pump more blood forward. Both ways cause the heart to work harder which may lead to heart failure later in life. The symptoms of failing valves include difficulty in breathing, chest pain, fainting (syncope), heart murmur and fatigue.

Risk factors

Prevention of endocarditis

Antibiotic for dental prophylaxis is no longer required for patient with bicuspid aortic valve.

Prevention of Infective Endocarditis (IE)

The incident of IE in congenital patient is higher than general population. Therefore it is important for congenital patient to maintain good oral, dental and skin hygiene as primary prevention. Cosmetic tattooing and piercing are discouraged due to the risk of IE. Antibiotic prophylaxis is considered for patient at highest risk for IE before surgery and dental procedures. Please discuss with your congenital team for the latest update on the antibiotic prophylaxis.

Pregnancy

If the aortic stenosis or regurgitation is mild, you are more likely to handle pregnancy well. However, women with severe aortic valve defect have a higher risk and would need to discuss with her cardiologist before contemplating pregnancy.

​Bicuspid aortic valve is present at birth (congenital) and it is one of the most common congenital heart defects. This defect may occur in 1-2% of the population, predominantly in males.

​Your cardiologist may order investigation tests including ultrasound of the heart (echocardiogram), test of the heart electrical activity (electrocardiogram), magnetic resonance imaging (MRI) and others.

​In some cases, a non-surgical but invasive procedure called balloon valvotomy may be used to treat aortic stenosis. This procedure involves putting a tube (catheter) directly into the narrow opening of aortic valve with a balloon attached to the end of the catheter which will be inflated to enlarge the opening of the stenotic valve. For severe narrowing or leaky valve, treatment may also involve surgical repair or replacement of the defective aortic valve.