Intermountain Heart Institute at Intermountain Medical Center

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Bicuspid Aortic Valve

A bicuspid aortic valve has two leaflets, instead of three.

The aortic valve sits at the top of the heart where the blood exits to travel to the brain and body. A normal aortic valve is tricuspid, meaning it is formed from three separate leaflets. In some individuals, the valve is malformed from birth, and two of the leaflets are fused together (bicuspid, or two leaflets total). This congenital heart valve disorder affects both the aortic valve and the aorta, the great vessel attached to the aortic valve.

Bicuspid aortic valves have a tendency to deteriorate with time. The valve can become stenotic, meaning it is thickened and calcified, obstructing the blood flow out of the heart. The valve can also be insufficient, meaning it allows blood to leak back into the heart because the leaflets do not perfectly meet. As the valve deteriorates, the heart must perform extra work to pump the blood the body needs.

Importantly, the aorta of an individual with a bicuspid aortic valve is weaker that normal. The portion of the aorta directly above the valve, called the “ascending aorta”, has a higher likelihood of developing an aortic aneurysm or dissection. It is estimated that a person with a bicuspid valve has nearly a ten-fold risk of aortic dissection.

Many patients do not experience symptoms during childhood and do not find out about the bicuspid valve until they are adults. Bicuspid aortic valve can be identified during a physical examination where the doctor hears a heart murmur.

Bicuspid aortic valve can run in families, and it is recommended that family members of individuals with a bicuspid valve also undergo some type of screening. This may include a visit with an adult congenital heart specialist, advanced imaging, or both.

This is a normal aortic valve, with three separate leaflets (shown in the closed position).
In a bicuspid aortic valve, two of the leaflets have fused into one.

Diagnostic Tests for Bicuspid Aortic Valve

The best test to evaluate bicuspid aortic valve is an echocardiogram. This test can also look at a portion of the ascending aorta to determine if there is an associated aneurysm.

  • Echocardiogram

    An echocardiogram is a procedure that uses high-frequency sound waves (ultrasound) to create a visual image (echocardiogram) of heart structures.

Treatments for Bicuspid Aortic Valve and Associated Aneurysm

Aneurysms associated with bicuspid aortic valves have a higher risk of dissection than others. Thus, surgical intervention is often recommended earlier in these patients. In some cases, simultaneous replacement of the valve and aorta is performed to address both problems.

  • Thoracic Aortic Aneurysm Repair

    Thoracic aortic aneurysm repair is an open-chest surgery that repairs a portion of the aorta, the main blood vessel that carries blood from your heart to your brain and vital organs.

  • Freestyle Aortic Root Replacement

    Freestyle aortic root replacement is a highly specialized operation that replaces the aortic root (the portion of the aorta closest to the heart) and the aortic valve in a single operation.

  • Aortic Valve Repair and Replacement

    Many patients require open heart surgery to treat aortic stenosis. A cardiovascular surgeon removes the diseased valve and replaces it with either a mechanical or tissue valve.

Services and Programs

Service and programs at Intermountain Heart Institute that help patients with bicuspid aortic valve:

  • Center for Aortic Disease

    The Center for Aortic Disease focuses on the care of patients with aortic disease using the most and advanced surgeries and less invasive repairs.

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