Dr. Grayson Wheatley is a Heart and Vascular Surgeon and Director of Aortic and Endovascular Surgery at TriStar Centennial Medical Center in Nashville, TN
Bicuspid Aortic Valve Surgery
From the desk of Dr. Grayson Wheatley
"Born With a Defective Aortic Heart Valve"
Nashville, Tennessee - The main valve of the heart, called the aortic valve, is most commonly composed of three distinct leaflets that open and close in coordination with the beating of the heart. There are a total of four valves in the heart (aortic valve, mitral valve, pulmonic valve and tricuspid valve).
Ten percent of people are born with only 2 leaflets to their aortic valve, called a "bicuspid aortic valve". Most of the time, people with a bicuspid aortic valve, also called "BAV", don't even know they have an abnormal heart valve and live active, healthy lives.
For more information about bicuspid aortic valves, check out my blog at badaorta.com.
Bicuspid Aortic Valve (BAV)
However, sometimes their doctor hears a heart murmur when listening with a stethoscope. There are different types of heart murmurs, and there are many heart problems which can cause heart murmurs. However, once a heart murmur is identified, additional tests, such as a cardiac echocardiogram ("sonogram or ultrasound of the heart"). A CT scan of the chest is also needed to evaluate the size of the ascending aorta.
People with a bicuspid aortic valve (BAV) are predisposed to having their heart valve wear out prematurely. When this happens, patients start to feel excessively tired and lack endurance with exercise due to a build-up of fluid in the heart as a result of the defective bicuspid aortic valve (BAV). This can happen to patients with bicuspid aortic valves (BAV) in their twenties, thirties and forties.
Many patients with bicuspid aortic valve (BAV) disease develop an aortic aneurysm of their aortic root and ascending aorta, called BAV Syndrome. Not all patients with an aortic root aneurysm or ascending aortic aneurysm have a bicuspid aortic valve (BAV), but a majority of patients with bicuspid aortic valves (BAV) can develop BAV Syndrome which includes an associated aneurysm of the aortic root and ascending aorta with the bicuspid aortic valve.
Request a consultation with Dr. Wheatley: 1-615-342-6900
most insurance plans accepted
Self-referrals and second opinions welcome.
We usually try to hold-off as long as possible before operating on defective bicuspid aortic valves. Once someone is diagnosed with a bicuspid aortic valve, depending on the severity of the problem, they can frequently be treated with blood pressure medications and followed with regular heart check-ups.
At some point, either the abnormal heart valve or the ascending aorta will deteriorate to the stage that it is causing potential harm to the patient. We recommend open heart surgery when the size of the ascending aorta or aortic root becomes 4.5cm or larger as detected by a CT scan. Another reason to recommend open heart surgery for patients with a bicuspid aortic valve is when the abnormal heart valve becomes so defective (usually "leaky") that the heart starts to show signs of dysfunction by echocardiogram.
Open heart surgery is required for bicuspid aortic valves and the associated aortic root and ascending aortic aneurysms. Sometimes, we can perform a valve-sparing aortic root replacement and repair the bicuspid aortic valve. Long-term studies suggest that repaired bicuspid aortic valves can last 10 to 20 years or more.
If we can't perform a valve-sparing aortic root replacement, then we will need to perform a Bentall procedure which involves replacing the ascending aortic root along with the aortic valve. We customize the valve replacement choice for each patient based on a number of factors. The two options are a mechanical heart valve or a tissue heart valve.
Some patients who develop an ascending aortic aneurysm in association with their bicuspid aortic valve also require a hemi-arch procedure at the same time as the open heart valve-sparing root replacement or Bentall procedure. The need for the additional hemi-arch procedure is determined by how far the ascending aortic aneurysm extends into the proximal aortic arch.
Once patients are completely recovered and healed-up from their heart surgery (6-8 weeks), they can return to full, unrestricted activity and lead healthy, normal lives. They will need to be on blood pressure medications for life, which helps protect both the heart and the repaired or replaced aortic heart valve, and also have routine heart check-ups.
The Aortic Center at Centennial Medical Center is pre-eminently qualified and skilled at treating patients with all forms of open aortic surgery and procedures (chest and abdomen) and is prepared to care for all patients with aortic aneurysms, aortic dissections, aortic valve disorders, and other types of aortic diseases including aortic transections, aortic pseudoaneurysms and penetrating aortic ulcers.
Contact us today to request your consultation at 1-615-342-6900 or email us at firstname.lastname@example.org and we will evaluate your unique aortic problem and provide a customized approach to your specific aortic problem.
Centennial Medical Center
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