Your heart and vascular health is important to us. That’s why we offer many free and low-cost screenings to you and our communities.
If you have a parent, sibling or child with bicuspid aortic valve (BAV) disorder, it’s important to know that this can be hereditary. Close relatives of those diagnosed with BAV also are at risk for an aneurysm of the aortic root and ascending aorta. Early detection is critical since up to 40 percent of BAV patients will experience complications by the time they reach 50.
For more information about the bicuspid aortic valve screening, go to bryanhealth.org or call the Early Detection Center at 402-481-8018.
Listen in as Keith Miller, MD, a cardiologist with Bryan Heart, discusses bicuspid aortic valve disease (BAV), and why is it important to be screened for BAV.
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Could You Have a Problem With Your Heart Valve?
Featured Speaker:
Learn more about Dr. Keith Miller
Keith Miller, MD, Bryan Heart
Dr. Keith Miller is a cardiologist with Bryan Heart.Learn more about Dr. Keith Miller
Transcription:
Could You Have a Problem With Your Heart Valve?
Melanie Cole (Host): Your heart is an amazing muscle that works with your circulatory vascular system to give you life. You hear the word "valve" and it sounds like a car part but what is bicuspid aortic valve disease? My guest today is Dr. Keith Miller. He's a cardiologist at Bryan Heart. Welcome to the show, Dr. Miller. I'd like to start by asking you to give a little physiology lesson about the valves and their role in our circulatory system.
Dr. Keith Miller (Guest): Thanks, Melanie. I really appreciate the chance to talk about this problem of bicuspid aortic valve disease that we're going to talk about today. It's a really important topic and I'm glad that there's an interest in it. Your question was, "What do the valves do in the heart?" and just like valves in many systems, they are there to keep the blood flowing in one direction and not in the other so that it all keeps flowing in the right direction. So, when a valve leaks, it means that some of that blood is not flowing in the right direction and it goes backwards and it can put a strain on the heart and the rest of the body.
Melanie: And, what is the bicuspid aortic valve?
Dr. Miller: So, bicuspid aortic valve disease is a congenital disorder, meaning a disorder you're born with in which the aortic valve of the heart develops with two, rather than the normal three leaflets or flaps. It is the most common congenital heart defect occurring in about one to two percent of individuals and more commonly in men than in women. Bicuspid aortic valve-these valves with two rather than three leaflets--often do not function normally and that's one of the main reasons this is an important problem. They are more likely to leak than normal aortic valves with three leaflets and this problem can become important as early as young adulthood. Later in life, often in people in their 50s and 60s, bicuspid aortic valves are more likely to develop wear and tear, leading to narrowing or stenosis of the valve, which may require that the valve is replaced surgically. Whether the problem is leaking or narrowing of the valve, the valve problem can begin to cause strain on the heart and lead to more significant problems like heart failure.
Melanie: And if it has a congenital component to it, Dr. Miller, do we know what causes this?
Dr. Miller: Yes, we do to some extent. We do believe this is a genetic problem. We know it's inherited to some degree, and that's one of the reasons I like to talk about this because if people have bicuspid aortic valve disease, their relatives are at risk for it also. Or, conversely, if they find out that their brother or sister or parent has had bicuspid aortic valve disease, then they should be screened for it. We think about one in 10 first-degree relatives of patients that have bicuspid aortic valve disease also have a bicuspid aortic valve. So, for that reason, we do recommend screening for bicuspid aortic valve if you have a parent, child, or sibling, that has bicuspid aortic valve. And, again, if you know that you, yourself, have a bicuspid aortic valve, it's important you recommend screening for your first-degree relatives.
Melanie: So, how would somebody know? I mean, if you've got a little baby, you wouldn't necessarily--unless, as you say there are genetic components--screen them, so what do we do? How do we know? Are there some symptoms?
Dr. Miller: Yes. Great question. So, testing for bicuspid disease is usually done because it is suspected for some reason--either because of a relative who is known to have a bicuspid valve or because of an abnormal physical examination finding. The typical finding on examination with a stethoscope done by a doctor or another clinician is a murmur, which is just an abnormal heart sound caused by abnormal blood flow through the bicuspid valve. Whatever the reason the bicuspid valve is suspected, the most common confirmatory test is an echocardiogram and that's a simple ultrasound test of the heart that's done through the chest wall from the outside of the body. An echocardiogram can also determine whether the valve leaks and if it has begun to show the type of wear and tear and calcification that can lead to other problems with the valve.
Melanie: So, if you do determine through echocardiogram that someone has this bicuspid valve disease, what do you do? Are there some treatments?
Dr. Miller: There are limited treatments available for this kind of valve disease. I think it's important to mention that, although complications can happen with this kind of valve problem--we talked about the leak and we talked about the narrowing--the complications are manageable and life expectancy in adults with bicuspid aortic valve disease is not shortened compared with the general population. So, depending on the severity of the valve problem when it is found, an echocardiogram is generally recommended at least once a year to monitor the valve problem. As far as treatments, if the valve develops a severe leak or if the narrowing of the valve that can develop later in life becomes severe, and if the heart is starting to show signs of strain, we generally recommend replacing the valve. That's done, most of the time, through an open heart surgery but, more recently, we actually have techniques to replace the aortic valve without opening the chest by using catheters that are delivered to the heart through the vessels, usually in the leg. So, those are the main treatments, but there have been questions over the years about whether there are any medical treatment that would alter the time course or the development of these valve problems. What we know and we do recommend, is excellent blood pressure control for anyone that has aortic valve disease, bicuspid aortic valve disease, and especially if there's a leak. There has been some interest in the possibility that cholesterol-lowering medicine might slow the progression of calcification of these aortic valves and, for the most part, those tests have been disappointing when we've actually done the clinical studies on that. It doesn't seem that cholesterol-lowering medicine does slow the progression of the disease. So, mostly it's good blood pressure control, periodic visits with a doctor and an echocardiogram and replacement of the valve, if it gets bad enough.
Melanie: Are there any lifestyle changes, Dr. Miller, that patients can do to help this treatment, to help keep it along to keeping their body healthy? You mentioned good blood pressure control. Is there anything else?
Dr. Miller: Yes. No, not really, and that's always been one of the frustrating things with some of these bicuspid aortic valve problems but, for the most part, of course, we recommend good lifestyle for a whole variety of reasons in preventing other kinds of heart problems, like heart attacks and other vascular complications, like strokes. But, as far as the specific bicuspid aortic valve problems, lifestyle really does not seem to make a difference. Now, I did say that blood pressure control is important and lifestyle changes can be very important to help with your blood pressure, but for the most part, it's medical treatment. One other things that I do want to mention is that one of the other reasons bicuspid aortic valve disease is important is that it's associated with another important condition called “aneurysm of the aorta”, which is the large artery in the chest and abdomen. And, that association probably exists because both the valve problem and that aortic aneurysm are caused by the same genetic defect and, if left untreated, an aortic aneurysm can rupture or the lining of the artery can tear and those can be very serious medical problems. So, early detection is important in susceptible people because an aneurysm may not cause any symptoms until the day it ruptures or tears. So, patients with an aortic aneurysm are more likely to experience those kinds of complications. Even though they're uncommon--the dissections and the ruptures--we do recommend screening for them if patients have bicuspid disease. That's also done with an echocardiogram and, if they're found, then we also monitor those along with the valve problem.
Melanie: Bryan Health offers a screening and, if you want to find out more information about it, you can go to bryanhealth.org or call the Early Detection Center at 402-481-8018. So, Dr. Miller, in just the last few minutes, give us your best advice about screening, who should be screened, and what you really want them to know about bicuspid aortic valve disease.
Dr. Miller: Well, I would say, for sure, if you know you have a relative who's had bicuspid aortic valve disease, you should be screened. That's very clear. If you have relatives that have had valve surgery or who have had a valve replaced, ask them about it and, if you're not sure what exactly they had, then you may talk to your doctor or ask them if they could get some records so you could figure out if that might have been the problem that they had. Otherwise, for people who don't know they have a relative with this problem, I would just talk to your primary care doctor and ask them when they listen to your heart in a physical examination, "Do I have any abnormal heart sounds? Is there a murmur or anything that would suggest that I have a risk for a bicuspid aortic valve?" And, if so, you should get an echocardiogram to get screened for that.
Melanie: Thank you so much, Dr. Miller. What a fascinating topic and such great information. For more information about bicuspid aortic valve screening, you can go to bryanhealth.org. That's bryanhealth.org or you can call the Early Detection Center at 402-481-8018. This is Melanie Cole. Thanks so much for listening.
Could You Have a Problem With Your Heart Valve?
Melanie Cole (Host): Your heart is an amazing muscle that works with your circulatory vascular system to give you life. You hear the word "valve" and it sounds like a car part but what is bicuspid aortic valve disease? My guest today is Dr. Keith Miller. He's a cardiologist at Bryan Heart. Welcome to the show, Dr. Miller. I'd like to start by asking you to give a little physiology lesson about the valves and their role in our circulatory system.
Dr. Keith Miller (Guest): Thanks, Melanie. I really appreciate the chance to talk about this problem of bicuspid aortic valve disease that we're going to talk about today. It's a really important topic and I'm glad that there's an interest in it. Your question was, "What do the valves do in the heart?" and just like valves in many systems, they are there to keep the blood flowing in one direction and not in the other so that it all keeps flowing in the right direction. So, when a valve leaks, it means that some of that blood is not flowing in the right direction and it goes backwards and it can put a strain on the heart and the rest of the body.
Melanie: And, what is the bicuspid aortic valve?
Dr. Miller: So, bicuspid aortic valve disease is a congenital disorder, meaning a disorder you're born with in which the aortic valve of the heart develops with two, rather than the normal three leaflets or flaps. It is the most common congenital heart defect occurring in about one to two percent of individuals and more commonly in men than in women. Bicuspid aortic valve-these valves with two rather than three leaflets--often do not function normally and that's one of the main reasons this is an important problem. They are more likely to leak than normal aortic valves with three leaflets and this problem can become important as early as young adulthood. Later in life, often in people in their 50s and 60s, bicuspid aortic valves are more likely to develop wear and tear, leading to narrowing or stenosis of the valve, which may require that the valve is replaced surgically. Whether the problem is leaking or narrowing of the valve, the valve problem can begin to cause strain on the heart and lead to more significant problems like heart failure.
Melanie: And if it has a congenital component to it, Dr. Miller, do we know what causes this?
Dr. Miller: Yes, we do to some extent. We do believe this is a genetic problem. We know it's inherited to some degree, and that's one of the reasons I like to talk about this because if people have bicuspid aortic valve disease, their relatives are at risk for it also. Or, conversely, if they find out that their brother or sister or parent has had bicuspid aortic valve disease, then they should be screened for it. We think about one in 10 first-degree relatives of patients that have bicuspid aortic valve disease also have a bicuspid aortic valve. So, for that reason, we do recommend screening for bicuspid aortic valve if you have a parent, child, or sibling, that has bicuspid aortic valve. And, again, if you know that you, yourself, have a bicuspid aortic valve, it's important you recommend screening for your first-degree relatives.
Melanie: So, how would somebody know? I mean, if you've got a little baby, you wouldn't necessarily--unless, as you say there are genetic components--screen them, so what do we do? How do we know? Are there some symptoms?
Dr. Miller: Yes. Great question. So, testing for bicuspid disease is usually done because it is suspected for some reason--either because of a relative who is known to have a bicuspid valve or because of an abnormal physical examination finding. The typical finding on examination with a stethoscope done by a doctor or another clinician is a murmur, which is just an abnormal heart sound caused by abnormal blood flow through the bicuspid valve. Whatever the reason the bicuspid valve is suspected, the most common confirmatory test is an echocardiogram and that's a simple ultrasound test of the heart that's done through the chest wall from the outside of the body. An echocardiogram can also determine whether the valve leaks and if it has begun to show the type of wear and tear and calcification that can lead to other problems with the valve.
Melanie: So, if you do determine through echocardiogram that someone has this bicuspid valve disease, what do you do? Are there some treatments?
Dr. Miller: There are limited treatments available for this kind of valve disease. I think it's important to mention that, although complications can happen with this kind of valve problem--we talked about the leak and we talked about the narrowing--the complications are manageable and life expectancy in adults with bicuspid aortic valve disease is not shortened compared with the general population. So, depending on the severity of the valve problem when it is found, an echocardiogram is generally recommended at least once a year to monitor the valve problem. As far as treatments, if the valve develops a severe leak or if the narrowing of the valve that can develop later in life becomes severe, and if the heart is starting to show signs of strain, we generally recommend replacing the valve. That's done, most of the time, through an open heart surgery but, more recently, we actually have techniques to replace the aortic valve without opening the chest by using catheters that are delivered to the heart through the vessels, usually in the leg. So, those are the main treatments, but there have been questions over the years about whether there are any medical treatment that would alter the time course or the development of these valve problems. What we know and we do recommend, is excellent blood pressure control for anyone that has aortic valve disease, bicuspid aortic valve disease, and especially if there's a leak. There has been some interest in the possibility that cholesterol-lowering medicine might slow the progression of calcification of these aortic valves and, for the most part, those tests have been disappointing when we've actually done the clinical studies on that. It doesn't seem that cholesterol-lowering medicine does slow the progression of the disease. So, mostly it's good blood pressure control, periodic visits with a doctor and an echocardiogram and replacement of the valve, if it gets bad enough.
Melanie: Are there any lifestyle changes, Dr. Miller, that patients can do to help this treatment, to help keep it along to keeping their body healthy? You mentioned good blood pressure control. Is there anything else?
Dr. Miller: Yes. No, not really, and that's always been one of the frustrating things with some of these bicuspid aortic valve problems but, for the most part, of course, we recommend good lifestyle for a whole variety of reasons in preventing other kinds of heart problems, like heart attacks and other vascular complications, like strokes. But, as far as the specific bicuspid aortic valve problems, lifestyle really does not seem to make a difference. Now, I did say that blood pressure control is important and lifestyle changes can be very important to help with your blood pressure, but for the most part, it's medical treatment. One other things that I do want to mention is that one of the other reasons bicuspid aortic valve disease is important is that it's associated with another important condition called “aneurysm of the aorta”, which is the large artery in the chest and abdomen. And, that association probably exists because both the valve problem and that aortic aneurysm are caused by the same genetic defect and, if left untreated, an aortic aneurysm can rupture or the lining of the artery can tear and those can be very serious medical problems. So, early detection is important in susceptible people because an aneurysm may not cause any symptoms until the day it ruptures or tears. So, patients with an aortic aneurysm are more likely to experience those kinds of complications. Even though they're uncommon--the dissections and the ruptures--we do recommend screening for them if patients have bicuspid disease. That's also done with an echocardiogram and, if they're found, then we also monitor those along with the valve problem.
Melanie: Bryan Health offers a screening and, if you want to find out more information about it, you can go to bryanhealth.org or call the Early Detection Center at 402-481-8018. So, Dr. Miller, in just the last few minutes, give us your best advice about screening, who should be screened, and what you really want them to know about bicuspid aortic valve disease.
Dr. Miller: Well, I would say, for sure, if you know you have a relative who's had bicuspid aortic valve disease, you should be screened. That's very clear. If you have relatives that have had valve surgery or who have had a valve replaced, ask them about it and, if you're not sure what exactly they had, then you may talk to your doctor or ask them if they could get some records so you could figure out if that might have been the problem that they had. Otherwise, for people who don't know they have a relative with this problem, I would just talk to your primary care doctor and ask them when they listen to your heart in a physical examination, "Do I have any abnormal heart sounds? Is there a murmur or anything that would suggest that I have a risk for a bicuspid aortic valve?" And, if so, you should get an echocardiogram to get screened for that.
Melanie: Thank you so much, Dr. Miller. What a fascinating topic and such great information. For more information about bicuspid aortic valve screening, you can go to bryanhealth.org. That's bryanhealth.org or you can call the Early Detection Center at 402-481-8018. This is Melanie Cole. Thanks so much for listening.