Can a bicuspid aortic valve be acquired?

[Rick]

I am 38 yrs old and was told two weeks ago tomorrow that my aortic valve regurgitates 2-3+ and that I shall require surgery at a yet undefined moment in my 40s. Additionally, all other three valves have level 1 regurgitation. This was confirmed at the Cleveland Clinic.

During childhood I never had a murmur or anything. At age 20, I was told I had mild aortic valve regurgitation and since have had 5 additional echos, one roughly every three years, until 2.5 years ago at age 35 where my regurgitation was still mild. Also, all these echos stated that I had a trileaflet aortic valve. At age 35 (late 2004), my cardiologist told me to have an echo again in 5 years.

Late 2007: I had three months or so of intermittent fever, extremely tired and sweats from September 2007 until December 2007 and an uncontrollable cough from November until January that has since subsided but still exists. My wife was diagnosed with Beta Hemolytic Streptococcus yesterday.

The MDs tell me my aortic valve had no vegetation but was calcified. They said typically bicuspid aortic valves are congenital. I cant help but have disbelief that all prior 6 echos were mistaken. Also, all my four grandparents lived to 86 years at least and my parents are alive and without heart issues.

Does anyone know if tricuspid aortic valves can become bicuspid? I am still in some shock and cant help but feel something must have happened.

Thanks.

 

[ctyguy]

I had a biscuspid aortic valve as well, wasn't aware of it until Valentine's day this year, thats when the cardiologist told me that I had severe stenosis. I have always been told that a biscuspid valve is a congenital birth defect and isn't necessarily hereditary. I was told its about 1 in every 50 people. Is it possible that two of the leaflets are so calcified that they have somehow fused ? Maybe your valve is tricuspid but presented as bicuspid during your last echo due to calcification ?

I had a mechanical valve (On-X) put in on 2/29/08. Im close now to getting back to work and feel pretty good. I had the procedure done at the Cleveland Clinic so if you have questions please feel free to ask. Besides myself there are lots of folks that will be more than willing to help you with questions. This forum is a fantastic resource.

Best of luck !

 

[Bradley White]

Rachel is correct "bicuspid" valves cannot be acquired. You are either born with three, two, or one cusp. It is likely that the previous echoes missed the fact that you had a bicuspid whereas they are notoriously difficult to detect via echo.

The only way I could possible imagine acquiring a bicuspid valve would be if a virus or bacteria literally destroyed one of your cusps leaving you with only two cusps. However, this would not be considered a classical bicuspid valve which normally have two cusps which each take up about 50% of the aperture of the valve. In this hypothetical case you would have two cusps taking up 2/3 of the aperture and no cusp in the other 1/3. This seems to me an unlikely scenario however.

Best,

Brad

 

[Susan BAV]

Rick - I hope I'm explaining this correctly but I have read--although I'm not exactly sure where--that a regular aortic valve can calcify to the point where two of the three cusps can fuse together, thus making one large cusp and one small cusp. Obviously that kind of valve wouldn't be working properly; and would likely need replaced.

A person with a bicuspid valve is born with it, however. But, also from what I've read, there are apparently different degrees of the flaw and not every bicuspid persons's aortic valve looks exactly alike others'. They are, afterall, a genetic defect.

Best wishes for you to recover completely from your infection and to have a successful surgery also.

 

[CHDDoug]

As I understand it, left side defects are typically congenital. Unfortunately, I've had to read and research these over the past 4+ years. My son was diagnosed at 20 weeks in utero that he'd be born with hypoplastic left heart (essentially no left ventricle...left side defect). He would eventually not make it to his second OHS. About 3 months after his passing, I was diagnosed with bicuspid aortic valve...left side defect (got an echo at the request of my son's cardiologist). I never had any symptoms and was never diagnosed until I was 29 years old. I had my family (back to my grandparents) all get echoes and everyone came back with a clean bill of health. I've since had my BAV replaced via the Ross procedure (8 weeks ago) and am doing great. I guess I say all of this to say that in all of my research, I've never read that a tricuspid aortic valve can turn into a bicuspid aortic valve. I'm not a doctor, but that's at least what I've found.

I wish you the best with your upcoming surgery...I'm sure everything will be just fine!

Take care.

 

[Rick]

chronic infection and leaflet fusion

chronic infection and leaflet fusion

I had 7 echos from 1990 until 2004 all saying that my aortic valve was trileaflet and now any echo says its bicuspid, even those on the same machines. The echos say I have fusion of the left coronary cusp and the right coronary cusp and that a raphe (the line where the fusion occurs) is noted. Additionally, now I have all other 3 valves with mild damage.

No one in my family has heart disease. The youngest grandparent or relative died at age 85!! Many have had echos.

I was told I have chronic chlamydia pneumoniae infection and that this is believed to cause chronic inflammation. In studies of rabbits, it damaged their aortas and hearts.

Unfortunately, after a long time (I had pneumonia at age 17 and am now 38) the bacteria lives dormantly inside the cells and they have not figured out how to get rid of it so it just attackes your body and causes repeated inflammation. I have had inflammatory processes in about 8 different parts of my body and was always told I was just unlucky. I just received a letter from a researcher specializing in this disease that will talk to infectious disease MD to figure out how to get at a potential treatment for me.

I am quite scared. Though I am non-contagious, my wife is very scared and is having a very hard time with all this.

The only thing that has helped me has been my faith in God. I was religious when younger and had moved away from God for years until this has happened. For whatever length of life I have I want to make sure and live it the right way.

At the same time, I am obvioulsy doing what I can with my MDs.

 

[aussigal]

You certainly have a unique case there Rick. Sounds like they are doing their best to secure the right treatment plan for you. Keep your faith strong and I'm sure you will cruise through this.