Understanding Your Bicuspid Aortic Valve: A San Diego Cardiologist's Complete Guide

I see patients every day in my San Diego practice who've recently learned they have a bicuspid aortic valve. The first question is almost always: "Doctor, is this serious?" I understand your concern, and I want you to know that having a bicuspid aortic valve doesn't mean you're facing an immediate crisis. What it does mean is that you have a condition that requires understanding, monitoring, and sometimes treatment.

A bicuspid aortic valve is something you're born with. Your aortic valve has two leaflets instead of the usual three. Think of it like having a door with two panels instead of three. About one in every hundred people has this anatomy, making it the most common congenital heart condition. While many people live their entire lives without problems, others will need monitoring and eventual treatment. My goal today is to help you understand what this means for your health and your future.

How Your Bicuspid Aortic Valve Works

Your aortic valve sits between your heart's main pumping chamber and your body's largest artery. Every time your heart beats, this valve opens to let blood flow out, then snaps shut to prevent backflow. In most people, this valve has three leaflets that work together like a three-way door. With a bicuspid valve, you have only two leaflets doing the same job.

Here's what happens over time: because two leaflets must handle the work of three, they experience more stress with each heartbeat. Think about it this way. If you had to carry a heavy box with two people instead of three, each person would bear more weight. Your valve leaflets face similar pressure, and this extra stress can lead to changes over the years.

The two-leaflet design also creates slightly different blood flow patterns through your valve. Instead of the smooth, symmetrical flow that occurs with three leaflets, blood may create more turbulence. This altered flow doesn't just affect the valve itself. It can also impact the wall of your aorta, the large artery that carries blood from your heart to the rest of your body.

Many of my patients ask whether they did something to cause this condition. The answer is no. This is simply how your heart formed before you were born. Genetics play a role, and if you have a bicuspid valve, there's about a 10% chance that one of your children might have it too. That's why I often recommend that family members get checked, though most will have normal valves.

The valve changes that develop aren't inevitable, and they don't follow the same timeline for everyone. Some people maintain good valve function for decades, while others develop problems earlier. The key is understanding what to watch for and staying on top of monitoring.

Understanding Your Test Results

When we evaluate your bicuspid aortic valve, we use several measurements to assess how it's functioning. The most important test is an echocardiogram, which uses sound waves to create pictures of your heart. This test tells us about two potential problems: aortic stenosis (when the valve becomes narrow) and aortic regurgitation (when the valve leaks).

For aortic stenosis, we measure something called the aortic valve area and the pressure difference across your valve. A normal aortic valve area is 3-4 square centimeters. Mild stenosis means your valve area is 1.5-2 square centimeters, moderate stenosis is 1.0-1.5 square centimeters, and severe stenosis is less than 1 square centimeter. We also look at the velocity of blood flow through your valve. Normal flow is less than 2.5 meters per second, while severe stenosis typically shows velocities over 4 meters per second.

These numbers matter because they help predict your future. Patients with mild stenosis may see their condition progress at a rate of about 0.1 square centimeters per year, while those with moderate stenosis often progress faster. The challenge is that this progression isn't always predictable. Some patients remain stable for years, while others change more rapidly.

Aortic regurgitation is graded differently. We look at how much blood leaks back through your valve after it closes. Mild regurgitation is common and often doesn't cause problems. Moderate regurgitation requires closer monitoring, and severe regurgitation typically needs treatment. We also assess how your heart is handling any regurgitation by measuring the size and function of your left ventricle.

Your echocardiogram also evaluates your aorta itself. Because bicuspid valves are associated with aortic dilation, we measure the diameter of different portions of your aorta. Normal measurements vary by body size, but generally, an aortic root or ascending aorta measuring more than 4.0-4.5 centimeters warrants attention.

When I review these results with patients, I emphasize that numbers tell only part of the story. How you feel, your activity level, and your overall health all factor into treatment decisions. A patient with technically "severe" stenosis who feels great and exercises regularly may be managed differently than someone with moderate stenosis who's experiencing symptoms.

Determining if You Need Treatment

Not everyone with a bicuspid aortic valve needs immediate treatment, but everyone needs a plan. The decision about when to intervene depends on several factors: your symptoms, the severity of valve problems, how your heart is responding to any valve issues, and the condition of your aorta.

Symptoms are often the most important factor in timing treatment. The classic symptoms of aortic stenosis include chest pain, shortness of breath with exertion, and dizziness or fainting spells. These symptoms typically develop gradually, which is why some patients don't realize how much their activity has decreased. I often ask my patients to think about what they could do five years ago compared to now.

Even without symptoms, treatment may be recommended if your heart shows signs of strain. When your valve becomes significantly narrowed or leaky, your heart's main pumping chamber may enlarge or its function may decline. We can detect these changes on your echocardiogram before you feel any symptoms. Early treatment in these situations often leads to better long-term outcomes.

The condition of your aorta also influences treatment timing. If your ascending aorta measures more than 5.0-5.5 centimeters, we typically recommend surgical repair regardless of your valve function. This recommendation exists because larger aortas carry an increased risk of potentially life-threatening complications like dissection or rupture.

Your age and overall health significantly impact treatment recommendations. A 30-year-old with severe aortic stenosis faces different considerations than a 75-year-old with the same condition. Younger patients generally receive surgical valve replacement, while older patients might be candidates for less invasive transcatheter procedures.

Family history also matters in treatment timing. If you have relatives who experienced aortic dissection or other serious aortic complications, we might recommend earlier intervention even with milder valve problems. Your genetics and family history help us assess your personal risk profile.

I want my patients to understand that "needing treatment" doesn't mean emergency surgery. Most valve problems develop slowly over years, giving us time to plan the best approach for your specific situation.

How Treatment Decisions Are Made

When we reach the point where your bicuspid aortic valve needs treatment, you'll have options. The choice between different treatments depends on your age, the specific anatomy of your valve and aorta, your other medical conditions, and your personal preferences about long-term care.

Surgical aortic valve replacement remains the gold standard treatment for most patients. During this procedure, your surgeon removes your diseased valve and replaces it with either a mechanical valve or a biological valve made from animal tissue. Mechanical valves last longer, potentially for your entire lifetime, but require lifelong blood-thinning medication. Biological valves typically last 10-20 years but don't require long-term blood thinners.

For patients with significant aortic dilation, surgery often involves replacing part of your aorta along with your valve. This might sound extensive, but it's a well-established procedure that prevents future aortic complications. The surgical approach depends on which part of your aorta is affected and how much replacement is needed.

Transcatheter aortic valve replacement (TAVR) offers a less invasive option for certain patients. Instead of open-heart surgery, the new valve is inserted through a small incision, usually in your leg, and guided to your heart through your blood vessels. TAVR works well for older patients or those with significant medical problems that make traditional surgery risky.

However, TAVR in bicuspid valves presents unique challenges. Your valve's unusual shape can make it more difficult to position the new valve properly, and there's a higher risk of complications like valve leakage or stroke. For this reason, TAVR in bicuspid valves requires careful evaluation and is typically reserved for patients who aren't good candidates for traditional surgery.

Some patients with bicuspid aortic valve regurgitation (but minimal stenosis) might be candidates for valve repair rather than replacement. This involves reshaping your existing valve leaflets to improve their function. Repair preserves your own valve tissue and avoids the need for artificial materials, but it's technically challenging and not appropriate for all patients.

The timing of intervention aims to balance the risks of waiting too long against the risks of operating too early. We want to intervene before irreversible heart damage occurs, but we also want to ensure you truly need the procedure. This is where regular monitoring becomes so important.

Common Fears and Misconceptions

Many of my patients arrive in my office worried about things they've read online or stories they've heard from others. Let me address some of the most common misconceptions about bicuspid aortic valves.

"I'm going to have a heart attack." This is probably the most frequent concern I hear, but having a bicuspid aortic valve doesn't directly increase your risk of heart attack. Heart attacks result from blockages in the arteries that supply your heart muscle, which is different from valve problems. While you should maintain heart-healthy habits like anyone else, your valve condition doesn't make you more prone to coronary artery disease.

"I can't exercise or be active." Actually, for most patients with bicuspid aortic valves, regular exercise is beneficial. If your valve function is normal or only mildly affected, there's typically no reason to restrict your activity. Even patients with more significant valve problems can often participate in moderate exercise. The key is having your cardiologist assess your specific situation and provide personalized exercise recommendations.

"My children will definitely have this condition." While bicuspid aortic valve can run in families, most children of affected parents will have normal valves. The chance of passing this condition to a child is about 10%, which means there's a 90% chance your child will have a normal three-leaflet valve. Still, screening family members is important because early detection allows for proper monitoring if needed.

"Surgery means I'll be disabled afterward." Modern valve surgery has excellent outcomes, with most patients returning to their previous activity levels or better. Many of my patients tell me they feel better after surgery than they had in years because their heart no longer has to work against a poorly functioning valve.

"Nothing can be done until I need surgery." This isn't true at all. While we can't prevent the progression of valve problems with medications, we can optimize your overall cardiovascular health, monitor changes carefully, and time interventions appropriately. Managing blood pressure, maintaining a healthy weight, and staying active all contribute to better long-term outcomes.

Some patients worry that having been born with a "defective" heart means they're fundamentally unhealthy. I remind them that many people with bicuspid aortic valves live normal, active lives. This condition represents a variation in anatomy, not a disease that defines your overall health.

What Your Diagnosis Can't Tell Us

While modern testing gives us excellent information about your bicuspid aortic valve, there are limitations to what we can predict. Understanding these limitations helps set realistic expectations and reduces anxiety about the unknown.

We cannot predict exactly when your valve function will change. Some patients with mild stenosis remain stable for decades, while others progress to severe stenosis within a few years. This uncertainty can be frustrating, but it's why regular monitoring is so important. Your individual progression pattern will become clearer over time as we track changes in your valve function.

Echocardiograms, while excellent diagnostic tools, have inherent measurement variability. Small changes in valve measurements from one test to the next might not represent actual progression but rather normal variation in testing conditions or technique. This is why I look for consistent trends over multiple tests rather than making decisions based on a single study.

Your symptoms don't always correlate perfectly with test results. Some patients with severe valve problems feel fine, while others with milder abnormalities experience significant symptoms. This disconnect occurs because people adapt differently to gradual changes, and individual fitness levels and activity expectations vary widely.

We also cannot perfectly predict surgical outcomes for any individual patient. While we have excellent data on average outcomes and risk factors, every person's response to surgery is somewhat unique. Factors like your overall health, other medical conditions, and even genetic variations can influence recovery and long-term results.

The relationship between your valve problems and potential aortic complications isn't entirely predictable either. While we know that bicuspid valves increase the risk of aortic dilation and dissection, we cannot predict exactly which patients will develop these problems or when they might occur.

These uncertainties aren't reasons for despair. They're realities that guide how we approach your care. Rather than trying to predict the unpredictable, we focus on regular monitoring, maintaining your overall health, and making treatment recommendations based on current evidence and guidelines.

Timing and Appropriateness of Interventions

One of the most challenging aspects of managing bicuspid aortic valve disease is determining the optimal timing for intervention. Operating too early exposes you to unnecessary surgical risks, while waiting too long can allow irreversible heart damage to occur. Finding the right balance requires careful consideration of multiple factors.

For most patients, symptoms drive the timing of intervention. If you develop chest pain, shortness of breath, or dizziness related to your valve problem, treatment is usually recommended regardless of your age. Symptoms indicate that your heart can no longer compensate adequately for the valve abnormality, and delaying treatment risks sudden deterioration.

In the absence of symptoms, we rely on objective measures of valve severity and heart function. Severe aortic stenosis with a valve area less than 1 square centimeter typically warrants intervention, even without symptoms, because outcomes are better when we act before heart function declines. Similarly, severe aortic regurgitation that causes your left ventricle to enlarge often requires treatment to prevent permanent heart muscle damage.

The condition of your aorta also influences timing. If your ascending aorta measures more than 5.5 centimeters, surgical repair is typically recommended to prevent dissection, regardless of your valve function. For patients with additional risk factors (such as family history of dissection, rapid aortic growth, or severe valve regurgitation), intervention might be recommended with smaller aortic dimensions.

Age plays a significant role in treatment timing and approach. Younger patients generally receive surgical valve replacement because they need a long-term solution and can tolerate the procedure well. Older patients, particularly those over 75, might be candidates for transcatheter procedures that avoid the risks of open-heart surgery.

Your other medical conditions affect both timing and treatment choice. Patients with significant lung disease, kidney problems, or other major health issues might warrant earlier intervention if their valve problems are severe, because they may not tolerate waiting until symptoms develop. Conversely, these same conditions might make any intervention riskier.

There are also situations where intervention is generally not appropriate. Very elderly patients with multiple serious medical conditions might not benefit from valve procedures, particularly if their life expectancy is limited by other health problems. Similarly, patients with severe mental impairment who cannot participate in their recovery might not be good candidates for surgery.

The decision-making process should involve you, your family, your cardiologist, and often a cardiac surgeon. Getting a second opinion is always reasonable, particularly for complex cases or when treatment recommendations differ from what you expected.

Managing Your Expectations Through the Process

Living with a bicuspid aortic valve involves a journey that unfolds over years or decades. Managing your expectations about this journey helps reduce anxiety and allows you to make informed decisions about your care and lifestyle.

If your valve function is currently normal or only mildly affected, you can expect to live a largely normal life with periodic monitoring. Most of my patients in this category continue their usual activities, travel freely, and pursue their career and personal goals without significant restrictions. The monitoring schedule might feel burdensome at first. Annual or biennial echocardiograms can seem like frequent reminders of your condition. But most patients adapt to this routine.

As valve function changes over time, you might notice gradual limitations in your exercise capacity or energy level. These changes often occur so slowly that you adapt without realizing it. This is why I ask patients to honestly assess their activity levels compared to previous years, not just whether they feel "fine" day to day.

If you eventually need surgical intervention, your expectations should be cautiously optimistic. Most patients have excellent outcomes from valve surgery, with significant improvement in their symptoms and quality of life. However, recovery takes time, typically several weeks to a few months, and requires patience with the healing process.

The choice between mechanical and biological valves involves trade-offs that affect your long-term expectations. Mechanical valves offer durability but require lifelong blood-thinning medication, which means regular blood tests and some lifestyle modifications. Biological valves avoid the need for blood thinners but will likely need replacement in the future, particularly in younger patients.

Even after successful treatment, ongoing monitoring remains important. Artificial valves can develop problems over time, and the portion of your aorta that wasn't replaced continues to require surveillance. Most patients find that post-surgical monitoring feels less stressful than pre-surgical monitoring because the major intervention is behind them.

Your emotional response to having a bicuspid aortic valve is entirely normal and expected. Many patients experience anxiety about their diagnosis, frustration with activity limitations, or fear about future procedures. These feelings often fluctuate. You might feel fine about your condition one day and worried the next. This emotional variability is part of living with any chronic medical condition.

Setting realistic short-term and long-term goals helps maintain perspective. Short-term goals might include staying active, maintaining regular follow-up appointments, and managing any associated conditions like high blood pressure. Long-term goals could involve understanding your treatment options, planning for potential interventions, and ensuring your family is informed about your condition.

Integration with Your Overall Healthcare

Having a bicuspid aortic valve doesn't exist in isolation from your other health concerns. Integrating valve management with your overall healthcare improves outcomes and helps prevent complications.

Blood pressure management becomes particularly important when you have a bicuspid aortic valve. High blood pressure increases the stress on both your valve and your aorta, potentially accelerating the progression of stenosis or regurgitation and increasing the risk of aortic dilation. While medications don't slow valve deterioration directly, controlling blood pressure reduces your overall cardiovascular risk and may help protect your aorta.

If you have other heart conditions (such as coronary artery disease or atrial fibrillation), these need coordinated management with your valve disease. For example, if you require heart surgery for blocked coronary arteries, we might recommend addressing your valve problem at the same time if it's significantly abnormal. This approach avoids multiple surgeries but requires careful planning.

Diabetes management also intersects with valve care. Diabetic patients may have accelerated valve calcification and face higher surgical risks, making optimal diabetes control even more important. The medications used to treat diabetes, blood pressure, and cholesterol can all be safely used in patients with bicuspid aortic valves.

Your medications require periodic review, especially if your valve function changes. Certain medications used for other conditions might need adjustment as your valve disease progresses. For example, if you develop heart failure related to severe valve problems, new medications might be needed to optimize your heart function before surgery.

Dental care becomes more important when you have valve abnormalities because of the increased risk of infective endocarditis, a serious infection of the heart valve. While routine dental cleanings don't typically require antibiotics, certain dental procedures might warrant antibiotic prophylaxis. Your cardiologist and dentist should coordinate this care.

If you're a woman planning pregnancy, your bicuspid aortic valve requires special consideration. Pregnancy increases the workload on your heart, which could be problematic if your valve function is significantly impaired. Pre-pregnancy counseling helps assess risks and optimize your health before conception.

Regular exercise remains beneficial for most patients with bicuspid aortic valves, but the type and intensity should be appropriate for your valve function. Your cardiologist can provide specific exercise recommendations based on your current condition and testing results. Generally, aerobic exercise is encouraged, while very intense weight lifting might be restricted in patients with aortic dilation.

Future Developments and Emerging Treatments

The field of valve disease treatment continues to evolve rapidly, with new developments offering hope for better outcomes and less invasive approaches. Understanding these emerging trends helps you stay informed about potential future options while maintaining realistic expectations about current treatment.

Transcatheter valve technologies are advancing quickly, with newer devices specifically designed for bicuspid valve anatomy. Current transcatheter valves were originally developed for tricuspid valves, which is why bicuspid anatomy poses technical challenges. Future devices may offer better outcomes in bicuspid patients, potentially expanding the use of these less invasive procedures to younger patients.

Valve repair techniques are also improving, particularly for patients with bicuspid aortic regurgitation. Surgeons are developing better methods for reshaping bicuspid leaflets and using new materials to reinforce repairs. While repair isn't suitable for patients with calcified, stenotic valves, it might become an option for more patients with regurgitation.

Research into the genetic basis of bicuspid aortic valve disease could eventually lead to targeted therapies. Scientists are identifying specific genes and molecular pathways involved in valve development and deterioration. This research might someday result in medications that slow valve progression or treatments that address the underlying genetic causes.

Improved imaging techniques are enhancing our ability to monitor valve disease and plan interventions. New echocardiographic methods provide better measurements of valve function, while advanced CT and MRI scanning offer detailed views of valve and aortic anatomy. These improvements help us track changes more accurately and plan procedures more precisely.

Artificial intelligence is beginning to play a role in valve disease management. Computer algorithms can analyze echocardiograms to detect subtle changes in valve function and predict future progression. While still in development, these tools might eventually help us make more personalized treatment recommendations.

Research into tissue engineering and regenerative medicine holds long-term promise for growing replacement valves from your own cells. These approaches could potentially provide valve replacements that grow and adapt with you, eliminating the need for future procedures. However, these technologies remain experimental and are years away from clinical use.

Better understanding of aortic disease mechanisms is leading to new approaches for preventing aortic complications. Research into the molecular causes of aortic dilation might result in medications that stabilize aortic wall structure or slow aneurysm growth.

While these advances are encouraging, it's important to make treatment decisions based on current evidence and available therapies. Future developments should influence your long-term planning but shouldn't delay necessary current treatment while waiting for experimental approaches.

Making Informed Decisions About Your Care

The decisions you'll face regarding your bicuspid aortic valve are rarely urgent, which gives you time to gather information and make thoughtful choices. Approaching these decisions systematically helps ensure you choose the path that best aligns with your values and goals.

Start by understanding your current situation thoroughly. Make sure you understand your specific valve anatomy, the severity of any problems, and how your heart is responding to valve issues. Don't hesitate to ask your cardiologist to explain test results multiple times or in different ways until you feel confident in your understanding.

When treatment becomes necessary, learn about all available options. While your cardiologist will recommend the best approach based on medical factors, understanding alternatives helps you participate meaningfully in the decision-making process. Ask about the benefits and risks of each option, expected recovery times, and long-term implications.

Consider seeking a second opinion, particularly for complex cases or when facing major surgery. Different medical centers might have varying expertise with specific procedures, and another specialist might offer insights or options you hadn't considered. Most cardiologists welcome second opinions and will help facilitate consultations with other experts.

Think about your personal priorities and values as they relate to treatment choices. Some patients prioritize avoiding future procedures and choose mechanical valves despite the need for blood thinners. Others prefer to avoid blood-thinning medications and accept that biological valves might eventually need replacement. Neither choice is right or wrong. The best choice is the one that fits your life and values.

Consider the impact of your decisions on your family and loved ones. If you have young children, you might weigh treatment options differently than someone whose children are grown. Similarly, family members might have concerns or preferences that are worth considering as you make decisions.

Don't feel pressured to make immediate decisions unless your condition has become unstable. Taking time to process information, discuss options with family, and consider your choices is usually appropriate and advisable. However, also recognize when delaying decisions becomes harmful. If symptoms are worsening or test results show concerning changes, timely action becomes more important.

Prepare practical questions for your healthcare team: What are the realistic timelines for different treatment options? What should you expect during recovery? When can you return to work or normal activities? What are the warning signs that would require immediate medical attention? Having clear, practical information helps you plan and reduces anxiety about the unknown.

Living Wisely with Your Bicuspid Aortic Valve

Having a bicuspid aortic valve means you'll always have this condition, but it doesn't mean you can't live a full, active, and satisfying life. The key is approaching your condition with knowledge, maintaining appropriate medical care, and keeping your valve health in perspective within your broader life goals.

Stay informed about your condition without becoming obsessed with it. Understand your current valve function, know what symptoms to watch for, and maintain regular follow-up appointments. However, don't let your valve condition dominate your thinking or limit your aspirations unnecessarily. Most patients find a balance where they're appropriately cautious without being overly restrictive.

Maintain your overall cardiovascular health through regular exercise, a heart-healthy diet, blood pressure control, and avoiding smoking. These lifestyle factors benefit everyone but are particularly important when you have structural heart disease. Good overall health also improves outcomes if you eventually need surgical intervention.

Build a good relationship with your cardiologist and healthcare team. Find providers who communicate clearly, respect your questions, and involve you in decision-making. Don't hesitate to change providers if you don't feel comfortable with the communication or care you're receiving.

Keep your family informed about your condition, especially if they might need screening for bicuspid aortic valve. Make sure important family members know your diagnosis, understand your treatment plan, and know what to do in case of emergency. This preparation provides peace of mind and ensures proper care if unexpected situations arise.

Plan for the possibility of future treatment while continuing to live your life fully in the present. This might mean understanding your insurance coverage, considering the timing of major life decisions, or discussing your condition with employers if necessary. However, don't postpone important life experiences solely because of your valve condition unless medical circumstances truly require it.

Remember that medical technology and treatment options continue to improve. The options available when you eventually need treatment may be better than what's available today. This perspective should be reassuring rather than a reason to delay necessary current care.

Finally, recognize that having a bicuspid aortic valve makes you part of a large community of people living successfully with this condition. Many of my patients find comfort in connecting with others who share this experience, whether through formal support groups or informal networks.

Your bicuspid aortic valve is one aspect of your health, but it doesn't define your life or limit your potential for happiness and achievement. With proper medical care, informed decision-making, and a balanced perspective, you can navigate this condition successfully while pursuing the life you want to live.

References

1. Otto, Catherine M., Rick A. Nishimura, Robert O. Bonow, et al. "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines." Journal of the American College of Cardiology 77, no. 4 (2021): e25-e197.

2. Isselbacher, Eric M., Ourania Preventza, John Hamilton Black III, et al. "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines." Journal of the American College of Cardiology 80, no. 24 (2022): e223-e393.

3. Michelena, Hector I., Alessandro Della Corte, Arturo Evangelista, et al. "International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes." The Annals of Thoracic Surgery 112, no. 3 (2021): e203-e235.

4. Borger, Michael A., Paul W.M. Fedak, Elizabeth H. Stephens, et al. "The American Association for Thoracic Surgery Consensus Guidelines on Bicuspid Aortic Valve-Related Aortopathy: Full Online-Only Version." The Journal of Thoracic and Cardiovascular Surgery 156, no. 2 (2018): e41-e74.

5. Otto, Catherine M., David E. Newby, and Graham S. Hillis. "Calcific Aortic Stenosis: A Review." JAMA 332, no. 23 (2024): 2014-2026.

6. Rodríguez-Palomares, José F., Lydia Dux-Santoy, Andrea Guala, Laura Galian-Gay, and Arturo Evangelista. "Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review." Journal of the American College of Cardiology 82, no. 5 (2023): 448-464.

7. Small, Andrea M., Katherine E. Yutzey, Bryce A. Binstadt, et al. "Unraveling the Mechanisms of Valvular Heart Disease to Identify Medical Therapy Targets: A Scientific Statement From the American Heart Association." Circulation 150, no. 6 (2024): e109-e128.

8. Sillesen, Anne Sophie, Oliver Vögg, Christian Pihl, et al. "Prevalence of Bicuspid Aortic Valve and Associated Aortopathy in Newborns in Copenhagen, Denmark." JAMA 325, no. 6 (2021): 561-567.

9. Morris, Shaine A., Jennifer N. Flyer, Angela T. Yetman, et al. "Cardiovascular Management of Aortopathy in Children: A Scientific Statement From the American Heart Association." Circulation 150, no. 11 (2024): e228-e254.

10. Evangelista, Arturo, Laura Galian-Gay, Andrea Guala, et al. "Atorvastatin Effect on Aortic Dilatation and Valvular Calcification Progression in Bicuspid Aortic Valve (BICATOR): A Randomized Clinical Trial." Circulation 149, no. 25 (2024): 1938-1948.

11. Davidson, Lance J., and Charles J. Davidson. "Transcatheter Treatment of Valvular Heart Disease: A Review." JAMA 325, no. 24 (2021): 2480-2494.

12. Masri, Anas, Vidyasagar Kalahasti, Serge Alkharabsheh, et al. "Characteristics and Long-Term Outcomes of Contemporary Patients With Bicuspid Aortic Valves." The Journal of Thoracic and Cardiovascular Surgery 151, no. 6 (2016): 1650-1659.

Published on damianrasch.com

The above information was composed by Dr. Damian Rasch, drawing on individual insight and bolstered by digital research and writing assistance. The information is for educational purposes only and does not constitute medical advice.