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The risk of calcification: Why does the bicuspid aortic valve predispose to heart disease?
Bicuspid Aortic Valve (BAV) is a heart disease that usually occurs during fetal development and causes the two valves of the aortic valve to fuse during development, forming a two-valve aortic valve. Instead of the normal three-valve valve. Bicuspid aortic valve is the most common congenital heart defect, affecting approximately 1.3% of adults. Typically, under normal circumstances, only the mitral valve is a bicuspid valve, which is located between the left atrium and the left ventricle of the heart. The main function of heart valves is to ensure one-way flow of blood inside the heart and in the vascular system. Most bicuspid aortic valve conditions are inherited.
Symptoms and Signs
In many cases, a bicuspid aortic valve does not cause any problems. However, patients may find themselves tiring more easily than those with normally functioning heart valves and performing less well on activities that require cardiorespiratory endurance because pressure on the aortic wall affects heart performance.
Complications
Calcification Problem
With age, the bicuspid aortic valve may develop calcification, which may lead to varying degrees of aortic stenosis, which may be evident by a heart murmur. If the valve does not close properly, aortic regurgitation can occur. If these conditions worsen, heart surgery may be necessary. The heart is put under more stress as it tries to pump more blood through a narrow valve or tries to circulate backflow blood through a leaky valve.
Eventually, the risks of heart disease caused by a bivalve aortic valve include dilation of the aorta due to having only two valves, which may lead to aortic valve rupture.
Aortic disease
Patients with bicuspid aortic valve have a notable feature: they are more likely to develop ascending aortic aneurysm lesions. The aortic outer matrix of BAV patients showed significant differences from normal tricuspid valves, especially the reduction of Fibrillin-1. It is believed that an increased ratio of MMP2 (matrix metalloproteinase 2) to TIMP1 (matrix metalloproteinase inhibitor 1) may lead to abnormal degradation of the valve matrix, thereby initiating the formation of aortic dissection or aneurysm.
The size of the ascending aorta needs to be carefully checked and should be examined periodically with CT scans or MRI to avoid ionizing radiation.
Aortic stenosis
A double aortic valve may also cause aortic stenosis (narrowing of the heart's aortic valve), which prevents the valve from opening fully, thereby reducing or blocking blood flow from the heart to the body. In some cases, the aortic valve fails to close tightly, allowing blood to flow backward into the left ventricle. Also associated with BAV is coarctation of the aorta.
PathophysiologyAortic valve fusion is most common between the right and left coronary valves, accounting for about 80%. In addition, fusion of the right coronary artery and noncoronary valve also occurs (about 17%), while fusion of the noncoronary valve and left coronary valve is relatively rare (about 2%). Among these fusion patterns, fusion of the RN valve was more strongly associated with future complications such as aortic regurgitation and stenosis.
Hemodynamics
Identifying aortic hemodynamics after left ventricular contraction helps predict complications of bicuspid aortic valves, and the risk of some complications, such as aortic aneurysm, depends on the specific valve fusion pattern.
Blood outflow from BAV is spiral and has a velocity greater than 1 m/s, which has a high potential for damage to the aorta.
Diagnosis
A bicuspid aortic valve is often associated with a right second intercostal heart murmur. Differences in blood pressure between the upper and lower extremities can often be found. Diagnosis can be aided by cardiac ultrasound or magnetic resonance imaging (MRI).
TreatmentFour-dimensional magnetic resonance imaging (4D MRI) is a technique that defines blood flow characteristics and patterns, accurately visualizing blood flow within the cardiovascular system.
Complications arising from structural heart problems are usually treated with surgical intervention, which may include aortic valve replacement or balloon valvuloplasty.
Prognosis
Bicuspid aortic valve causes major complications in more than one-third of patients. These include narrowing of the aortic valve opening, backflow of blood in the aorta, dilatation of the ascending aorta, and infection of the heart valves. Patients with aortic regurgitation and ascending aortic dilatation require regular follow-up examinations.
When facing the challenge of bicuspid aortic valve, how can we seek better prevention and treatment methods to ensure that our heart health is not threatened?
