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Treatment of bicuspid aortic valve stenosis in adults
| AuthorsMartin G Keane, MDMartin G St John Sutton, MBBS, FRCP, FACC, FASE | Section EditorsCatherine M Otto, MDThomas P Graham, Jr, MD | Deputy EditorSusan B Yeon, MD, JD, FACC |
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GRAPHICS
The only definitive therapy for aortic stenosis is aortic valve replacement. A congenitally bicuspid valve is a common cause of aortic stenosis requiring surgery in all age groups. This was illustrated in a report of 932 adults with isolated nonrheumatic aortic stenosis who underwent operative excision of the stenotic valve; none underwent mitral valve replacement, none had mitral stenosis, and none had undergone previous aortic valvulotomy [1]. A congenitally malformed valve was present in 54 percent: 49 percent had a bicuspid valve and 4 percent had a unicuspid valve (mostly in patients ≤50 years of age).
The causes according to age at the time of aortic valve replacement were as follows:
- Among the 7 percent of patients who underwent surgery at ≤50 years of age, approximately two-thirds had a bicuspid valve and one-third had a unicuspid valve.
- Among the 40 percent of patients who underwent surgery between the ages of 50 and 70, approximately two-thirds had a bicuspid valve and one-third a tricuspid valve; a unicuspid valve was rare.
- Among the remaining patients over age 70, approximately 60 percent had a tricuspid valve and 40 percent had a bicuspid valve.
The different aspects of therapy of bicuspid aortic valve stenosis in adults will be briefly summarized here with links to more complete discussions in the appropriate general topics on aortic stenosis. The management of congenital aortic stenosis in children and the etiology, natural history, and clinical manifestations of congenital aortic stenosis are discussed separately. (See "Valvar aortic stenosis in children" and "Causes and clinical course of bicuspid aortic valve".)
The only effective treatment for symptomatic aortic stenosis is valve replacement. In patients who refuse or are not candidates for surgical intervention, therapeutic options are limited and of only marginal benefit.
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