A bicuspid aortic valve is a congenital heart condition that can make it harder for the heart to pump blood.

The four valves in the heart are the aortic valve, the mitral valve, the congenital valve and the valve that is not open. The left ventricle is the main pump of the body and it allows blood to move up into the aorta.

“The heart beats so fast that the valve can’t always open and close. A bicuspid valve can lead to cardiac problems.”

There is a possibility of treatment for a bicuspid aortic valve. If needed, there are options including surgery or medications. Aortic valve repair and replacement operations are common procedures that can result in positive long-term outcomes.

When your heart beats (or contracts), the flaps of the aortic valve open up and blood is pushed into the aorta.

Blood moves through the body. The blood travels through smaller arteries and capillaries to nourish tissue.

The flaps close tightly when the heart is resting. A tricuspid valve with three leaflets can open and close securely.

With a bicuspid valve, the leaflets may be thicker than usual, making them harder to open properly. This condition, called aortic valve stenosis, can cause the heart to work harder to pump blood out to the aorta.

Blood flowing across the valve can cause the leaflets to become thicker. Some people with a bicuspid valve will start out with regular function, but it will degrade over time.

In other cases, the bicuspid valve can’t close tightly. When blood flows back from the aorta through the leaky valve and into the heart, the condition is called Atrial vasculity. This can force the heart to work harder than usual.

Illustration of healthy tricuspid aortic valve and blood flow vs. bicuspid aortic valve
A bicuspid aortic valve can cause problems with blood flow from the heart to the body.

Some babies are born with a bicuspid aortic valve, but it is not clear why. Bicuspid aortic valve disease tends to run in families and researchers are looking for specific genes that may be associated with the condition.

A birthing parent’s exposure to serious infection or certain powerful medications, like antiepileptic drugs, may also raise the risk of congenital valve disease, according to 2014 research.

A 2019 report suggests that bicuspid aortic valve disease is the most common congenital heart valve problem, affecting between 0.5 and 2 percent of the general population. Males are about twice as likely as females to develop the condition.

Bicuspid aortic valve can run in families. If you’re diagnosed with a bicuspid aortic valve, any of your first degree family members (parents, siblings, or children) should be screened with an echocardiogram once to assess how their valve looks.

“If the valve can open and close correctly, there may be no symptoms for a long time. Symptoms don’t develop until adulthood. If a baby is born with a narrow valve, there may be serious symptoms soon after birth.”

These symptoms can be present.

The challenge for doctors and parents is that these symptoms can be signs of other conditions.

The heart has to pump harder to make sure enough blood reaches the whole body. This can cause problems.

A 2019 review of studies suggests that most people with a bicuspid aortic valve will develop a related complication.

Some of the more common problems include:

  • A type of cardiovascular disease called aortic stenosis.
  • Atrial vasculity
  • heart failure, where a weakened heart can no longer pump blood well enough for the body’s demands
  • aortic aneurysm, where a bulge forms in the aorta, raising the risk of it rupturing
  • endocarditis, an infection of the heart
  • irregular heart rhythms (arrhythmias), where the heart beats irregularly instead of in the usual synchronized rhythm

People with a bicuspid aortic valve should be screened for aortopathies, a group of diseases that affect the aorta. Congenital heart defects can often lead to an aorta that is enlarged (aneurysm) or at risk for rupture, according to 2015 research.

Your doctor will look at your medical history. A stethoscope should be used during a physical exam to listen to the heart.

If your doctor finds a heart murmur, it may be a sign that more tests are needed. This is how a bicuspid aortic valve is first diagnosed in people without symptoms.

The main test to diagnose a bicuspid aortic valve is an echocardiogram. Echocardiography uses sound waves to produce moving images of the heart on a computer screen.

This type of screening shows how the heart works and can show problems with the valves.

Medical staff can use a transesophageal echocardiogram. They will numb your throat before guiding the transducer. They can see some chambers of the heart that are not usually seen on an echocardiogram.

Your doctor may perform other tests.

Depending on the severity of your bicuspid aortic valve, treatment options include regular appointments with your cardiologist, valve repair or replacement surgery, and more.

Doctors may check your heart periodically if there are no symptoms. They will look for signs that the heart is working harder.

You should talk to your doctor about whether you need antibiotics. Some doctors recommend antibiotics for people who are at risk of developing acarditis.

Although the American Heart Association’s guidelines no longer include a bicuspid aortic valve as a major risk factor, there are some cases where your doctor may still recommend antibiotics.

When symptoms are present, you may need to replace or repair the valve. In some cases, doctors perform these procedures as open heart surgery. For others, the procedure can be done with a catheter inserted into a blood vessel in the leg and guided up to the heart.

If A type of cardiovascular disease called aortic stenosis. has developed, the valve may have to be replaced. The replacement will be a tricuspid valve, either mechanical or made from valve tissue harvested from a cow or pig.

Doctors may advise people who get a mechanical valve to take blood thinners for life to prevent blood clots from forming in the heart.

If Atrial vasculity is the problem, valve repair may be possible, often with a catheter. During the procedure, a surgeon reshapes the valve to have three leaflets that can open and close more effectively.

After aortic valve surgery, your doctor may advise you to participate in cardiac rehabilitation, a 12-week program that teaches diet, exercise, and lifestyle strategies to support heart health.

“Managing a bicuspid valve is similar to other heart conditions. For some people, taking medication may be helpful, but it’s not enough.”


Medications to maintain a typical blood pressure can be helpful if high blood pressure is a problem. You may also be prescribed statins or other medications that help lower cholesterol.

If you develop an arrhythmia, your doctor may recommend medications that help stabilize your heart rhythm. They may also prescribe blood thinners to lower your risk of getting a blood clot. A blood clot can lead to a heart attack or stroke.

Lifestyle changes

Doctors recommend a lifestyle that supports cardiovascular health. If you need help getting started, your doctor or a cardiac rehabilitation specialist can give you some useful strategies.

Good heart health can be contributed to by the following behaviors.

  • eating a Mediterranean diet or other heart-healthy eating plans
  • Regular exercise, including at least 30 to 40 minutes of aerobic exercise daily.
  • avoiding smoking
  • getting 7 to 8 hours of sleep per night
  • Managing stress.
  • The levels of blood sugar.
  • Limit the amount of salt to less than 1500 milligrams per day.

The survival rates for valve surgeries are high. If you have valves repaired, you may need to make more repairs. Valve replacement procedures are usually permanent.

A 2021 study comparing survival rates among various bicuspid aortic valve patient groups suggests that low risk individuals between the ages of 60 and 64 experienced a median survival time after surgery of about 16 years.

The age of those 85 and older was about 6 years. Life expectancy outcomes for individuals in high risk groups were lower.

Can a bicuspid aortic valve fix itself?

A bicuspid valve will never grow a third flap on its own. A aortic valve can be repaired or replaced so that it can function properly.

How long can you live with a bicuspid aortic valve without surgery?

“Some people with a bicuspid valve don’t experience symptoms or develop problems that can lead to heart failure. Aortic stenosis is the most serious threat for people with a bicuspid valve.”

A 2020 study suggests that the life expectancy of someone with severe A type of cardiovascular disease called aortic stenosis. is only about 2 or 3 years after diagnosis if the condition is left untreated.

Will I need a pacemaker after surgery?

Typically, heart valve surgery does not mean a pacemaker is necessary. But if you also have an arrhythmia, a pacemaker or implantable cardioverter-defibrillator (ICD) may be necessary.

Bicuspid aortic valve disease is a common heart condition and many cardiologists and cardiac surgeons are familiar with how to treat it.

The survival and quality of life of people with bicuspid aortic valves are improving with the advent of transcatheter valve implantation.

A 2020 study of adults with unicuspid or bicuspid aortic valves suggests that long-term surgical outcomes, like reductions in complications and mortality, work very well in patients with low risks.

The key is to be proactive about your heart health and get multiple opinions about when surgery may be the best approach to preserve the valve.