Overview
The aortic valve is a one-way valve between the heart and the aorta, the main artery from the heart that distributes oxygen-rich blood to the body. Normally, the aortic valve has three small flaps or leaflets that open widely to allow blood to flow from the heart to the aorta and close securely to prevent blood from flowing backwards into the heart.
In bicuspid aortic valve disease (BAVD), the valve has only two leaflets. About 1-2% of the population has BAVD, and it is twice as common in males as in females. BAVD is a congenital heart disease, the two-leaflet valve develops in the early stages of pregnancy, and the defect is present at birth.
Bicuspid valves may work for years without causing symptoms or signs of a problem. But later in life, about a half of people with BAVD with have aortic valve stenosis (narrowed) and about one third will have aortic valve regurgitation (leaky).
In some patients with bicuspid aortic valve, patients may also have:
- Aortic aneurysms (bulging)
- Other types of valve disease, such as mitral valve prolapse
- Marfan Syndrome or other connective tissue disorders, along with a bicuspid aortic valve
In rare cases, patients may have only one cusp or leaflet, called unicuspid valve disease.
Treatment Options
BAVD Care
Patients with bicuspid aortic valve disease may come to the center for many reasons. You may:
- Have been newly diagnosed with bicuspid aortic valve disease (BAVD)
- Have BAVD and want a second opinion about your treatment plan
- Have BAVD and are seeking treatment by an experienced center.
In addition, bicuspid valve disease can be hereditary. About 10% of people with bicuspid valve disease have family members who also have bicuspid valve disease. The Bicuspid Valve Center specialists work with families to screen members to determine if they also have this condition.
State of the Art Diagnostic Testing
Cleveland Clinic’s imaging specialists have expertise in 2D and 3 D echo, performing over 76,000 echoes per year. In addition cardiac CT and MRI, and nuclear testing is available to precisely diagnose your valve disease and plan treatment.
Treatment plans are designed based on the patient’s individual needs. Our treatments include:
- Aortic valve repair and replacement
- Heart surgery that involves the aortic valve and aorta
- Combined heart surgeries for valve and atrial fibrillation as well as complex conditions
- Interventional options with transcatheter valve procedures for aortic valve disease
- Programs for long-term monitoring of valve disease
Publications
Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves.
Masri A, Kalahasti V, Alkharabsheh S, Svensson LG, Sabik JF, Roselli EE, Hammer D, Johnston DR, Collier P, Rodriguez LL, Griffin BP, Desai MY. J Thorac Cardiovasc Surg. 2016 Jun;151(6):1650-1659.e1. doi: 10.1016/j.jtcvs.2015.12.019. Epub 2015 Dec 19.
Outcomes After Operations for Unicuspid Aortic Valve With or Without Ascending Repair in Adults.
Zhu Y, Roselli EE, Idrees JJ, Wojnarski CM, Griffin B, Kalahasti V, Pettersson G, Svensson LG. Ann Thorac Surg. 2016 Feb;101(2):613-9. doi: 10.1016/j.athoracsur.2015.07.058. Epub 2015 Oct 9.
Aortic Dissection in Patients With Bicuspid Aortic Valve-Associated Aneurysms.
Wojnarski CM, Svensson LG, Roselli EE, Idrees JJ, Lowry AM, Ehrlinger J, Pettersson GB, Gillinov AM, Johnston DR, Soltesz EG, Navia JL, Hammer DF, Griffin B, Thamilarasan M, Kalahasti V, Sabik JF 3rd, Blackstone EH, Lytle BW. Ann Thorac Surg. 2015 Nov;100(5):1666-73; discussion 1673-4. doi: 10.1016/j.athoracsur.2015.04.126. Epub 2015 Jul 22.
Our Doctors
The Bicuspid Aortic Valve Center is co-directed by:
Shinya Unai, MD – Surgical Director
Milind Desai, MD – Medical Director
Together with Eric Roselli, MD, Director of the Aorta Center; Brian Griffin, MD, Medical Director of the Valve Center; and Vidyasagar Kalahasti, MD, Director of the Cardiovascular Marfan Syndrome & Connective Tissue Clinic, this team has brought together a team of experts in diagnosis and treatment of aortic valve disease.
Multidisciplinary Team
Medical Team
- Ajay Bhargava, MD
- Patrick Collier, MD, PhD
- Milind Desai, MD
- Maan Fares MD
- Michael Faulx, MD
- Brian Griffin, MD
- Richard Grimm, DO
- Donald Hammer, MD
- Serge Harb, MD
- Julie Huang, MD
- Umesh Khot, MD
- Wael Jaber, MD
- Christine Jellis, MD
- Vidyasagar Kalahasti, MD
- Deborah Kwon, MD
- Rhonda Miyasaka, MD
- Venu Menon, MD
- Zoran Popovic, MD, PhD
- Jay Ramchand, MD, PhD
- Leonardo Rodriguez, MD
- Maran Thamilarasan, MD
- Tom Wang, MD
- Heba Wassif, MD, MPH
- Bo Xu, MD
Cardiothoracic Surgery
- Faisal Bakaeen, MD
- Marijan Koprivanac, MD
- Kenneth McCurry, MD
- Eric Roselli, MD*
- Nicholas Smedira, MD
- Edward Soltesz, MD*
- Lars Svensson, MD, PhD
- Michael Tong, MD*
- Shinya Unai, MD*
- Patrick Vargo, MD
- James Yun, MD
(*) Performs aortic valve repair and valve sparing aortic root replacement
Cardiothoracic Anesthesia
Pediatric & Congenital Heart Surgery
- Hani Najm, MD- Chair of Pediatric and Congenital Heart Surgery
- Tara Karamlou, MD
Interventional Cardiology
Cardiovascular Clinical Genetics
A team is available for genetic testing and counseling
Appointments
Due to the nature of bicuspid aortic valve disease, your needs as a patient will guide your care. For example, you may want to have regular follow-up over a long period of time, or maybe you have just been diagnosed with valve disease and want to establish a treatment plan. Perhaps you are exploring treatment options and need a surgery consultation. No matter what your needs, we are here for you every step of the way. If you have any questions please do not hesitate to call.
Traveling to Cleveland Clinic
To help make your visit to Cleveland Clinic as easy as possible, please visit:
Information on travel to the Miller Family Heart, Vascular & Thoracic Institute.
Clinical Team Appointments
Schedule an Appointment
Toll-free 800.659.7822
If your scheduled appointment is at least one week away, you will be asked to send in a copy of your medical records, including a medical history, test results and films (echocardiogram, ultrasound, chest X-ray, MRI, CT). All information should be sent in the same package (clearly marked with your name and address) via Airborne Express, Federal Express, or certified US mail (make sure you have a tracking number) to the physician you will be seeing at Cleveland Clinic. Your appointment may be with Cardiovascular Imaging (Desk J1-5) or Clinical Cardiology (Desk J2-4), depending on your condition and needs.
The address to mail your records is:
Physician Name
Cleveland Clinic
Desk #
9500 Euclid Ave.
Cleveland, OH 44195
If your scheduled appointment is less than one week away, please bring your records to your appointment.
What to expect during your appointment
Your appointment may last the entire day, so be prepared. Your appointment will begin by meeting with a nurse or physician assistant (PA) who will collect information about your medical history, symptoms and test results, and enter your information into our electronic medical record. This will help the doctor during your exam.
You may need blood and imaging tests, such as an electrocardiogram, echocardiogram, MRI or CT scan. The specialists in the Bicuspid Aortic Valve Center will use these tests to help diagnosis your condition and to create an individualized treatment plan for you. A cardiologist from the Bicuspid Aortic Valve Center will review your records, take a medical history, perform a physical exam, and, if needed, consult with other physicians in the Bicuspid Aortic Valve Canter to discuss your condition. If you need to meet with one of the multidisciplinary specialists, we will try to arrange a meeting with them within a day to limit your travel to and from Cleveland Clinic. The Bicuspid Aortic Valve Center cardiologist will talk to you about your diagnosis and plan of care within 1 to 2 days, depending on when your test results are completed.
How long will you need to stay at Cleveland Clinic?
You should plan on spending 1 to 2 days in the Cleveland area. Your stay may be longer if a treatment is scheduled at the time of your visit.
Follow-up
Your doctor will talk to you about your plan for follow-up care.
Cardiovascular Surgery Team Appointments
If you would like information about your surgical options for your valve disease, you can send your medical records in for a review. The process involves several steps:
- Contact the Heart, Vascular & Thoracic Institute Resource Nurses, who will collect information such as your contact information and the type of surgery you need.
- The nurses will give you a list of the information needed to complete the surgical review and tell you how to send in your information.
- You will send in your records to be reviewed by one of our surgeons.
- The surgeon’s office will call you to let you know about your surgical options. The process generally takes a couple weeks once we receive your films, unless your physician determines that there is an urgent need for surgery.
- If you decide to have surgery at Cleveland Clinic, you will be given a surgery date. In some cases, the surgeon will want to see you for a consultation and then schedule your surgery at another time.
What to expect during your appointment
You will need to arrive a few days before your surgery to have a full evaluation and meet your surgical team. You and your family will attend a program to prepare you for what to expect before, during and after your surgery. See Heart Surgery at Cleveland Clinic for more information about having surgery at Cleveland Clinic.
How long will you need to stay at Cleveland Clinic?
Your hospital stay depends on many factors, such as your condition, the type of surgery you need and your medical history. Generally, patients who live outside of the Cleveland area come to Cleveland a day or two prior to surgery, stay in the hospital 5 to 7 days, and stay in Cleveland at least one night after leaving the hospital before traveling home. We ask that you return to Cleveland Clinic for a post-op visit during the first week after you leave the hospital, so you may want to plan on staying in the area until after that visit.
Follow-up
Your doctor will talk to you about your plan for follow-up care.
More Information
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Videos: Watch Valve Disease and Treatments Videos by our doctor.
Interactive Tools: If you have aortic stenosis, take our Interactive Aortic Stenosis Assessment Tool to see if surgery is recommended for your aortic stenosis.
