Surgeon Q&A: Bicuspid Aortic Valve Gradients & Aortic Aneurysms

Bicuspid aortic valve disease is the most prevalent congenital heart defect, affecting approximately one to two percent of the world’s population. Although the valve defect may go unnoticed while patients are young, it can eventually cause complications with valve function, like stenosis and regurgitation. In addition to valve complications, there can also be involvement with the ascending aorta or aortic root in the form of an aneurysm. In many cases, impaired aortic valve function and aortic aneurysm happen simultaneously. Given all the variables accompanying bicuspid aortic valve disease, it’s no wonder that patients have numerous questions about treatments and interventions when they start to experience problems associated with the bicuspid aortic valve.

We received a patient question on this topic from Chappie, one of our YouTube viewers, based on a video we posted about bicuspid valves featuring Dr. Bill Brinkman. Chappie asked, “Would a bicuspid aortic valve with a normal 1.1 peak gradient need replacement if my aortic aneurysm needs to be repaired?”

We were thrilled to meet Dr. Brinkman during the Society of Thoracic Surgeons Conference to answer Chappie’s question. Dr. Brinkman is a leading aortic valve surgeon at Baylor, Scott & White The Heart Hospital-Plano in Plano, Texas. He has performed over 2,500 heart valve surgeries throughout his extraordinary career.

Facts About Aortic Aneurysms and Bicuspid Aortic Valve Gradients

Here are the key insights shared by Dr. Brinkman:

• Bicuspid aortic valve treatment in the presence of an aneurysm is not always required. Dr. Brinkman explained, “If that valve is working well, we will usually do what’s called a valve sparing replacement of the ascending aorta. Sometimes, if the root is enlarged, we will do a re-implantation or a David procedure, and we’ve had a lot of success and very good outcomes.”

• Brinkman explained that a primary factor in determining treatment is the condition of the valve leaflets and whether they are thickened or stiffened. Regarding Chappie’s peak gradient, he said, “When you have a peak gradient that low, it means the leaflets are very supple and opening and closing very easily like a flag in the wind as opposed to stiff leaflets that are barely opening. If you have stiff leaflets, we’re talking replacement with a mechanical valve, biological valve, or a Ross operation.”

• What gradient number might cause a patient concern when looking at their echocardiogram? “When somebody says you have an increased gradient, that usually implies aortic stenosis,” said Dr. Brinkman. “Anything over 40 is what we call severe and would be a clear indication for surgery. Now, if you have a mild gradient, maybe like 15 to 20, and we’re in there fixing the aneurysm, we may want to go ahead and replace it, but it’s not a valve that you would want to repair because the leaflets are not that solid to begin with.”

Thanks Dr. Brinkman and Baylor, Scott & White!

On behalf of all the patients in our community, thank you, Dr. Bill Brinkman, for everything you and your team are doing at Baylor, Scott & White The Heart Hospital- Plano in Plano, Texas.

Related links:

• See 50+ Patient Reviews for Dr. Brinkman
• Ask Dr. Brinkman: Treating Bicuspid Aortic Valves and Aortic Aneurysms
• Patient Review: Cardiac Surgery Outcomes Report from Baylor, Scott & White

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Brinkman below.