What is a Bicuspid Aortic Valve & Ascending Thoracic Aortic Aneurysm?

Normal Aorta Anatomy

Blood flows from the left ventricle into the aortic root.
A small portion of this blood flows into the coronary arteries which supply the muscle of the heart.
The remainder of the blood flows through the aortic valve into the ascending aorta, the aortic arch, and finally the descending aorta.

Bicuspid Aortic Valve

A normal aortic valve has three leaflets or cusps i.e. tricuspid valve. A bicuspid valve results from an abnormal fusion of two leaflets, resulting in a valve with only two leaflets or cusps. Bicuspid aortic valve is a congenital defect resulting from abnormal development of the valve. It is a common abnormality and occurs in 1-2% of people. This is the second most common cause of aortic valve disease requiring surgery. Eventually this valve can become stenotic or insufficient, thereby compromising blood flow to the rest of the body. This usually occurs when that person is in their 50's or 60’s. Tonya was unlucky in that her valve became severely stenotic in her mid-30’s.

Stenotic Bicuspid Valve
Specimen

Bicuspid Aortic Valve and Thoracic Aortic Aneurysm Cross section

Cross-section through heart
showing aortic valve and ascending aorta
Click here for a heart valve animation

Normal Aorta

Thoracic Aortic Aneurysm

This is an abnormal dilatation of the aorta within the chest. It can involve the ascending aorta, descending aorta, or both. Ascending aortic aneurysms can accompany bicuspid aortic valve, as in Tonya.
Tonya’s aneurysm was a large ascending aortic aneurysm which also involved the aortic root. If the aneurysm becomes too large, the risk of aortic rupture increases. Tonya’s surgery included replacement of her entire ascending aorta with a Dacron graft.

Additional Reference:

How the Heart Valves Work - This links to a cool animated video which shows how the valves work with normal blood flow through the heart. It also shows both valvular stenosis and regurgitation (insufficiency).

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