Do I Need Surgery for Bicuspid Aortic Valve and Severe Regurgitation?

In the past two years, there have been abnormal findings in the electrocardiogram during health check-ups, and an ultrasound has detected aortic valve insufficiency. Is surgery necessary in this case?

Hello Doctor: In the past two years, my ECG during health check-ups has shown abnormalities, and I have been diagnosed with aortic valve insufficiency.
The examining physician mentioned that I was born with a missing leaflet.
After undergoing an echocardiogram, I was referred to a cardiac surgeon.
I would like to ask: 1.
Does this suggest that surgery for valve replacement is recommended? 2.
As I am a boxing and aerobic fitness coach, should I change my exercise regimen before the valve replacement? After the replacement, will I still be able to engage in high-intensity cardiovascular or strength training? 3.
What is the estimated total cost for aortic valve replacement surgery? Additionally, please help me interpret the medical records from the clinic: 【Subject Finding】History of Bicuspid aortic valve with Severe Aortic Regurgitation.
TEE examination in 2021/12: 2.
Bicuspid aortic valve (suspected right and left fusion) with flail of the right and left fusion cusps, resulting in severe eccentric aortic regurgitation (2D-VC = 0.727 cm, 3D-VCA = 1.33 cm², PHT = 166~192 ms); 3.
No atrial septal defect or ventricular septal defect (perimembranous type QP/QS: ) 2022/11/03: Bicuspid aortic valve with severe aortic regurgitation with follow-up echocardiograms yearly, sometimes experiencing acid regurgitation and left upper extremity soreness within days, noted exercise with no symptoms.
2022/11/10: Echo: Bicuspid aortic valve with severe aortic regurgitation, LV: 70-> 70 mm; response to medication with famotidine preparation.
【Object Finding】Chest (PA): > Mildly increased lung markings.
Suggest correlation with clinical profile and follow-up.
> Mildly enlarged cardiac silhouette.
> Thoracolumbar spondylosis with osteophyte formation.
Normal sinus rhythm.
Moderate voltage criteria for left ventricular hypertrophy, may be a normal variant.
2021-11-19 Cholesterol 182 mg/dL.
TET: negative.
---------- Bicuspid aortic valve with Severe Aortic Regurgitation 1.
Normal left ventricular wall motion, left ventricular ejection fraction (LVEF) 2.
LVESD = 43 mm, aortic root 31 mm, ascending aorta 30 mm 3.
A jet from aorta to right ventricle in SAX view 4.
Mild pulmonary regurgitation, mild tricuspid regurgitation.
2022/01 TEE: pending report.

Mr. Zhang, 40~49 year old female. Ask Date: 2022/11/11

Dr. He Dongjin reply Cardiology

Hello, I suggest that you directly discuss the possible risks, costs, pre-operative preparations, and post-operative recovery with your cardiac surgeon or the physician who is scheduled to perform your surgery.
Theoretically, any treatment is aimed at improving your future condition compared to your current state, which is what makes the treatment meaningful.
Therefore, after the surgery and recovery, you should ideally have better physical health than you do now.
Regarding health insurance, it’s important to clarify with the surgeon whether there are any out-of-pocket expenses.
Changhua Hospital cares about your well-being.

Reply Date: 2022/11/11

More Info

When it comes to managing a bicuspid aortic valve (BAV) with severe aortic regurgitation (AR), the decision to undergo surgery is often based on several clinical factors, including the severity of symptoms, the degree of regurgitation, and the overall function of the heart. Given your situation, here are some insights regarding your questions:
1. Is Surgery Recommended?
Based on the information provided, it appears that your condition has been assessed as severe aortic regurgitation due to a bicuspid aortic valve. In general, surgical intervention is recommended when patients exhibit significant regurgitation and associated symptoms, or when there are signs of left ventricular (LV) dilation or dysfunction. Since you have been referred to a cardiac surgeon, it suggests that your healthcare team is considering surgery as a viable option. The goal of surgery would be to replace the malfunctioning valve to prevent further deterioration of heart function and to alleviate symptoms.

2. Changes in Exercise Regimen:
As a boxing and aerobic fitness coach, your physical activity is likely quite demanding. Prior to surgery, it is advisable to modify your exercise routine, particularly if you experience symptoms such as shortness of breath, fatigue, or chest discomfort. High-intensity workouts may place additional strain on your heart, which could be detrimental given your current condition. After valve replacement surgery, many patients can return to their previous levels of physical activity, including high-intensity training, but this should be done gradually and under the guidance of your healthcare provider. Cardiac rehabilitation programs are often recommended post-surgery to help patients safely regain their strength and endurance.

3. Cost of Aortic Valve Replacement:
The cost of aortic valve replacement can vary widely based on several factors, including the type of valve used (biological vs. mechanical), the healthcare facility, and whether you have insurance coverage. In the United States, the total cost for such a procedure can range from $50,000 to over $200,000, depending on the complexity of the case and the length of hospital stay. It is essential to discuss with your healthcare provider and insurance company to get a clearer picture of the expected costs and any out-of-pocket expenses you may incur.

In summary, surgery for a bicuspid aortic valve with severe regurgitation is often necessary to prevent complications and improve quality of life. It is crucial to have open discussions with your cardiac surgeon about the timing of the surgery, the type of valve that will be used, and the expected recovery process. Additionally, modifying your exercise routine before surgery and participating in a structured rehabilitation program afterward can significantly aid in your recovery and help you return to your active lifestyle safely. Always ensure that you are following your healthcare provider's recommendations closely throughout this process.

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