Hundreds of thousands of people are living with apotentially serious heart conditionthey don't know they have. Experts say one to two percent of the population - up to one in 50 people - are born with a bicuspid aortic valve (BAV) which is a potentially serious condition, but which is often without symptoms until middle age.

However, once diagnosed, those with the heart defect will need regular check-ups and to follow some strict rules to help prevent it from developing endocarditis, a life-threatening heart infection. These include steps to limit the risk of infection so some lifestyle rules include regular dental visits - and avoiding tattoos, microblading or body piercing.

Unfortunately, many of the symptoms of the condition can be easily missed or thought to be something else. To help spot the condition The Aortic Dissection Charitable Trust has set out what to watch for.

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It said: "BAV often remains unnoticed, with many unaware of their condition for years. Symptoms, when they do appear, are usually linked to complications like aortic regurgitation or stenosis."

"In younger patients, BAV might be more asymptomatic but could lead to complications later in life. Older individuals may experience more pronounced symptoms and are at higher risk for associated conditions like aortic stenosis."

The Leeds Teaching Hospitals NHS Trust explains that the main pumping chamber of the heart, the left ventricle, pumps blood to the body through a large artery called the aorta. Between the left ventricle and the aorta is a one way valve, the aortic valve, that prevents blood coming back into the heart once it has been pumped out.

The aortic valve is usually made of three cusps - or leaflets - that open and close as the blood is pumped out. About 1-2% of people have aortic valves that have two cusps rather than the usual three.

It added: "This is known as a Bicuspid Aortic Valve (BAV). This is usually an incidental finding and these valves can function very well throughout life but do have a tendency for the valve to become narrow and/or leak as people get older.

"As well as an abnormality with the valve, people with bicuspid aortic valves frequently have an abnormality with the main blood vessel (aorta) leaving the heart too, causing it to become stretched."

According to the Leeds Teaching Hospitals, it will be diagnosed with a simple test, such as an ultrasound scan of the heart, known as an echocardiogram. It said: "This valve will then require monitoring every few years in the Outpatients department, to ensure it continues to function well and does not start to leak or become narrow.

"Sometimes the main blood vessel, the aorta may stretch (dilate) over years with the risk of a tear once it gets beyond a certain size." It said this was why it is important that it is monitored by a cardiologist through scans of the valve and the aorta.

Patients with a Bicuspid Aortic Valve are at risk of infection in the heart (called endocarditis), especially if the valve has a mild leak, warned the Leeds Teaching Hospitals Trust. "Endocarditis may be caused by infections of the teeth or gums. It is important to visit the dentist regularly (every 6-12 months) and to follow good dental hygiene.

"Any procedures that break the skin such as tattooing, body piercing and cosmetic treatments, including eyebrow microblading, Botox and dermal fillers are best avoided as they also carry a small risk of infection which may spread to the heart."

It added: "Children with bicuspid valves who do not have narrowing or leak should not be restricted in terms of activity or exercise and should be treated as normal unless there are other associated problems with the heart."

According to Leeds Teaching HospitalsEndocarditis is an illness where infection develops on the heart valves or other heart tissues. It warned: "This infection is extremely difficult to treat. It usually requires a long hospital stay and being treated with antibiotics given into a vein.

"Patients who develop endocarditis can be extremely unwell and often require heart surgery to remove the infected area. Sometimes people die from endocarditis."

It added: "The most common source of the bacteria that cause endocarditis is the mouth. Everyone’s mouth carries bacteria but if your teeth and gums are in poor condition the risk of developing endocarditis is increased. Good oral health is therefore particularly important to reduce the risk of endocarditis."

To reduce the risk:

• brush teeth twice a day using a fluoride toothpaste


• have a healthy diet and avoid sugary snacks and drinks. Drink plain water or milk between meals


• visit the dentist for regular check ups


• if a child has toothache or a mouth infection, seek dental care as soon as possible

According to the Aortic Dissection Charitable Trust it is important to know what to watch out for as some symptoms can be dismissed. It said: "The heart, performs tirelessly, pumping blood throughout our bodies.

"However, sometimes, its components may not form typically, leading to conditions like Bicuspid Aortic Valve. BAV affects a significant portion of the population, and understanding it is crucial for early diagnosis and effective management."

It warned the issue of having just two flaps instead of three complicated the functioning of the heart making people with the condtion predisposed to valve-related diseases, such as aortic regurgitation, where the valve fails to close properly, leading to blood leakage back into the heart, or aortic stenosis, where the valve narrows affecting the blood flow from the heart to the aorta.

It added those with this condition frequently experience aortopathy, which involves aortic dilation and is often linked with BAV. This can progress to more severe complications, including aortic aneurysm, dissection, and rupture, "highlighting the importance of vigilant monitoring and timely intervention to manage the potential complications arising from a bicuspid aortic valve".

Adult symptoms

The Aortic Dissection Charitable Trust explained many adults with BAV may not exhibit symptoms initially. It added: "However, signs like shortness of breath, chest pain, or fatigue can emerge. Diagnosis typically involves echocardiograms, identifying the valve’s abnormal structure."

• fatigue - common sign, often overlooked


• chest discomfort - pain or discomfort in the chest area


• dizziness or fainting - sudden, unexplained episodes


• heart palpitations - an uncomfortable awareness of the heart beating


• shortness of breath - especially noticeable during physical exertion

Symptoms in children

• easily fatigued - quicker to tire during play or activity


• chest pain - uncommon in children, but a possible sign


• fainting - sudden and unexplained


• pale skin - can indicate reduced blood flow


• breathing difficulties - struggling for breath, particularly during feeding for infant

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