If you’re born with a two-leaflet aortic valve, you will need to make heart-healthy choices and work with your healthcare team to reduce complications and respond quickly if symptoms develop.

A bicuspid aortic valve is a common congenital heart defect. While people with the condition can usually live healthy, normal lives, a bicuspid aortic valve can cause complications, including a leaky or stiffened heart valve that can lead to heart failure if not treated.

The key to living with a bicuspid aortic valve is to follow a heart-healthy lifestyle and follow the advice of a cardiologist experienced in treating valve disorders. You may also need to take medications to manage your blood pressure and cholesterol levels. If the condition worsens and begins causing symptoms, you may need to consider surgery to repair or replace the valve.

Learn more about what it means to have a bicuspid aortic valve and how various individuals have managed to thrive, despite the challenges of their condition.

The aortic valve manages the flow of blood from your heart’s left ventricle into the aorta, your largest artery and one that supplies blood to most of the body. Typically the aortic valve has three flaps, also called leaflets or cusps. A bicuspid aortic valve has only two flaps.

A 2021 study suggests that 0.5–1.4% of the population is born with a bicuspid aortic valve, making it the most common congenital heart defect.

Aortic stenosis (narrowing of the valve) is the most common complication of bicuspid aortic valve, and it usually appears in people between 50 and 70 years old.

Most often, signs (such as narrowing of the aortic valve) of a bicuspid aortic valve appear in people who are between 50 and 70 years old.

Children and young adults often experience no symptoms of bicuspid aortic valve. But when the condition worsens and symptoms do emerge, usually well into adulthood, they can include the following:

  • chest pain or tightness
  • fatigue
  • lightheadedness or fainting
  • shortness of breath
  • swelling in legs

Your doctor may hear a heart murmur when listening to your heart with a stethoscope.

Certain lifestyle behaviors are especially harmful for an individual with any type of heart condition. Among the behaviors you should avoid are:

  • excessive alcohol intake
  • following a poor diet, including excessive amounts of sodium, added sugar, saturated fats, and processed foods
  • leading a sedentary lifestyle with little exercise
  • smoking

In general, moderate alcohol consumption is safe for someone with most congenital heart conditions.

However, alcohol can interact with certain medications, including antihypertensive drugs such as alpha-blockers. You may consider discussing any concerns you have about alcohol intake with your doctor.

It’s also important to understand that excessive alcohol consumption (usually defined as more than one drink per day for women and more than two for men) can raise the risk of high blood pressure, heart arrhythmias, and other health problems.

Basic heart-healthy behaviors are recommended if you have a bicuspid aortic valve, though you should consult with your doctor before making any drastic changes, such as a new exercise regimen. Some of the key steps to staying healthy include:

  • a diet rich in fruits, vegetables, lean proteins, and whole grains, such as the Mediterranean diet
  • regular aerobic exercise, such as a brisk 30-minute walk each day, if you’re able
  • 7 to 9 hours of sleep each day
  • stress management through meditation or other relaxation strategies

In their 2020 guidelines for managing heart valve disorders, the American College of Cardiology and the American Heart Association recommend lifetime monitoring by a cardiology specialist. That’s because a bicuspid aortic valve is associated with problems such as an aortic aneurysm.

According to this 2021 study, life expectancy for someone with asymptomatic bicuspid aortic valve is like that of anyone in the general population. If you have a bicuspid aortic valve, it’s important to make heart-healthy lifestyle choices and manage your condition with the help of your doctor.

People who are older may develop severe valve disease. You may or may not have symptoms at this stage, but most people will. If your imaging tests show severe valve disease, there is a high mortality risk unless you have surgery.

A 2021 study suggests that about half of all people with a bicuspid aortic valve will require valve repair or replacement one day. For individuals who have had surgery, the average 10-year survival rate is about 84%.

From countless hours pumping iron in the gym to dozens of action-filled movies, Arnold Schwarzenegger has put his heart through tougher workouts than most people on the planet.

His accomplishments are all the more impressive, given that he was born with a bicuspid aortic valve.

But in 1997, at 50 years old, the former California governor and seven-time Mr. Olympia bodybuilding champion slowed down long enough to undergo a heart procedure. The unusual procedure involves relocating the pulmonary valve (which controls blood flow from the right ventricle to the lungs) to act as the aortic valve. An artificial valve is then inserted in place of the pulmonary valve. Eventually, in 2020, Schwarzenegger received an artificial aortic valve at the Cleveland Clinic. In the days afterward, he posted a message on Instagram: “I feel fantastic and have already been walking the streets of Cleveland enjoying your amazing statues. Thank you to every doc and nurse on my team!”

In the fall of 2022, Claire Sprouse gave birth to her first child, Milo. But the healthy outcome for mom and baby wasn’t a given. Claire was born with a bicuspid aortic valve, and pregnancy placed an increased workload on her heart that led to symptoms for the first time in her life. She was told she risked heart failure by continuing with the pregnancy.

Under the care of a multidisciplinary team at NYU-Langone Hospital, Claire received a new aortic valve when she was 21 weeks pregnant. There is relatively little research into valve procedures involving pregnant individuals, but after reviewing the risks and benefits of a transcatheter aortic valve replacement (TAVR) with her doctors, Claire agreed to the procedure. “I feel as good as new, sporting a shiny new aortic valve,” Claire said. “It worked out better than I thought.”

Having a bicuspid aortic valve is a serious health concern, but not necessarily one that will interfere with your quality of life or your life expectancy. It will require you to develop a good relationship with your healthcare team and to stay up-to-date with doctor appointments and recommended heart imaging and other tests.

But if you follow your doctor’s advice and make consistent heart-healthy choices, you should be able to enjoy a life of good health. And if you one day need a procedure to repair or replace your aortic valve, know that these procedures are done every day, usually with very positive outcomes.