Bicuspid Aortic Foundation View From Here February 2011

Like most families, we had never heard of a bicuspid aortic valve.
When I was told my husband was born with BAV,
and years later told he had an aneurysm of the aorta above his heart,
I thought I must have married a man with a very rare condition.

It was surprising to me to learn that BAV was a common, well-known heart defect, identified long ago (drawn by Leonardo da Vinci). I wondered why BAV was not more visible to the public, since it is the most common heart defect present at birth.

We were told when his BAV was replaced, that my husband was "fixed", implying there was nothing else to be concerned about. Later, when my husband was diagnosed with an ascending aortic aneurysm, we were shaken. No longer could we believe that he was "fixed" for life. We lost our naivete' regarding BAV. And we wondered why no one had warned us, no one had told us he was at risk from a bulging aorta. The bulge had already been there at the time of his valve surgery, but we were never told. It had grown silently, without our knowledge.

The story of BAV in the medical literature includes a paper from 1928 by Abbott. This paper is listed on the BAV history list. For some time, I wondered who Dr. Abbott was. Today, I have this entire paper from 1928, as well as Dr. Abbott's Atlas of Congenital Heart Disease, in my possesion. They are rich treasures, written by this woman of amazing genious, an extraordinary, gifted physician.

Dr. Maude Abbott understood and published something very important in 1928 - something just beginning to dawn on medicine today: "The presence of a bicuspid aortic valve appears to indicate, at least in a portion of the cases in which it occurs, a tendency to spontaneous rupture of the aorta, which hangs always, like a sword of Damocles, above the unsuspecting subjects of this type of coarctation.... it seems probable that the thinning, which is not infrequently seen in the wall of the ascending aorta in these cases, may also be of congenital origin and due to the same arrest of development that lead to an incomplete evolution of the endocardial cushions destined to become the aortic cusps. That such a thinned area would yield the more readily to form a dissecting aneurysm, with later rupture under the increased pressure that exists in the upper body in adult coarctation, would appear to be self-evident. Extension of such a congenital weakening of the media to the whole arterial system might similarly explain the coincidence of cerebral hemorrhage and such a process might even have a part in the peculiar changes at the area of coarctation itself."(from Abbott: Coarctation of the Aorta, American Heart Journal, Volume 3, 1928) (see The Natural and Modified History of Congenital Heart Disease.)

Today, Dr. Abbott speaks across the decades through her published work. Her meticulously documented study of her own cases and that of others sheds great light upon those with BAV and associated vascular weakness. Having cared for these patients in life and examined through autopsy their bodies after death, she understood a great deal through this incontrovertible evidence about the nature of BAV and TAD.

From her writing, we can conclude that if still with us today, she would have understood what my family, and other BAV families everywhere, have experienced. She would not have been surprised by the aneurysm of my husband's ascending aorta, nor by Carrie's brain aneurysm. BAV should be a red flag for these things, but they were shocks to us. Today we realize they were recognized risks long ago.

Tragically, the technology was not available in Dr. Abbott's day to help those with BAV/TAD very much. Carefully studied, compassionately cared for, the patients died. No blood pressure medicine, no antibiotics, no echocardiogram, MRI, or CT, no heart lung machine, no valve replacement - the current era's wonders were not yet available.

Dr. Abbot's wisdom remains with us, as relevant now as when she first published her work.
It is our privilege to highlight it's importance today.

Dr. Maude Abbott has been called the "Canadian Queen of Cardiology". The Queen of Canadian Cardiology

As we observe Heart Month 2011,
sixty-one years after her death,
we honor her as our "Queen of BAV Hearts".

Together let us
safeguard life-saving
knowledge and advancements in medicine,
and let us support the pioneering physicians
who help us today,
creating a climate of hope.

Sincerely,

Arlys Velebir

Chair, Board of Directors
Bicuspid Aortic Foundation

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