Issue link: http://cp.revolio.com/i/447803
sYMPToMs complications from BaV can put tremendous stress on the heart, leading to: • shortness of breath • chest discomfort • dizziness • Poor energy • Heart failure if left untreated PuBLic Figures WiTH BaV actor/politician arnold schwarzenegger Former First lady Barbara Bush Late actor/comedian robin williams actor/ director robby Benson Broncos coach John Fox WHen THings go aWrY Normally, the heart's aortic valve has three leaflets that control blood flow to the body. BAVs either consist of two leaflets or of three leaflets with two that are fused together. Often, BAVs are not diagnosed until adulthood, when they are detected incidentally during unrelated medical evaluations or because of symptoms, such as shortness of breath. People can live a full life symptom-free and unknowing of BAV, but, not uncommonly, potentially life-threatening complications can result. Galasso's disease progressed in two serious and not uncommon ways, Sperling says. First, his valve was severely blocked, and second, he developed an aortic aneurysm right above the heart, both of which occur in as many as 50 percent of BAV patients in their lifetimes. Healthy aortic valves act like swinging doors, their three leaflets opening wide as the heart pumps blood out through the aorta to fuel the rest of the body, and snapping shut once the blood is through. With BAVs, calcium deposits can collect on and around the leaflets, as with Galasso, causing hardening and narrowing of the valve (aortic stenosis), which impedes blood flow. The opposite problem can also develop, with the leaflets not shutting properly, allowing blood leakage back into the heart (regurgitating valve). Both problems left untreated stress the heart and can lead to complications, including heart failure, Sperling says. As with Galasso, BAV patients also commonly develop aortic aneurysms right above the heart. The deadly balloon-like bulges can form slowly over a long period of time due to an intrinsic problem with the aorta's 'architecture', which is a genetic issue. If they burst, the event is often fatal. "Aortic aneurysm rupture is a leading cause of death in our society, greater than HIV-related fatalities or drunk-driving-related deaths," Sperling says. sTaTe-oF-THe-arT care To prevent these and other complications, the program's outreach mission is key, Sperling says. "You have to identify BAV patients early and then have a responsible 'babysitter' like me," he says, adding that finding BAVs and even aneurysms can be tricky. "Cardiac ultrasound ('echocardiograms') can miss the finding of BAV altogether and also may fail to detect certain aortic aneurysms above the heart." Identifying 'occult' BAV and developing tools that are better at predicting aortic risk are chief research focuses of Sperling's. The new HealthONE program brings together experts and advanced diagnosis and treatment options for comprehensive care. For instance, Sperling's expertise includes two rare surgeries. One is repair — rather than replacement — of leaking aortic valves. And the second is the David Procedure, also called valve-sparing aortic root replacement, for aneurysms located in a complicated area called the aortic root. With the new program, Galasso learned of medical guidelines that call for the screening of his first-degree relatives, despite being counseled for his BAV all of his life. "That was the first we'd heard of that, in my initial consultation with Dr. Sperling," says Galasso, whose family will now be screened. Roughly one in three first-degree relatives (children, siblings, parents) will also have a BAV or aneurysm, Sperling says. Galasso says he hopes many patients benefit from the new program, as he did. "It's important for patients to understand their condition, look at all the options, ask a lot of questions, and look for the best medical care they can find. Fortunately for me, it was right there in my backyard." Angelo Galasso and his wife, Monique, try not to let his heart condition control their lives. "Aortic aneurysm rupture is a leading cause of death in our society, greater than HIV-related fatalities or drunk- driving-related deaths." 30 • Medical Profile