buy viagra 20 mg online If the leaflets do not close correctly, aortic regurgitation can occur. If these become severe enough, they may require heart surgery. People with bav may become tired more easily than those with normal valvular function and have difficulty maintaining stamina for cardio-intensive activities-due to poor heart performance. The heart is put under more stress in order to either pump more blood through a stenotic valve or attempt to circulate regurgitation blood through a leaking valve. [edit] diagnosis, treatment, and prognosis heart bicuspid aortic valve diagram the condition can be associated with a heart murmur located at the right second intercostal space. Often there will be differences in blood pressures between upper and lower extremities. The diagnosis can be assisted with echocardiography (echocg) or magnetic resonance imaging (mri). Most patients with bicuspid aortic valve whose valve becomes dysfunctional will need careful follow-up and potentially valve replacement at some point in life. Regular echocg and mri may be performed. For diagnosed patients, genetic testing is done to allow for future offspring with the disease to be monitored and treated early in life. Patients with bicuspid aortic valve should be followed by a cardiologist or cardiac surgeon with specific interest in this valve pathology. If the valve is normally functioning or minimally dysfunctional, average lifespan is similar to that of those without the anomaly. [6] [edit] aorta complications one of the most notable associations with bav is the tendency for these patients to present with ascending aortic aneurysmal lesions. The extracellular matrix of the aorta in patients with bav shows marked deviations from that of the normal tricuspid aortic valve. It is currently believed that an increase in the ratio of mmp2 (matrix metalloproteinases 2) to timp1 (tissue inhibitor metalloproteinases 1) may be responsible for the abnormal degradation of the valve matrix and therefore lead to aortic dissection and aneurysm. However, other studies have also shown mmp9 involvement with no differences in timp expression. The size of the proximal aorta should be evaluated careful. buy generic viagra viagra online buy viagra cheap viagra online viagra for sale viagra without a doctor prescription buy generic viagra buy viagra