Combination aortic and mitral stenosis: what are the particularities?

Abstract

Multivalvular heart disease is a frequent situation, but there is only few medical literature about its management. The combination between aortic stenosis(AS) and mitral stenosis(MS) is an illustrative example. This situation is far from being exceptional especially in developing countries. The aim of our study is to describe the clinical features, electrical and echocardiographic characteristics of patients with both MS and AS. We achieved a prospective, single-centric study from October 2017 to january 2019, concerning register of patients followed for valvulopathies, collected from the hospital of day and echocardiography vacations in the cardiology department of Ibn Rochd University Hospital in Casablanca, Morocco. We included only patients having association MS and AS. The valvular register included 320 patients, 20 of them (6%) had combined AS and MS. Mean age was 47,57 (± 16.27); sex ratio = 0.7. Clinical presentation was dyspnea in 95% (76% stage II and 16% stage III of NYHA), 5% Angina, 15% hemoptysis, and 28% palpitations. A Left and right heart failure were found in 10% and 14.3%. ACFA was noted in 42%. Left ventricular hypertrophy was found in 47.6%, left and right ventricular dysfunction in 28,6% and 23%. The mean mechanism was rheumatic in 90%. MS was very severe in 30%, severe in 70%; with a mean mitral surface at 1.1 cm 2 , and mean gradient at 9 mmHg. AS was severe in 45%, moderate in 25%, and mild in 30%, with a mean aortic surface at 0,7cm 2 /m 2 , and mean gradient at 31 mmHg. A state of low flow was found in 30% with a VES < 35 ml/m 2 responsible of a low aortic gradient in 5%. Pulmonary hypertension was noticed in 45%. The association AS and MS is not rare in our context. It is important not to underestimate the diagnosis and therapeutic challenges raised by this entity. These complex situations require a multidisciplinary approach of heart team involving cardiologist, surgeons and imaging specialists (1).