Abstract
The combination of aortic stenosis (AS) and mitral regurgitation (MR) is common in patients with degenerative valvular disease. It is characterized by having complex pathophysiology, leading to potential diagnostic pitfalls. Evidence is scarce in the literature to direct the diagnostic framework and treatment of patients with this particular combination of multiple valvular diseases. In this complex scenario, the appropriate use of advanced echocardiography and multimodality imaging methods plays a central role. Transcatheter mitral valve replacement or repair and transcatheter aortic valve replacement widen the surgical options for valve diseases. Therefore, there is an increasing need to reconsider the function, timing, and mode intervention for patients with a combination of AS with MR towards more personalized treatment.
Highlights
In Western countries, degenerative aortic valve stenosis (AS) is commonly associated with mitral regurgitation (MR), as these are the most prevalent valvular heart diseases in the general population [1]
The combination of volume overload caused by significant MR, whether primary or secondary, and the reduced preload reserve caused by left ventricular (LV) hypertrophy resulting from AS, has a net effect on reducing forward flow across the aortic valve and, the aortic velocity and gradient [15], leading to a possible underestimation of the severity of AS by Doppler echocardiography [16]
When color Doppler quantification methods are internally inconsistent, volumetric methods are recommended
Summary
In Western countries, degenerative aortic valve stenosis (AS) is commonly associated with mitral regurgitation (MR), as these are the most prevalent valvular heart diseases in the general population [1]. There is a scarcity of evidence in the literature to direct patients’ diagnostic frameworks and treatments with this particular combination of multiple valve heart disease. This article aims to provide a current review of severe degenerative AS combined with MR (AS + MR) concerning the primary role of echocardiography, with an emphasis on the role of advanced imaging and the complexity of the decision-making process. It is beyond the scope of this review to discuss AS + MR in the context of congenital heart valve diseases or other acquired pathogeneses including rheumatic heart disease and endocarditis
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