Aortic stenosis and mitral regurgitation: not as simple as it looks.

摘要

MITRAL REGURGITATION (MR) in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS) is a common finding, and reported incidence varies from 61% to 90%. Although most reported MR is functional (ie, in the absence of a structural abnormality), significant MR (>grade 2/4) has been reported in almost 13% of such cases.2 The presence of concomitant coronary artery disease, fluid overload, and structural changes in the left ventricle (LV) also are believed to contribute to concomitant mitral valve dysfunction in patients with critical AS. Additionally, chronic left ventricular outflow tract obstruction as seen in AS can cause permanent geometric changes in left ventricular shape and structure, which eventually result in reduced mitral leaflet co-aptation and significant MR.1 It is obvious that the pathophys-iology of this condition is more complicated than MR because of the structural abnormalities of leaflets.