Step Forward in Rheumatic Valve Disease: Simultaneous PTMC and TAVI as a Viable Treatment Strategy

Rheumatic heart disease remains prevalent in low-income countries, often leading to combined severe mitral stenosis (MS) and aortic stenosis (AS). Although percutaneous transmitral commissurotomy (PTMC) is the standard treatment for severe MS with suitable anatomy, rheumatic AS is typically excluded from major transcatheter aortic valve implantation (TAVI) trials because of its noncalcific nature.

We present a 72-year-old woman with severe rheumatic AS and MS who underwent simultaneous PTMC and TAVI. PTMC was performed via the right femoral vein using a 25-mm Accura balloon, followed by TAVI with a self-expanding Evolut-R valve, optimizing hemodynamics for her small aortic annulus.

Simultaneous PTMC and TAVI can be a safe and effective alternative to surgery in selected patients, offering a less invasive option for managing combined rheumatic valve disease. This case demonstrates its feasibility; however, further studies are needed to assess long-term outcomes.