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Combined Rheumatic Mitral and Aortic Stenosis: Hemodynamics and a Tailored Approach to Management

Bhanu Duggal1, Vijay Kumar Varada1, Anirudh Mukherjee1

  • 1Department of Cardiology, AIIMS Rishikesh, Rishikesh, Uttarakhand, India.

JACC. Case Reports
|August 22, 2025
PubMed

Insights

Rheumatic heart disease (RHD) affecting both mitral and aortic valves is rare. Simultaneous valve procedures offer a viable treatment strategy, particularly in resource-limited settings.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Rheumatic Heart Disease

Background:

  • Rheumatic heart disease (RHD) disproportionately affects South Asia, sub-Saharan Africa, and Oceania.
  • Combined mitral and aortic stenosis is a rare manifestation of RHD, seen in only 2.4% of patients.

Observation:

  • Presents three distinct cases of severe rheumatic aortic and mitral stenosis.
  • Highlights the complex hemodynamics associated with combined stenotic lesions.

Findings:

  • Double valve replacement is the conventional treatment but carries significant perioperative and postoperative risks.
  • Simultaneous percutaneous transvenous mitral commissurotomy and aortic valve replacement presents a potential alternative strategy.

Implications:

  • This combined approach may be particularly beneficial in low- and middle-income countries.
  • Offers a less invasive option for managing complex RHD valve disease.
Abstract

Keywords:
aortic stenosisballoon mitral valvotomydouble valve replacementmitral stenosisrheumatic heart disease

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