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[Echographic evaluation of the severity of aortic stenosis in cases with associated mitral stenosis]
Insights
Echocardiography may underestimate aortic stenosis severity when mitral stenosis is also present. Combined aortic and mitral stenosis can mask typical signs of aortic stenosis on echocardiograms.
Area of Science:
- Cardiology
- Medical Imaging
Context:
- Echocardiography is crucial for diagnosing valvular heart disease.
- Differentiating combined aortic stenosis (AS) and mitral stenosis (MS) from isolated AS is clinically important.
Purpose:
- To compare echocardiographic findings in patients with combined AS and MS versus isolated AS.
- To identify challenges in diagnosing AS severity in the presence of MS.
Summary:
- Echocardiographic assessment of aortic stenosis severity was compared between 6 patients with combined AS and MS and 10 with isolated AS.
- Aortic stenosis severity was similar in both groups, but echocardiographic signs of AS were less pronounced in the combined group.
- Patients with combined AS and MS showed significantly less ventricular wall thickening than those with isolated AS, potentially due to reduced left ventricular filling from MS.
Impact:
- Echocardiographic criteria for diagnosing AS severity may be unreliable when MS is present.
- Further investigation is needed to understand the mechanisms behind reduced myocardial hypertrophy in combined AS and MS.
Abstract:
The echocardiographic findings of six patients with pure mitral stenosis associated with pure aortic stenosis were compared with the findings from a series of ten cases of pure aortic stenosis without mitral disease. Each patient also underwent haemodynamic studies in order to quantitate the severity of the stenoses. The aortic stenosis was of the same degree of severity in both series (0.71 +/- 0.24 cm2 and 0.73 +/- 0.16 cm2). The systolic separation of the aortic valve was greater than 1 cm in 4 of the 6 cases on echocardiography, corresponding to a false negative of tight aortic stenosis. This appearance corresponded to a doming of the aortic valve on 2D echocardiography. The wall thickness was significantly less in the AS + MS series than in pure SA series (1.13 +/- 0.13 cm compared with 1.52 +/- 0.21 cm; p less than 0.01). The wall was found to be thicker, the tighter the MS. Overall, the diagnostic criteria of the severity of AS on echocardiography (restricted opening of the valve and the severity of ventricular wall hypertrophy) were absent in the association of AS + MS. The absence of myocardial hypertrophy can not be fully explained. It could be related to a decreased filling on the left ventricle and therefore a smaller systolic ejection volume because of the mitral obstruction.