Combined mitral and aortic valve disease

Abstract Surgical treatment of multiple valve disease requiring replacement of two valves is associated with a high mortality. Different combinations of mitral and aortic valve stenosis or incompetence result in different changes of adaptation by the heart. The left ventricular response to pure pressure overload, as in combined mitral and aortic stenosis, is concentric hypertrophy, whereas the changes that occur in response to pure volume overload, as in combined mitral and aortic regurgitation, are dilatation and hypertrophy. The records of 124 patients with a variety of combinations of mitral and aortic valve disease were reviewed. Surgical mortality could be directly related to the presence of left ventricular concentric hypertrophy and the small size of the left ventricular chamber. Surgical treatment was accomplished with a surgical mortality of 52.5 percent (21 of 40 patients) when both valves were stenotic; however, when botb valves were insufficient the surgical mortality was only 9 percent (3 of 32 patients). This presentation includes correlation of surgical results with the clinical, electrocardiographic roentgenographic and hemodynamic data. An attempt is made to clarify the indications for double valve replacement. The operative technique used in the treatment of these patients with combined mitral and aortic valve disease is described.