CLINICAL AND HAeMODYNAMIC OBSERVATIONS ON COMBINED MITRAL AND AORTIC STENOSIS

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Abstract
Certain clinical, radiological, cardiographic, and hemodynamic findings have been studied in 35 patients with dominant or pure stenosis of both aortic and mitral valves. The cases with the highest aortic valve gradients usually have only mild or moderate mitral stenosis. When severe mitral stenosis and severe aortic stenosis co-exist, the aortic gradient is usually only small or moderate, a finding attributed to the low cardiac output. These observations largely account for the low incidence of angina and syncope, of cardlographic and radiological evidence of left ventricular hypertrophy, of post-stenotic dilatation of the aorta, and of calcification of the aortic valve. Clinically significant aortic stenosis may be overlooked and the mitral valve lesion may be erroneously thought to be dominant regurgitation. When the aortic peak systolic gradient is 20 to 25 mm or more, in the presence of severe mitral stenosis, critical aortic stenosis requiring valvotomy may be present. Correct evaluation of a gradient of this order, obtained at mitral valvotomy, is difficult; and accurate assessment requires preoperative left heart catheterization, with measurement of valve gradients and cardiac output and calculation of valve areas.