COMBINED AORTIC AND MITRAL STENOSIS

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Abstract
The clinical and hemodynamic features in 15 patients with combined mitral and aortic stenosis have been presented. All underwert surgical relief of their dual obstruction, and the findings at operation nave been correlated with pre-operative data. The only constant sign was the presence of an aortic systolic murmur in association with established mitral stenosis. While left heart catheterization before operation may provide additional information, the results taken alone may be equivocal. In isolated aortic stenosis, the aortic systolic gradient is not usually considered significant unless it is 60 or above. However, in combination with mitral stenosis, critical stenosis of the aortic valve may present with a peak aortic systolic gradient of little more than 20 mm Hg. Conversely, where the gradient exceeds 100 mm, the mitral stenosis may only be of comparatively mild degree. Four deaths occurred, a mortality of 27%. The causes of these are analysed in full. The survivors have been followed for a period varying from several months to 4 years after operation. Five are extremely well and completely asymptomatic, while a further 4 have derived considerable improvement. The technique employed has been that of transventricular approach which affords easy access to both valves. The mitral valve is split to 3.5 cm, the aortic valve to 3.0 cm.