Details
Category: Volume 07 Issue 05 May 2019
Hits: 1073

Title: Management of Mild to Moderate Aortic Valve Disease undergoing Mitral Valve Surgery

Authors: Dr Sunil Dhar, Dr Amit Agarwal, Dr Mayank Yadav, Dr Anubhav Gupta

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.92

Abstract

Introduction

The optimal management strategy of patients undergoing mitral valve intervention for rheumatic heart disease and having mild to moderate aortic valve disease is controversial. The decision making in this clinical setting is difficult as there are no guidelines on the management of combined valvular diseases. Mild aortic stenosis has a propensity of rapid progression however does it warrant a concomitant aortic valve replacement at the time of mitral valve intervention is not clear. In 2014 AHA guidelines recomended concomitant aortic valve replacement in patients with moderate aortic stenosis undergoing cardiac surgery for other indications including mitral valve surgery (Level of Evidence: C). These guidelines also recommended concomitant aortic valve replacement for moderate aortic regurgitation in patients undergoing surgery for ascending aorta, coronary artery bypass grafting(CABG),or mitral valve surgery (Level of Evidence:C).[1].

Theoretically the type of mitral valve intervention also affects the above decision making. In patients undergoing balloon mitral valvotomy or mitral valve repair, which are likely to have future mitral valve procedure, can be dealt with a more conservative approach for the aortic valve disease than patients undergoing mitral valve replacement. With the above scenario in mind, we analysed the published literature on this subject using MEDLINE.

Hence, the aim of this study was to review all published literature on this clinical subset, allowing conclusions to be drawn regarding the progression of mild and moderate aortic valve disease and optimal surgical management.

References

  1. Nishimura,R.A.,Catherine,M.O.,Bonow,R.O.,Carabello,B.A.,Erwin,P.J.,Guyton,R.A.et al,2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation,2014;129:2440-2492.
  2. Mishra, P., Seth, H., Khandekar, J., Mohapatra, C., Ammannaya, G., Raut, C., et al. Double Valve Replacement (Mitral and Aortic) for Rheumatic Heart Disease: A 20-year experience with 300 patients.. Journal of Cardio-Thoracic Medicine, 2016; 4(3): 484-489. doi: 10.22038/jctm.2016.7427 .
  3. Levinson GE, Alpert JS. Aortic stenosis. In: Alpert JS, Daten JE, Rahimtoola SH, eds. Valvular heart disease. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000:207-8.
  4. Wagner,S., Selzer, A. Pattern of progression of aortic stenosis: a longitudinal haemodynamic study. 1982;65:709-12.
  5. Bogart, D.B., Murphy, B.L.,Wong BYS, Pugh DM, Dunn MI. Progression of aortic stenosis. 1979; 76:391-6.
  6. Faggiano P, Aurigemma GP, Rusconi C, Gaasch WH. Progression of valvular aortic stenosis in adults: literature review and clinical implications. Am Heart J. 1996;132:408-17.
  7. Kennedy KD, Nishimura RA, Holmes DR, Bailey KR. Natural history of moderate aortic stenosis. J Am CollCardiol. 1991;17(2):313-9.
  8. Cheitlin MD, Gertz EW, Brundage BH, Carlson CJ, Quash JA, Bode RS. Rate of progression of severity of valvular aortic stenosis in the adults. Am Heart J. 1979;98:689-700.
  9. Otto CM, Burwash IG, Legget ME, Munt BI, Fujioka M, Healy NL, et al. Prospective study of asymptomatic valvular aortic stenosis. Circulation 1997;95:2262-70.
  10. Lester SJ, Heilbron B, Gin K, Dodek A, Jue J. The natural history and rate of progression of aortic stenosis. 1998;113(4):1109-14.
  11. Brener SJ, Duffy CI, Thomas JD, Stewart WJ. Progression of aortic stenosis in 394 patients: relation to changes in myocardial and mitral valve J Am CollCardiol. 1995;25(2):305-10.
  12. Padial LR, Oliver A, Vivaldi M, Sagie A, Freitas N, Weyman AE, et al. Doppler echocardiographic assessment of progression of aortic regurgitation. Am J Cardiol 1997;80:306-14.
  13. Vaturi M, Porter A, Adler Y. The natural history of aortic valve disease after mitral valve surgery. J Am CollCardiol. 1999;33:2003-8.
  14. Choudhary SK, Talwar S, Juneja R, Kumar AS. Fate of mild aortic valve disease after mitral valve intervention. J Thorac Cardiovasc Surg. 2001;122:583-6.
  15. Ha JW, Choi SH, Chang BC, Nam CM, Jang Y, Chung N, et al. Is prophylactic aortic valve replacement indicated during mitral valve surgery for mild to moderate aortic valve disease. Ann Thorac Surg. 2002;74:1115-9.
  16. Namboodiri N, Remash K, Tharakan JA, Shajeem O, Nair K, Titus T, et al. Natural history of aortic valve disease following intervention for rheumatic mitral valve disease. J Heart Valve Dis. 2009;18:61-7.
  17. Hwang H.Y, Kim K.H, Ahn H, Attitude after a mild aortic valve lesion during rheumatic mitral valve surgery. Journal of Cardiovascular Surgery.2014;147(5):1540-46
  18. Kim DJ, Joo H-C, Lee S-H, Chang B-C, Lee S. Natural history of mild aortic valve disease untreated at the time of rheumatic mitral valve replacement. Interact Cardio Vasc Thorac Surg 2018;27:828–35.
  19. Ledesma,M.S.,Kim DJ, Joo H-C, Lee S-H, Chang B-C, Lee S. Natural history of mild aortic valve disease untreated at the time of rheumatic mitral valve replacement. Interact Cardio Vasc Thorac Surg 2018;27:828–35.
  20. Bernal JM, Fernandez-Vals M, Rabasa JM, Gutierrez-Garcıa F, Morales C, Revuelta JM. Repair of nonsevere rheumatic aortic valve disease during other valvular procedures: is it safe? J Thorac Cardiovasc Surg. 1998;115:1130-5.

Corresponding Author

Dr Anubhav Gupta

Professor & Head, Department: Department of CTVS, VMMC & Safdarjung Hospital, India