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.

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Dr Anubhav Gupta

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