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J Am Coll Cardiol, 1999; 33:2003-2008
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

The natural history of aortic valve disease after mitral valve surgery

Mordehay Vaturi, MD*, Avital Porter, MD*, Yehuda Adler, MD*, Yaron Shapira, MD*, Gideon Sahar, MD{dagger}, Bernardo Vidne, MD{dagger} and Alex Sagie, MD*

* Dan Scheingarten Echocardiography Unit and Valvular Clinic, Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv, Israel
{dagger} Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv, Israel

Manuscript received October 31, 1998; revised manuscript received January 11, 1999, accepted February 8, 1999.

Reprint requests and correspondence: Dr. Alex Sagie, Dan Scheingarten Echocardiography Unit, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel

OBJECTIVES

The present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.

BACKGROUND

Little is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition there is no firm policy regarding the appropriate treatment of mild aortic valve disease while replacing the mitral valve.

METHODS

One-hundred thirty-one patients (44 male, 87 female; mean age 61 ± 13 yr, range 35 to 89) were followed after mitral valve surgery for a mean period of 13 ± 7 years. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively by cardiac catheterization and during follow-up by transthoracic echocardiography.

RESULTS

At the time of mitral valve surgery, 59 patients (45%) had mild aortic valve disease: 7 (5%) aortic stenosis (AS), 58 (44%) aortic regurgitation (AR). At the end of follow-up, 96 patients (73%) had aortic valve disease: 33 AS (mild or moderate except in two cases) and 90 AR (mild or moderate except in one case). Among patients without aortic valve disease at the time of the mitral valve surgery, only three patients developed significant aortic valve disease after 25 years of follow-up procedures. Disease progression was noted in three of the seven patients with AS (2 to severe) and in six of the fifty eight with AR (1 to severe). Fifty two (90%) with mild AR remained stable after a mean follow-up period of 16 years. In only three patients (2%) the aortic valve disease progressed significantly after 9, 17 and 22 years. In only six patients of the entire cohort (5%), aortic valve replacement was needed after a mean period of 21 years (range 15 to 33). In four of them the primary indication for the second surgery was dysfunction of the prosthetic mitral valve.

CONCLUSIONS

Our findings indicate that, among patients with rheumatic heart disease, a considerable number of patients have mild aortic valve disease at the time of mitral valve surgery. Yet most do not progress to severe disease, and aortic valve replacement is rarely needed after a long follow-up period. Thus, prophylactic valve replacement is not indicated in these cases.

Abbreviations and Acronyms
  AR = aortic regurgitation
  AS = aortic stenosis
  AV = aortic valve
  CABG = coronary artery bypass grafting
  Fc = functional class
  LVEF = left ventricular ejection fraction




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