Unger Philippe, Lancellotti Patrizzio, de Cannière Didier
Acta Cardiol. 2016 Feb;71(1):3-6. doi: 10.2143/AC.71.1.3132091.
The coexistence of mitral and aortic stenosis is not exceptional. Whereas rheumatic fever is currently plummeting in the Western countries, the incidence of degenerative disease is inversely increasing. The haemodynamic interactions which may interfere both with the usual echocardiographic parameters and with the invasive assessment may render the diagnosis difficult. The therapeutic challenges raised by this entity should not be underestimated. The increased morbidity and mortality of multivalvular surgery has to be balanced with the risk of a second operation down the line if one valvular involvement, deemed of a lesser importance, is neglected. This complex situation requires the multidisciplinary approach of a heart team involving surgeons, cardiologists, geriatrists if need be and imaging specialists.
二尖瓣和主动脉瓣狭窄并存并不罕见。尽管目前西方国家风湿热的发病率正在急剧下降，但退行性疾病的发病率却呈反向上升。血流动力学相互作用可能会干扰常规超声心动图参数和侵入性评估，从而使诊断变得困难。不应低估这一疾病实体所带来的治疗挑战。多瓣膜手术增加的发病率和死亡率必须与日后二次手术的风险相权衡，如果忽视了一个被认为不太重要的瓣膜病变的话。这种复杂情况需要一个心脏团队采取多学科方法，该团队包括外科医生、心脏病专家、必要时的老年病专家以及影像专家。
