Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, 4000 Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, 70124 Bari, Italy.
Arch Cardiovasc Dis. 2019 Jun-Jul;112(6-7):430-440. doi: 10.1016/j.acvd.2019.04.003. Epub 2019 May 29.
The combination of aortic and mitral regurgitation is a typical example of a frequent yet understudied multiple valve disease scenario. The aetiology is often rheumatic or degenerative; less frequently it can be induced by drugs or radiation, or caused by infective endocarditis or congenital valvular lesions. Aortic regurgitation resulting in secondary mitral regurgitation is also not uncommon. There are limited data to guide the management of combined aortic and mitral regurgitation. Left ventricular dysfunction is frequent at initial presentation, and even more so postoperatively, suggesting that surgical management should not be delayed, particularly when symptoms occur or when there is evidence of even subtle left ventricular dysfunction. The decision to operate on one or both valves not only depends on the severity of each lesion, but also on several other factors, including age, co-morbidities and frailty, the increased operative risk of double valve surgery, the increased risk of long-term thrombotic and bleeding complications with multiple mechanical valves, the risk of leaving one valve unoperated and the probability of requiring redo surgery. The role of a multidisciplinary heart valve team is critical in this setting to optimize management and outcomes. The role of transcatheter approaches is currently limited, but technological advances will probably soon change the management paradigm.
主动脉瓣和二尖瓣反流的联合是一种常见但研究不足的多瓣膜疾病情况的典型例子。病因通常为风湿性或退行性；较少见的情况下，它可能由药物或辐射引起，或由感染性心内膜炎或先天性瓣膜病变引起。由主动脉瓣反流引起的继发性二尖瓣反流也并不罕见。目前针对联合主动脉瓣和二尖瓣反流的治疗管理，仅有有限的数据可供参考。左心室功能障碍在初始表现时很常见，术后更为常见，这表明不应延迟手术治疗，特别是出现症状时，或存在甚至轻微左心室功能障碍的证据时。是否对一个或两个瓣膜进行手术不仅取决于每个病变的严重程度，还取决于其他几个因素，包括年龄、合并症和虚弱程度、双瓣手术的手术风险增加、多个人工机械瓣膜长期血栓形成和出血并发症的风险增加、遗留一个瓣膜未手术的风险以及再次手术的可能性。多学科心脏瓣膜团队在这种情况下的作用至关重要，可优化管理和预后。经导管治疗方法目前的作用有限，但技术进步可能很快会改变治疗模式。
