Kim Seok Hyun, Lim Ji Hoon, Lee Sang Hyun, Lim Mi Hee, Lee Chee-Hoon, Ju Min Ho, Je Hyung Gon, Park Yong Hyun
Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Division of Cardiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Cardiovascular Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Cardiol Res Pract. 2025 Jun 17;2025:6689214. doi: 10.1155/crp/6689214. eCollection 2025.
Recognizing the natural progression of the remaining valve disease following the intervention of a single valve is crucial in multiple rheumatic valvular diseases as often encountered in clinical practice. We aimed to investigate whether performing mitral valve (MV) intervention alone for multiple rheumatic MV and aortic valve (AV) disease is safe. Rheumatic AV disease progresses slowly and severity does not differ significantly after MV intervention. We retrospectively investigated the progression of AV disease with rheumatic changes following MV intervention in a single tertiary center. Among 890 patients initially screened, 76 patients met the criteria for assessment. Six patients fell under severe aortic stenosis (AS) definition-wisely and four of them were classified as low-flow low-gradient severe AS despite normal ejection fraction. Eventually, four patients were found to have true-severe AS at a median follow-up period of four years (mean 5.8 years) and only one of them underwent AV surgery for severe AS per se. None of the patients with aortic regurgitation deteriorated to severe. Only a small portion of rheumatic AV involvement progresses to severe AS after MV intervention, and performing MV intervention for severe mitral stenosis or mitral regurgitation in patients with concurrent mild or moderate AS or aortic regurgitation due to rheumatic changes is reasonable.
认识到在临床实践中经常遇到的多种风湿性瓣膜病中，单次瓣膜干预后剩余瓣膜病的自然进展至关重要。我们旨在研究对于多种风湿性二尖瓣（MV）和主动脉瓣（AV）疾病仅进行二尖瓣干预是否安全。风湿性主动脉瓣疾病进展缓慢，二尖瓣干预后严重程度无显著差异。我们在一个单一的三级中心回顾性研究了二尖瓣干预后伴有风湿性改变的主动脉瓣疾病的进展。在最初筛查的890例患者中，76例符合评估标准。6例患者符合重度主动脉狭窄（AS）的定义，其中4例尽管射血分数正常，但被归类为低流量低梯度重度AS。最终，在中位随访期4年（平均5.8年）时，发现4例患者患有真正的重度AS，其中只有1例因重度AS本身接受了主动脉瓣手术。主动脉瓣反流患者均未恶化为重度。二尖瓣干预后，只有一小部分风湿性主动脉瓣受累进展为重度AS，对于因风湿性改变并发轻度或中度AS或主动脉瓣反流的重度二尖瓣狭窄或二尖瓣反流患者进行二尖瓣干预是合理的。
