Combined Rheumatic Mitral and Aortic Stenosis: Hemodynamics and a Tailored Approach to Management.

BACKGROUND

The greatest rates of rheumatic heart disease (RHD) are currently seen in South Asia, central sub-Saharan Africa, and Oceania. Mitral and aortic stenosis involvement is one of the rarest combinations, affecting only 2.4% of patients.

CASE SUMMARY: We describe 3 patients with concomitant severe rheumatic aortic and mitral stenosis, each with a unique clinical presentation. Each case highlights the complex hemodynamic nature of the combined stenotic lesion.

DISCUSSION: Double valve replacement is usually recommended as the treatment of choice for these stenotic lesions. However, such a universal approach for all stenotic lesions is problematic owing to the complications that can occur during the perioperative and postoperative periods of double valve replacement.

TAKE-HOME MESSAGE: Simultaneous percutaneous transvenous mitral commissurotomy and aortic valve replacement can be a treatment strategy for concomitant severe rheumatic aortic and mitral stenosis, especially in low- and middle-income countries.