Mixed Aortic Stenosis and Regurgitation

Definition, Etiology, Clinical FeaturesTop

Mixed aortic stenosis (AS) and aortic regurgitation (AR) refers to concomitant stenosis and regurgitation of the aortic valve.

Etiology: Congenital (most commonly a bicuspid aortic valve), degenerative, rheumatic disease, prior balloon valvuloplasty for AS in childhood, or prior mediastinal irradiation.

Clinical features are similar to other types of acquired aortic valve disease and depend on the dominant lesion (AS vs AR). The coexisting AR causes a louder systolic murmur by increasing transvalvular flow across the stenotic valve.

Treatment Top

1. Surgery: The decision is made on an individual basis, taking into consideration the symptoms, transvalvular gradient, aortic valve area, and left ventricular size and function.

Indications: In patients with dominant stenosis, even if the symptoms are mild; in patients with dominant regurgitation in the case of severe symptoms or reduced left ventricular ejection fraction. In patients with postradiation disease, the most common indication for surgery is concomitant coronary artery disease.

2. Pharmacotherapy: Depends on the dominant lesion. Note that vasodilators used for AR may increase the transvalvular gradient of AS; agents that slow the heart rate (beta-blockers) may increase regurgitant volumes in AR.

3. Prevention of infective endocarditis: see Infective Endocarditis.