Mixed Mitral Valve Disease

Chapter: Mixed Mitral Valve Disease
McMaster Section Editor(s): P.J. Devereaux
Section Editor(s) in Interna Szczeklika: Andrzej Budaj, Wiktoria Leśniak
McMaster Author(s): Hisham Dokainish, Matt Sibbald
Author(s) in Interna Szczeklika: Piotr Szymański, Piotr Hoffman
Additional Information

Definition, Etiology, Clinical FeaturesTop

Mixed mitral valve disease refers to coexisting mitral stenosis (MS) and mitral regurgitation (MR).

Etiology: Rheumatic disease, less frequently degenerative or endocarditic lesions.

Clinical features are similar to that of MS and MR, and depend on which of these hemodynamic lesions is dominant (see Mitral Stenosis; see Mitral Regurgitation). Most frequently the systolic murmur typical of MR is prominent and may mask the soft rumble typical of MS. The first heart sound may be increased in intensity.

Diagnosis Top

Diagnostic Tests

In patients with hemodynamically significant combined MS and MR, chest radiographs reveal enlargement of the left atrium and ventricle (also the right ventricle if the valve disease is severe and chronic) and features of pulmonary congestion, less frequently pulmonary hypertension. In patients with dominant MS the size of LV may be normal.

Treatment Top

1. Pharmacologic treatment of heart failure.

2. Antithrombotic treatment in patients with atrial fibrillation.

3. Prevention of infective endocarditis and of recurrent rheumatic disease (see Acute Rheumatic Fever).

4. Invasive treatment: Patients with coexisting moderate or severe MR are ineligible for percutaneous valvuloplasty; usually, treatment involves mitral valve replacement.

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