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, 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.
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.
1. Pharmacologic treatment of heart failure.
2. Antithrombotic treatment in patients with atrial fibrillation.
4. Invasive treatment: Patients with coexisting moderate or severe MR are ineligible for percutaneous valvuloplasty; usually, treatment involves mitral valve replacement.