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Subject Area

Cardiac Surgery

Article Type

Original Study

Abstract

Objectives This study aimed to assess the clinical outcome of moderate aortic incompetence after mitral valve replacement in patients with severe rheumatic mitral stenosis. Background The fate of aortic valve disease after mitral valve surgery for rheumatic mitral stenosis still needs to be investigated more. In addition, appropriate management of moderate aortic incompetence is required during and after replacement of the stenotic mitral valve. We aimed to evaluate the early-term fate of moderate aortic incompetence and the need for aortic valve surgery after mitral valve replacement in rheumatic patients. Patients and methods Fifty rheumatic heart disease patients, with combined severe mitral stenosis and moderate aortic incompetence, underwent mitral valve replacement. We followed them up for 1 year with serial transthoracic echocardiography to assess the fate of aortic incompetence. Results Preoperatively, the aortic incompetence mean vena contracta was 0.46 ± 0.049 cm. Postoperatively, after 1-year follow-up, we detected a significant increase in the aortic regurgitation mean vena contracta to 0.49 ± 0.077 cm (P = 0.001). However, both figures are still in the moderate category (0.4–0.6 cm). In terms of the aortic incompetence jet size ratio, the preoperative mean was 48 ± 3.350 and after 1 year follow-up, it was 49.2 ± 9.613; an insignificant increase was found (P = 0.387). The ejection fraction showed a significant decline at 1 year postoperatively, with a value of 56 ± 4.651, in comparison with the preoperative value of 60.4 ± 8.809 (P < 0.0001). There was no perioperative mortality or aortic valve replacement after 1 year. Conclusion In patients with rheumatic severe mitral stenosis and moderate aortic incompetence, the aortic incompetence will progress with time. Also, a decrease in the ejection fraction will occur. These findings lead surgeons to repair or replace the aortic valve at the time of mitral surgery.

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