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Long-term outcome of aortic valve disease in rheumatic patients after a mitral valve intervention.


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Department of Adult Cardiology - Philippine Heart Center

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Heart Center Journal
Publication Date
April-June 2006


Background: This study was performed to assess the long-term outcome of untreated mild to moderate aortic
valve (AV) disease present at the time mitral valve (MV) intervention and to identify factors that can predict progression of aortic valve lesions.

Methods and Results:  A total of 88 subjects, 19 years old and above, who underwent mitral valve intervention with concomitant mild to moderate aortic valve disease were studied. Subjects were classified into 3 groups: 1) those subjects with isolated aortic stenosis (AS); 2) those subjects with pure aortic regurgitation (AR); 3) those with combined AS and AR at the time of MV intervention. From these subjects, progression of AV disease was followed-up. Follow-up data were obtained using the 2DED study results. The primary endpoint was the year when the progression of AV disease was noted. Subjects classified into those with combined AS and AR at the time of MV intervention accounted for 20 of the 88 study subjects. The remaining 68 subjects (n=88) were identified to have had pure AR None of the 88 subjects were classified under isolated aortic stenosis. It was observed that only 24% (16 out of 68 subjects) with pure AR had progression of the AR and freedom from development of moderate to severe AV disease in patients who initially had pure mild-moderate AR was 90% in 2 years, 83% in 5 years and 66% in 8 years. On the other hand, it was noted that about 50% (10 out of 20 subjects) with initial AS and AR had progression to moderate to severe AV lesions, and freedom from development of moderate to severe AV disease was 60% in 2 years, 40% in 5 years, and 25% in 8 years time. It was significantly less (p<O.0001) than those who had pure AR lesions initially. Among the demographic factors analyzed, only the presence of mild AS with AR at the initial intervention predicted for development of significant AV disease on follow-up.

Conclusion:  Mild to moderate pure aortic regurgitation usually progresses more slowly and rarely develop into a
hemodynamically significant AV disease over a long follow-up period. However, a combined AS and AR lesion progresses more rapidly and needs a closer follow-up. Of-the various factors analyzed, the presence of mild AS with AR at initial presentation is significantly correlated with increased rate of AV disease proqression.


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