Natural Progression of Rheumatic Aortic Valve Disease Following Mitral Valve Intervention: A 16‐Year Single‐Center Experience

Figures

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  Figure 1. Patient sorting diagram. Patients who demonstrated rheumatic involvement of the AV following MV intervention for rheumatic MS or MR at Pusan National University Yangsan Hospital between December 1st, 2008 and December 31st, 2023, were included. Among 890 patients initially screened, 76 patients met the criteria for assessment.

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  Figure 2. The changes in the grading of AS and distribution of individual Vmax and mPG values. The changes in the grading of aortic stenosis as per four standards are presented. For each assessment standard, results with missing data across the four time points (n = 76) are given. Severe AS was rarely observed in the echocardiographic assessment immediately after surgery (Postop.1) but was most commonly identified at Postop.2. Beyond this point, further progression was uncommon, with minimal changes in AS severity observed in the echocardiographic data at the 5-year follow-up. (a) AS grading as per integrative assessment, incorporating the velocity-time integral ratio to classify low-flow, low-gradient severe AS despite preserved left ventricular ejection fraction. (b) AS grading as per AVA perspective, where AVA was calculated using the continuity equation as the Doppler-derived effective orifice area. (c) AS grading as per Vmax perspective. (d) AS grading as per mPG perspective. (e) Distribution of individual Vmax values. (f) Distribution of individual mPG values. Complete sets of echocardiographic data at all four time points are given in Supporting Figure 1. Mean follow-up interval of…

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  Figure 3. The changes in the grading of AR. No patient showed progression to severe AR during the follow-up. (a) Results with missing data across the four time points (n = 76). (b) Complete sets of echocardiographic data at all four time points (n = 43). Mean follow-up interval: Postop.1: 10.6 ± 4.8 days; Postop.2: 17.9 ± 2.4 months; Last: 6.3 ± 0.5 years. The terminology “Preop.” refers to the assessment conducted just before MV surgery, “Postop.1” refers to the initial echocardiographic findings following MV surgery, “Postop.2” refers to results approximately one year after MV surgery, and “Last” designates the most recent echocardiographic assessment conducted prior to the AV intervention, aside from the one-year follow-up. In cases where the one-year results were the latest available, they were treated as the “Postop.1” assessment.