Key result
Simultaneous PTMC and AVR shows feasibility for severe rheumatic aortic and mitral stenosis.
Why the study?
Mitral and aortic stenosis is one of the rarest RHD combinations, and universal double valve replacement is problematic due to perioperative and postoperative complications.
Case Report (n=3)
No
A tailored approach using PTMC and subsequent AVR or observation may be a viable alternative to double valve replacement for combined rheumatic mitral and aortic stenosis in resource-limited settings.
Rare combined rheumatic stenoses highlight complex hemodynamics; case series extends descriptive literature but leaves open optimal management strategies.
BACKGROUND: The greatest rates of rheumatic heart disease (RHD) are currently seen in South Asia, central sub-Saharan Africa, and Oceania. Mitral and aortic stenosis involvement is one of the rarest combinations, affecting only 2.4% of patients. CASE SUMMARY: We describe 3 patients with concomitant severe rheumatic aortic and mitral stenosis, each with a unique clinical presentation. Each case highlights the complex hemodynamic nature of the combined stenotic lesion. DISCUSSION: Double valve replacement is usually recommended as the treatment of choice for these stenotic lesions. However, such a universal approach for all stenotic lesions is problematic owing to the complications that can occur during the perioperative and postoperative periods of double valve replacement. TAKE-HOME MESSAGE: Simultaneous percutaneous transvenous mitral commissurotomy and aortic valve replacement can be a treatment strategy for concomitant severe rheumatic aortic and mitral stenosis, especially in low- and middle-income countries.
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Duggal et al. (2025) conducted a case report in Combined rheumatic mitral and aortic stenosis (n=3). Percutaneous transvenous mitral commissurotomy (PTMC) and tailored management was evaluated. Simultaneous percutaneous transvenous mitral commissurotomy and aortic valve replacement can be a treatment strategy for concomitant severe rheumatic aortic and mitral stenosis.
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