Addressing the hemodynamic dilemma of combined mitral and aortic stenosis

Accurate assessment of valvular hemodynamics is essential in the decision-making process when referring a patient for cardiac surgery who has suspected coexistent aortic and mitral valve disease. Often times, one valvular lesion is worse than the other, and the question of "prophylactically" replacing the less severe valve at the time of surgery is controversial. In these situations and because of uncertainty regarding noninvasive assessment, hemodynamic evaluation in the cardiac catheterization laboratory provides critical information in guiding therapy.