Challenges in Multivalvular Heart Disease: Indian Scenario

Multivalvular disease (MVD) is a common scenario with various clinical challenges and limited availability of evidence-based recommendations. The pathophysiology of patients having MVD is dependent on the specific combination of valve lesions. The anesthesiologist should be aware of the echocardiographic pitfalls as many commonly used echocardiographic parameters for the assessment and quantification of valve lesions is validated only in patients with single-valve disease. It is also necessary to take into account the interaction between the different valve lesions while interpreting echocardiography. The management decisions of such patients depend on the assessment of the different valve lesions and their effect on symptoms, pulmonary hypertension, and left ventricular dysfunction. The decision to intervene on multiple valves should take into account both the surgical risk of combined procedures and the advantages of available percutaneous techniques. In this review, we discuss the common clinical scenario, pathophysiology, echocardiographic challenges, and guideline-directed management options in patients with MVD.