Combined Mitral and Aortic Stenosis

Rheumatic fever commonly affects both the mitral and aortic valves, and in a significant pro- portion of patients with rheumatic heart disease the physical findings of both mitral and aortic stenosis are present.Detailed evaluation, however, will usually reveal that only one of the lesions is of hemodynamic importance and responsible for the patient's disability.Less commonly, left heart catheterization will reveal pressure gradients across both valves of sufficient magnitude to indicate that a combined operative approach will be necessary.At the National Heart Institute we have recently studied eight patients with combined mitral and aortic stenosis.In each, mitral commissurotomy and aortic valvotomy were carried out by a closed technique.The clinical findings in these patients, the operative method employed, and the results of their pre-and post-operative hemodynamic evaluations form the basis of this report. CLINICAL AND HAEMODYNAMIC FINDINGSThe ages of the eight patients ranged from 20 to 48 years, and six of them were women.A clear history of rheumatic fever was given by six patients.Exertional dyspncea had been experienced by all of them, and the majority complained also of orthopncea and paroxysmal nocturnal dyspncea of varying severity.In two patients hemoptysis, and in two others arterial embolism, had occurred.It is of interest that only one patient (V.J.) described anginal pain and none had experienced vertigo or syncope.