Cardiology>>>>>Valvular heart disease and Endocarditis
Question 10#

You are asked to review an echocardiogram of a 82-year-old woman who has both severe aortic stenosis (AS) and severe mitral regurgitation (MR). All the following statements are true in patients with combined or multiple valve lesions except:

A. Associated MR may lead to underestimation of the severity of AS
B. Severe AS may lead to overestimation of coexisting MR
C. Significant aortic regurgitation (AR) lengthens the Doppler pressure half-time (PHT) in mitral stenosis (MS)
D. The presence of significant AR may overestimate the gradient across the aortic valve
E. Planimetry should be utilized

Correct Answer is C

Comment:

AR shortens the PHT in mitral stenosis. PHT is a measure of the change in pressure between two cardiac chambers. In significant AR, there is likely to be high LV end-diastolic pressures. This leads to a higher pressure difference between the LV and LA—hence shortening of the PHT in MS. This underestimates the severity of MS. Associated MR leads to underestimation of the severity of AS since decreased stroke volume due to MR lowers the flow (and gradient) across the AV. Similarly, severe AS causes high ventricular pressures leading to overestimation of coexistent MR In mixed aortic valve disease, the presence of significant AR will lead to increased stroke volume and hence flow (and gradient) across the aortic valve. Therefore AR can overestimate the severity of AS. Methods that are less dependent on loading conditions, such as planimetry of valve area, should be utilized.