# Natural Progression of Rheumatic Aortic Valve Disease Following Mitral Valve Intervention: A 16-Year Single-Center Experience

## TL;DR

This study examines how rheumatic aortic valve disease progresses after mitral valve surgery, finding that severe aortic stenosis is rare in these patients.

## Contribution

The study provides long-term clinical evidence on the safety of treating mitral valve disease without immediate aortic valve intervention in rheumatic heart disease.

## Key findings

- Only four patients developed true-severe aortic stenosis after a median follow-up of four years.
- None of the patients with aortic regurgitation worsened to severe levels.
- MV intervention for severe mitral disease is reasonable even with mild-to-moderate rheumatic aortic valve disease.

## Abstract

Background: Recognizing the natural progression of the remaining valve disease following the intervention of a single valve is crucial in multiple rheumatic valvular diseases as often encountered in clinical practice. We aimed to investigate whether performing mitral valve (MV) intervention alone for multiple rheumatic MV and aortic valve (AV) disease is safe.

Hypothesis: Rheumatic AV disease progresses slowly and severity does not differ significantly after MV intervention.

Methods: We retrospectively investigated the progression of AV disease with rheumatic changes following MV intervention in a single tertiary center. Among 890 patients initially screened, 76 patients met the criteria for assessment.

Results: Six patients fell under severe aortic stenosis (AS) definition-wisely and four of them were classified as low-flow low-gradient severe AS despite normal ejection fraction. Eventually, four patients were found to have true-severe AS at a median follow-up period of four years (mean 5.8 years) and only one of them underwent AV surgery for severe AS per se. None of the patients with aortic regurgitation deteriorated to severe.

Conclusions: Only a small portion of rheumatic AV involvement progresses to severe AS after MV intervention, and performing MV intervention for severe mitral stenosis or mitral regurgitation in patients with concurrent mild or moderate AS or aortic regurgitation due to rheumatic changes is reasonable.