Pathophysiology and management of multivalvular disease.
Multivalvular disease (MVD) is common among patients with valvular disease, and has a complex pathophysiology dependent on the specific combination of valve lesions. Diagnosis is challenging because several echocardiographic methods commonly used for the assessment of stenosis or regurgitation have been validated only in patients with single-valve disease. Decisions about the timing and type of treatment should be made by a multidisciplinary heart valve team, on a case-by-case basis. Several factors should be considered, including the severity and consequences of the MVD, the patient's life expectancy and comorbidities, the surgical risk associated with combined valve procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses, and the likelihood and risk of reoperation. The introduction of transcatheter valve therapies into clinical practice has provided new treatment options for patients with MVD, and decision-making algorithms on how to combine surgical and percutaneous treatment options are evolving rapidly. In this Review, we discuss the pathophysiology, diagnosis, and treatment of MVD, focusing on the combinations of valve pathologies that are most often encountered in clinical practice.
Cardiology Department, CHU Saint-Pierre, Université Libre de Bruxelles, 322 rue Haute, B-1000, Brussels, Belgium.
Philippe
P
Unger
Quebec Heart &Lung Institute, Department of Medicine, Laval University, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
Marie-Annick
MA
Clavel
Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
Brian R
BR
Lindman
Quebec Heart &Lung Institute, Department of Medicine, Laval University, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
Patrick
P
Mathieu
Quebec Heart &Lung Institute, Department of Medicine, Laval University, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
Philippe
P
Pibarot
D006328:Cardiac Catheterization; D000066491:Clinical Decision-Making; D015150:Echocardiography, Doppler; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D064847:Multimodal Imaging; D012086:Reoperation; D012307:Risk Factors