11.13.2 Stenosis and insufficiency of the same valve

 The haemodynamic behaviour is determined by the dominant mechanism (see Mitral disease and Aortic disease) (see Figure 11.164). The type of remodelling of the LV and LA on echocardiography generally gives the answer: the LV is dilated in failure and restrictive in stenosis. When both are severe, stenosis is the predominant haemodynamic phenomenon. The regurgitant volume increases the anterograde flow through the valve (in systole in AI, in diastole in MI); this situation tends to overestimate the degree of stenosis on Doppler echocardiography. However, the degree of haemodynamic disturbance is greater than for the same degree of isolated pathology; therefore, the indication for surgery is generally based on the patient's symptoms during exercise rather than on the calculated values.

In mitral disease, the half-pressure time is inappropriate for measuring the degree of stenosis; the continuity equation is unreliable for assessing the regurgitant orifice area. In aortic disease, the continuity equation can be used with LVOT to assess stenosis, but the half-pressure time cannot be used to quantify AI [1,2].

 

Hemodynamics sought in regurgitation and stenosis of the same valve

In terms of equivalent severity, stenosis predominates High preload Low if dominant stenosis, high if dominant insufficiency Preservation of contractility (inotropes according to the degree of LV dilatation) High SAR in dominant stenosis, low in dominant failure Normal PAR (reduced in PHT)

 

 

© CHASSOT PG, BETTEX D, August 2011, last update November 2019