Multiple and Mixed Valvular Heart Disease: State-of-the-Art

Multiple and mixed valvular heart disease (MMVD) is defined as the combination of stenotic or regurgitant lesions occurring on ≥2 cardiac valves (ie, multiple valvular heart disease [VHD]) or the combination of stenotic and regurgitant lesions on the same valve (ie, mixed VHD). This condition is frequent in clinical routine, with a notable shift in epidemiology over recent years, marked by a decline in rheumatic heart disease and an increase in degenerative causes. Even if echocardiography stands as the cornerstone for diagnosing VHD, practicians need to remain cautious because some echocardiographic parameters might be invalid in the context of MMVD. Considering echocardiography's pitfalls, MMVD needs to be assessed using multiparametric perspective, including cardiovascular magnetic resonance, cardiac computed tomography, biomarkers, and the assessment of comorbidities. Multimodality imaging seems to be a promising approach to assess patient's prognosis, by providing a precise analysis of cardiac remodeling and an accurate evaluation of MMVD severity. Due to the heterogeneity of this clinical scenario, studies are typically conducted in single centers with a limited number of patients. Therefore, there is a lack of dedicated guidelines regarding the severity assessment and the clinical decision-making for these MMVD patients. The aim of this review is to provide a state-of-the-art using the available evidence on the management of MMVD considering the interactions between different valve lesions, the diagnostic pitfalls, and the strategies that should be considered including the role of multimodality imaging in the presence of MMVD.

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Publication Details

Journal
Journal of the Heart Valve Society
Published
2025-04-01
DOI
https://doi.org/10.1177/30494826251330128
Citations
2
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
2.78
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article

Multiple and Mixed Valvular Heart Disease: State-of-the-Art

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2 citations
Journal of the Heart Valve Society
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2.78
article

Multiple and Mixed Valvular Heart Disease: State-of-the-Art

Alexandre Unger, Trecy Gonçalves, Andreea Sorina Afana, Valérie Bousson, Damien Mandry, Yohann Bohbot, Charles Fauvel, Jean‐Guillaume Dillinger, Paul-Jun Martial, Théo Pezel, Philippe Unger, Gilles Soulat, Olivier Huttin, Solenn Toupin, François Pontana, J. Florence, Jérôme Garot, Emmanuel Gall, Patrick Henry, Augustin Coisne, Elie Mousseaux, Elsa Richard de Vesvrotte
article en
2 citations

Abstract

Multiple and mixed valvular heart disease (MMVD) is defined as the combination of stenotic or regurgitant lesions occurring on ≥2 cardiac valves (ie, multiple valvular heart disease [VHD]) or the combination of stenotic and regurgitant lesions on the same valve (ie, mixed VHD). This condition is frequent in clinical routine, with a notable shift in epidemiology over recent years, marked by a decline in rheumatic heart disease and an increase in degenerative causes. Even if echocardiography stands as the cornerstone for diagnosing VHD, practicians need to remain cautious because some echocardiographic parameters might be invalid in the context of MMVD. Considering echocardiography's pitfalls, MMVD needs to be assessed using multiparametric perspective, including cardiovascular magnetic resonance, cardiac computed tomography, biomarkers, and the assessment of comorbidities. Multimodality imaging seems to be a promising approach to assess patient's prognosis, by providing a precise analysis of cardiac remodeling and an accurate evaluation of MMVD severity. Due to the heterogeneity of this clinical scenario, studies are typically conducted in single centers with a limited number of patients. Therefore, there is a lack of dedicated guidelines regarding the severity assessment and the clinical decision-making for these MMVD patients. The aim of this review is to provide a state-of-the-art using the available evidence on the management of MMVD considering the interactions between different valve lesions, the diagnostic pitfalls, and the strategies that should be considered including the role of multimodality imaging in the presence of MMVD.

Journal of the Heart Valve SocietyVol. 2(2)
Université Libre de Bruxelles (BE), Inserm (FR), Université Paris Cité (FR), Université de Lille (FR), Institut Pasteur de Lille (FR), Erasmus Hospital (BE), University of Medicine and Pharmacy of Craiova (RO), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Assistance Publique – Hôpitaux de Paris (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Européen Georges-Pompidou (FR), Hôpital Européen (FR), Laboratoire d’Imagerie Biomédicale (FR), Hôpital Lariboisière (FR), Universitair Ziekenhuis Brussel (BE), Institut Cardiovasculaire Paris Sud (FR), Centre Hospitalier Universitaire de Saint-Pierre (BE), Marqueurs cardiovasculaires en situation de stress (FR), Université de Rouen Normandie (FR)
Good health and well-being
Openalex Percentile: Top 9%
Cardiac Valve Diseases and Treatments
2.78
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