Treatment of Rheumatic Heart Disease with Mitral Regurgitation and Aortic Regurgitation (Mixed Multivalve Disease)

Clinical Scenario

Mixed Multivalve Disease

This protocol addresses rheumatic heart disease presenting as concurrent mitral regurgitation (MR) and aortic regurgitation (AR) — a pattern of combined multivalve involvement that poses distinct management challenges. Scientific data to guide medical management of this mixed lesion are limited, making a structured, evidence-informed approach essential.

Valve Involvement

The simultaneous presence of mitral regurgitation and aortic regurgitation defines this mixed multivalve scenario. Medical adjuncts — including afterload reduction, diuretic therapy, and possibly β-blockade — may have a complementary role in this setting, but the evidence base for medical-only management is thin.

Management Approach

For combined MR and AR in rheumatic heart disease, the evidence-based pathway centres on heart valve surgery — either valve repair or replacement. Which surgical strategy applies, and under what conditions, is detailed in the full structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/CIR.0000000000000921

In the most common scenario of multivalve disease with MR and AR, medical therapy with afterload reduction, diuretic agents, and possibly β-blockade may be complementary.

There are no scientific data to guide medical management of mixed valve disease, and surgery is often indicated.

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