Pathophysiology

Rheumatic heart disease remains an important cause of combined aortic and mitral disease. Between 32 and 50 percent of patients with cardiac manifestations of rheumatic fever have both aortic and mitral disease. In aged patients, calcification can lead to both aortic stenosis and mitral incompetence. Infective endocarditis can extend from either the mitral or aortic valve to the adjacent valve though the inflammatory process. Intravenous drug users may have multivalvular disease. Tricuspid regurgitation often occurs with right ventricular dilation secondary to pulmonary hypertension that may be due to mitral disease or combined aortic and mitral disease.

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