Preoperative assessment of aortic regurgitation in patients with mitral valve disease

When open operations are performed for the repair of malformations of the mitral valve, the associated aortic regurgitation may prove a serious technical handicap. It is desirable, therefore, to determine as precisely as possible before operation, the presence and severity of any aortic reflux which may be encountered when the left atrium is opened. Accordingly, aortic regurgitation assessed by the commonly employed clinical, hemodynamic and angiographie features was compared with the degree of aortic reflux encountered during operation in 156 patients in whom open operations on the mitral valve were performed. The intensity of the murmur of aortic regurgitation, the level of the arterial diastolic blood pressure, and the arterial pulse pressure were found not to correlate accurately with the amount of aortic reflux encountered at operation. However, the absence of the murmur usually precluded troublesome aortic reflux, and the combination of a diastolic blood pressure greater than 70 mm. Hg and an arterial pulse pressure less than 40 mm. Hg excluded the presence of more than trivial aortic regurgitation at operation. Cineaortographic data provided the most precise means for the prediction of operative aortic reflux. Patients without cine evidence of aortic regurgitation had none at operation; those with mild aortic regurgitation rarely had troublesome reflux during bypass; half of the patients with moderate aortic regurgitation had bothersome operative aortic reflux, while nearly all of those with marked aortic regurgitation on cine study exhibited severe reflux during bypass and required aortic valve replacement. On the basis of these findings, it is our policy to perform preoperative cineaortographic studies in all patients with mitral valve disease who exhibit decrescendo diastolic murmurs along the sternal border.