الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The high rate of multi-valvular involvement in patients who had underwent mitral valve surgery has raised the question of the need for prophylactic AV replacement at the same time.
Because of the highly selection of the patients with preserved ventricular functions they have a low morbidity and no mortality.
Regardless the differences between pre and postoperative echocardiographic dimensions of the left atrium, left ventricular end diastolic diameter, left ventricular end systolic diameter and ejection fraction between the both groups there is no significant progress in the severity of the aortic regurgitation, although there was a belief by some surgeons that these echocardiographic changes may affect the degree of aortic regurgitation.
Based on our results, patients with moderate aortic regurgitation disease at the time of mitral valve surgery rarely develop a hemodynamic significant aortic valve disease over a short follow-up period.
The minor progression in the AV disease over a moderate period of time and the increased perioperative mortality and morbidity of a dual valve replacement do not justify the performance of prophylactic AV replacement.
Because all of the patients in our study had rheumatic disease, this statement should be generalized only to this subgroup of cardiac patients. Early operations can be justified by good operative outcomes in asymptomatic patients.
Risk assessment is a critical issue to decide proper timing of interventions. We suggest a regular follow up of those functionally stable patients. Echocardiographic measurements might be required at a 12 months frequency to evaluate chamber size and ejection fraction in addition to the physical performance.
The heart team has a central role of utmost importance before and during decision making, as well as for the planning of the appropriate cardiac surgical procedures.
If surgery is not indicated, serial clinical and echocardiographic evaluation is required in patients who remain asymptomatic.
Delaying surgery is only indicated if the patient has stable aortic valve disease and preserved cardiac function. If the patient is in cardiac failure or unable to compensate for either the increase in LV volume or pressure, then surgery should proceed.