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MULTIVALVULAR DISEASE, In India and south Asia,rheumatic heart disease is highly prevalent., RHD is the most common cause of multivalvular disease., RHD is responsible for mixed valvular disease., A valve could be simultaneously,stenotic as well as incompetent., The common combinations of MULTIVALVULAR affections are…, 1.MS with AR, 2.MR with AR, 3.MS with AS, Certain features of multivalvular and mixed valvular lesions are…, 1.The clinical picture will be according to the dominant lesion...e.g...if MS is long, standing and severe,in spite of gross AR the diastolic pressure will not be low and the, SVR will be high., 2.CCF is common…..multivalvular and mixed valvular disease are associated with large, hearts and severe systemic venous congestion., One of the largest LA dimensions is seen in patients with mixed valve disease., 3.Myocardial preservation….multivalvular conditions are associated with compromised, LV as well as RV functions.Hence myocardial protection receives top priority during, surgery., 4.Functional valvular lesion…., When a ventricle fails,it dilated., Dilated ventricle is associated with dilatation of mitral and tricuspid valve annulus., The dilatation results in failure of leaflets coaptation., This give rise to AV valve regurgitation., When the distal lesion is treated,the ventricular dilation regress and the annulus is back, to original size and functional regurgitation disappears.., Other cause of MULTIVALVULAR disease…………, Marfan's syndrome, Infective endocarditis, Endo myocardial fibrosis, MANAGEMENT, Mild to moderate AR with other valvular affections……, Mild to moderate AR does not warrent surgery for aortic valve disease and usually these, patients are taken up for mitral valve disease or CABG., The AR poses problems with respect to….., 1.LV distention during cooling or CPB..appropriate venting is required., 2.Delivery of root cardioplegia...requires compression of subaortic region., 3.LV distention at the time of release of cross clamp., Significant mitral and aortic valve disease…..the mitral valve disease is treated first as, retraction of LA and passing sutures for mitral valve replacement in the presence of, prosthetic aortic valve is very difficult., Associated significant TV disease…..

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During multiple valvular surgery,due to long cross clamp time,multiple cardioplegia, doses required., Hence problems like hyperkalemia and hemodilution should be anticipated…, , The end…….