MULTIVALVULAR DISEASE
Combined valvular lesions are common, especially in rheumatic heart disease. In addition to organic lesions, development of mitral and tricuspid regurgitation or pulmonic regurgitation may occur secondary to the hemodynamic disturbance of other valvular lesions. In general, the manifestations of the more proximal valve lesion are the more prominent. For example, in patients with mitral and aortic valvular lesions of similar severity, mitral valve manifestations may predominate and the degree of aortic stenosis may be underestimated. Failure to correct all significant valvular lesions at the time of surgery may lead to an inadequate clinical result and illustrates the importance of excluding concomitant lesions at the time of catheterization. The surgical risk for double valve replacement is greater than that for single valve replacement.