Multiple valve disease

Multiple valvular heart disease is a highly prevalent condition. Whereas the burden of rheumatic heart disease is decreasing, degenerative etiologies are becoming increasingly prevalent in industrialized regions. Hemodynamic interactions may impact both the clinical expression and the diagnosis of each singular lesion, and the clinician should be aware of its specific diagnostic pitfalls. There is currently little if any evidence-based management strategy. Patients should be followed by a Heart Valve Team in the setting of heart valve clinics, using a “case by case” therapeutic strategy. In addition to the severity of each singular lesion, clinical and imaging factors should be considered, including the individual risk profile, the increased morbidity associated with multiple prostheses, and the natural history of each valvular lesion if left untreated. Advances in transcatheter valve therapies are likely to change the therapeutic paradigm, but these approaches still require prospective validation before gaining wide acceptance.SCOPUS: ch.b