Patient handout

Mixed aortic valve disease (combined AS + AR)

PRODUCTION

1. Your condition

This handout is for mixed aortic valve disease (combined as + ar). Your care team identified this based on: combined systolic ejection + early diastolic aortic murmur.

Other reasons your team may use this plan: echo: combined ≥moderate as and ≥moderate ar; exertional dyspnea / angina / syncope at modest individual lesion severity; bicuspid or rheumatic aortic valve with mixed lesion.

3. When to call your provider

Contact your care team if any of the following happen:

Symptoms OR LV dysfunction/dilatation at modest individual severity → AVR referral now — 2020 ACC/AHA VHD
Aortic root/ascending at threshold → aortic surgery — 2022 Aortic
Acute-on-chronic AR (dissection/IE) → ED + emergency route — 2020 ACC/AHA VHD

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptomatic with ≥moderate AS + ≥moderate AR — AVR indicated at a LOWER combined threshold (burden additive) — 2020 ACC/AHA VHD
heart pumping strength (LVEF) ≤55% or LVESD >50 mm attributable to combined burden — AVR even if neither lesion is isolated-severe — 2020 ACC/AHA VHD
Acute decompensation from dissection/IE superimposed on mixed AVD — emergency surgery — 2020 ACC/AHA VHD(life-threatening)
Pregnancy/planning — combined burden poorly tolerated; mWHO risk class; STOP ACEi/ARB → BB; pre-pregnancy AVR if severe; cardio-obstetric — ESC 2018 Pregnancy

5. Follow-up

Family screening (bicuspid); route to HFrEF engine if LV dysfunction

6. Sources

Guideline: 2020 ACC/AHA VHD Guideline + 2022 ACC/AHA Aortic Disease Guideline + 2021 ESC/EACTS VHD Guideline