The aortic and mitral valve share a common fibrous border call the aortic-mitral curtain. Due to this anatomic linkage, normal aortic and mitral valve function are interdependent demonstrating coupled reciprocal behavior. Thus, during the cardiac cycle when aortic annular area is at its maximum, mitral annular area is at its minimum and vice versa. Additionally, the angle between the aortic and mitral valves is smallest during left ventricular ejection. Overall, this annular area reciprocity and angulation likely play a role in the efficiency of the heart as a pump.
When isolated aortic valve stenosis is present, changes to the ‘unaffected’ mitral valve occurs resulting in small mitral annular areas and reduced mitral annular function. These changes persist even with surgical or percutaneous treatment of the aortic valve. In contrast, in patients with degenerative mitral valve disease, the aortic valve appears to remain unaffected. However, after mitral valve repair with an annuloplasty ring, aortic annular pulsatility is reduced, which could impact normal aortic root function. Overall, diseases affecting the aortic or mitral valves and interventions to treat these diseases should include assessment of the impact on both valves.
KeywordsAortic valve Mitral valve Aortic-mitral coupling
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