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Concomitant AS and MR — EECC MCQ

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HardValvular Heart DiseaseConcomitant AS and MREECC

A 80-year-old man with severe symptomatic aortic stenosis and moderate mitral regurgitation (secondary, due to LV dilatation) undergoes TAVI. Post-TAVI echocardiography shows the MR has improved from moderate to mild. What is the most likely mechanism for this improvement?

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Correct answer: A — Reduction in LV afterload leading to reverse remodelling and decreased mitral annular dilatation

Secondary (functional) MR in the context of severe AS is often caused by elevated LV pressures and volumes leading to mitral annular dilatation and leaflet tethering. After TAVI (or SAVR), the relief of aortic stenosis reduces LV afterload, allows LV reverse remodelling, reduces LV and mitral annular dimensions, and thereby improves leaflet coaptation. This phenomenon occurs in approximately 50-70% of patients with secondary MR undergoing AVR/TAVI and is an important consideration when assessing concomitant MR in severe AS patients.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease