This thesis explored the diagnosis, management and prognosis of the most common valvular heart diseases: aortic stenosis (AS) and mitral regurgitation (MR) and enlightened their challenging types: the discordant low-gradient severe AS and the secondary MR in non-ischemic cardiomyopathy. This thesis provides new insights into the use of fusion aortic valve area index, by incorporating the measurement of left ventricular outflow tract area on cardiac computed tomography in the continuity equation, for the diagnosis of low-gradient AS. For the treatment of low-gradient AS, TAVR is shown to result in reverse LV remodeling and functional recovery. In comparison to other minimal invasive surgical methods it results in less prosthesis-patient-mismatch although paravalvular aortic regurgitation is a caveat. Regarding the diagnostic assessment of secondary MR due to LV dysfunction this thesis concluded that LV GLS reflects the real LV dysfunction while LVEF overestimates LV function without accounting for the forward LV flow. Mitral valve repair offers LV reverse remodeling and increase in forward flow when used for the treatment of this challenging condition. Regarding the prognostication of low-gradient AS and secondary MR this thesis advocates for the evaluation of the valvular calcium on cardiac computed tomography and the evaluation of LV GLS and forward flow that are associated with survival.LUMC / Geneeskund
