AVR plus MVR commonly refered to as DVR is a path breaking cardiac surgery in patients with combined valvular heart disease. Still, it carries considerable mortabidity, if not done with high degree of expetise and standards . Apart from technical perfection, an inherent issue exist that might affect long term Impact.
Here is lateral view of X – ray chest showing a DVR.
High resolution jpeg Image

Final message
What will happen to the native anatomical and physiological functional unit of Aorto-mitral continuity after DVR? Will LV inflow encroach the LV outflow or vice versa? These questions are less often asked. In the process, we often ignore a concept called Aortic-mitral coupling or inter-dependence.
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