The Chicken or the Egg

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TTEpreopPS3CV2D
Short case presentation
84 yo female with a history of a SEMI, (normal ECG and an elevated troponin 0.22->2.70) that was treated with ASA and Lovenox in the ER, DVT 20 yrs ago, hypertension, NIDDM, hypothyriodism, and a TIA several years ago. Her current medications include Plavix, Atacand, Glipizide, Levothyroxin, Metformin, Imdur, and Lopressor. She lives alone. Her initial TTE showed an LVEF 50%, Stage 1 diastolic dysfunction, LVH, LAE, RAE, thickened MV leaflets, MAC, mild MR, mild MS, mild AR and severe AS. The mAVG was 30 mmHg with an AVA of 0.89cm2. The AV Vmax is 3.66 m/sec. The MV Vmax was 2.34 m/sec with a mMVG of 8 mmHg and a MVA of 2.72 cm2. The PAP is 38 mmHg. There was inferior and anterior HK present. A cardiac cath showed a LAD 95%, OM 80%, Cx 70%, RCA 80%

Please give your assessment of the intraoperative echo exam.
Why is there a discrepency between the preop AVA and the mean AVG?
How does mitral stenosis affect the aortic valve calculations?
How does aortic stenosis affect the mitral valve calculations?