Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

2011 ◽  
Vol 21 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Rachel H. Webb ◽  
Nigel J. Wilson ◽  
Diana R. Lennon ◽  
Elizabeth M. Wilson ◽  
Ross W. Nicholson ◽  
...  
Keyword(s):  
Heart Disease ◽  
New Zealand ◽  
High Risk ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Secondary Prophylaxis ◽  
Accurate Diagnosis ◽  
High Risk Population ◽  
Step Model ◽  
Rheumatic Heart

AbstractAimsEchocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.Methods and resultsTo optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified asdefinite, probable, orpossible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence ofdefiniteandprobablerheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.ConclusionsWe found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

scholarly journals Prosthetic mitral valve thrombosis in a known case of rheumatic heart disease at 37 weeks pregnancy: a case report

2021 ◽  
Vol 10 (8) ◽  
pp. 3254
Author(s):  
Kirty Nahar ◽  
Nikita Nahar
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Prosthetic Valve ◽  
Late Onset ◽  
Open Heart Surgery ◽  
Fetal Loss ◽  
Valve Thrombosis ◽  
Rheumatic Heart

Pregnancy with prosthetic valve is a challenging situation since this is a hypercoagulable state and maintenance of anticoagulation for prosthetic valves becomes difficult due to the teratogenic effects and altered pharmacokinetics of anticoagulant drugs. Despite adequate anticoagulation, the incidence of prosthetic valve thrombosis has been estimated as 4% to 14% during pregnancy. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss, especially in early pregnancy. Furthermore, bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns.  Mrs. X, a 36-year-old, gravida 3, para1+1 with 37 weeks pregnancy presented at Apollo hospitals, Ahmedabad in emergency department with complaints of severe dry cough and breathlessness for 24 hours. On through workup, she was diagnosed as mitral valve thrombosis in a known case of rheumatic heart disease post mitral valve replacement at 37 weeks pregnancy with late onset fetal growth restriction. After multi-speciality consultation she underwent thrombolytic therapy followed by high-risk emergency caesarean section. She delivered healthy male child, weight 2.21 kg and was discharged on 4th post-op day. Management of pregnant patients with mechanical valves is complex, especially when valve thrombosis and other complications occur. Multidisciplinary approach is essential and, in this case, led to successful maternal and foetal outcome.

The variable spectrum of anterior mitral valve leaflet restriction in rheumatic heart disease screening

2021 ◽  
Author(s):  
Luke David Hunter ◽  
Anton F. Doubell ◽  
Alfonso J. K. Pecoraro ◽  
Mark Monaghan ◽  
Guy Lloyd ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Disease Screening ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Rheumatic Heart

225 Rheumatic heart disease in Timor Leste school students (RHD-TL) follow-up study: assessment of secondary prophylaxis and outcomes in Timor Leste

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Horton ◽  
B Remenyi ◽  
K Davis ◽  
N Mock ◽  
E Paratz ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Secondary Prophylaxis ◽  
Penicillin G ◽  
School Students ◽  
Borderline Cases ◽  
Follow Up Study ◽  
Timor Leste ◽  
Rheumatic Heart

Abstract Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

Mortality and hospitalisation costs of rheumatic fever and rheumatic heart disease in New Zealand

2012 ◽  
Vol 48 (8) ◽  
pp. 692-697 ◽  
Author(s):  
Richard J Milne ◽  
Diana Lennon ◽  
Joanna M Stewart ◽  
Stephen Vander Hoorn ◽  
Paul A Scuffham
Keyword(s):  
Heart Disease ◽  
New Zealand ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Rheumatic Heart

R15 Long-term Outcome Following Mitral Valve Repair in Rheumatic Heart Disease

2021 ◽  
Vol 30 ◽  
pp. S21-S22
Author(s):  
K.F.L. Lee ◽  
O.J.O.J. Lee ◽  
T.L.D. Chan ◽  
K.L.C. Ho ◽  
W.K.T. Au
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Rheumatic Heart

Underuse of Injectable Penicillin in Secondary Prophylaxis of Rheumatic Heart Disease in Nepal

2020 ◽  
Vol 01 (01) ◽  
pp. 009-012
Author(s):  
Laudari S
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Cross Sectional Study ◽  
Secondary Prophylaxis ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Rheumatic Heart

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef􀏐icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of de􀏐inite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by aortic valve in 70 patients (20.00%) and rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed on oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.

Sign in / Sign up

Export Citation Format

Share Document