Echocardiographic screening of pregnant women by non-physicians with remote interpretation in primary care

2020 ◽  
Author(s):  
Bruno R Nascimento ◽  
Craig Sable ◽  
Maria Carmo P Nunes ◽  
Kaciane K B Oliveira ◽  
Juliane Franco ◽  
...  
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pregnant Women ◽  
Rheumatic Heart Disease ◽  
Morphological Changes ◽  
Severe Disease ◽  
Left Ventricular ◽  
Rheumatic Heart

Abstract Background Impact of heart disease (HD) on pregnancy is significant. Objective We aimed to evaluate the feasibility of integrating screening echocardiography (echo) into the Brazilian prenatal primary care to assess HD prevalence. Methods Over 13 months, 20 healthcare workers acquired simplified echo protocols, utilizing hand-held machines (GE-VSCAN), in 22 primary care centres. Consecutive pregnant women unaware of HD underwent focused echo, remotely interpreted in USA and Brazil. Major HD was defined as structural valve abnormalities, more than mild valve dysfunction, ventricular systolic dysfunction/hypertrophy, or other major abnormalities. Screen-positive women were referred for standard echo. Results At total, 1 112 women underwent screening. Mean age was 27 ± 8 years, mean gestational age 22 ± 9 weeks. Major HD was found in 100 (9.0%) patients. More than mild mitral regurgitation was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular dysfunction in 4 (0.4%), left ventricular hypertrophy in 2 (0.2%) and suspected rheumatic heart disease in 36 (3.2%): all, with mitral valve and two with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%): RHD findings in 12 patients (all with mitral valve and two with AV disease), mitral regurgitation in 40 (14 with morphological changes, 10 suggestive of rheumatic heart disease), other AV disease in two (mild/moderate regurgitation). Conclusions Integration of echo screening into primary prenatal care is feasible in Brazil. However, the low prevalence of severe disease urges further investigations about the effectiveness of the strategy.

scholarly journals Strain patterns in primary mitral regurgitation due to rheumatic heart disease and mitral valve prolapse

2020 ◽  
Author(s):  
Gopalan Nair Rajesh ◽  
S.G. Shyam Lakshman ◽  
Haridasdan Vellani ◽  
Chakanalil Govindan Sajeev ◽  
Boban Thomas
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Rheumatic Heart Disease ◽  
Mitral Valve Prolapse ◽  
Primary Mitral Regurgitation ◽  
Rheumatic Heart

scholarly journals Pattern of rheumatic heart disease in patients admitted at tertiary care centre of Nepal

2018 ◽  
Vol 15 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Prabha Chapagain Koirala ◽  
Ram Kishor Sah ◽  
Deewakar Sharma
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Rheumatic Heart Disease ◽  
Tertiary Care ◽  
Female Ratio ◽  
National Heart ◽  
Number Of Patients ◽  
Rheumatic Heart

Background and Aims: As in other developing countries, Rheumatic Heart Disease (RHD) remains a major public health problem in Nepal. The most commonly affected people are children and adults in their productive years of age. The major contributing factors for high prevalence of Rheumatic Heart Disease in developing countries are poverty, illiteracy and limited access to healthcare services. The study was done to assess the basic pattern of Rheumatic Heart Disease among patients admitted at tertiary care center of Nepal: Shahid Gangalal National Heart Center.Methods: It is a cross sectional prospective study done among the patients admitted in Shahid Gangalal National Heart Center, Kathmandu.Results: RHD was more common among patients of age group 10-40 years, the most common age being 31-40 years (28.5%), with the male female ratio 1:1.6. Majority of the admitted patients had come from Central Development Region, and least number of patients had come from Far Western Region. About 46.5% of patients were illiterate and majority of patients were without any income source. Mitral valve was the most commonly affected valve (98.2%) and mitral regurgitation was the most common valvular lesion.Conclusion: RHD mainly affects children and young people of low socioeconomic group. In our study, mitral valve was the most commonly affected valve and mitral regurgitation was the most common valvular lesion. Mitral Stenosis was  statistically significant in female patients while aortic regurgitation as well as aortic stenosis were significant in male patients.Nepalese Heart Journal 2018; 15(1): 29-33

P3134Variations in anterior mitral valve leaflet restriction that may lead to the erroneous diagnosis of rheumatic heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L D Hunter ◽  
M J Monaghan ◽  
G Lloyd ◽  
H W Snyman ◽  
A J K Pecoraro ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
South African ◽  
Rheumatic Heart Disease ◽  
Screening Program ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Rheumatic Heart

Abstract Introduction Anterior mitral valve leaflet (AMVL) restriction is a prominent morphological feature of rheumatic heart disease (RHD). The World Heart Federation (WHF) criteria for echocardiographic diagnosis of RHD rely on the use of colloquial terms such as “dog-leg” to define AMVL restriction rather than a strict, reproducible definition. We recognise AMVL restriction when the tip of the leaflet is seen to point away from the interventricular septum and towards the posterior left ventricular (LV) wall at peak diastole in the parasternal long axis (PSLAX) view. This definition however risks inclusion of a finding commonly identified in our high-risk screening program (Echo in Africa- EIA) which demonstrates gradual AMVL bowing (so-called “slow-bow”) from the proximal to mid-leaflet but with free motion ('fluttering') of the tip during diastole. This is in contrast to RHD-related restriction which typically involves the distal AMVL tip only. We propose that the former is a normal variant of the AMVL and is unrelated to the RHD process, provided no concomitant morphological features of RHD are identified. Purpose Determine the prevalence of “slow-bow” AMVL restriction between two cohorts of schoolchildren with a documented high-and low-RHD prevalence. Methods Retrospective analysis of EIA data obtained from children (aged 13–18) attending two separate South African schools. The high-RHD prevalence school (HR) demonstrated a 0.8% rate of WHF “definite RHD”. The low-RHD prevalence school (LR) demonstrated no cases of WHF “definite RHD”. Cases of AMVL restriction were identified and classified according to the definitions provided above. Results A total of 941 screening studies (HR cohort n=577 /LR cohort n=364) were evaluated. 74 cases of AMVL restriction (12.82%, 95%, CI 10.34–15.80) were identified in the HR cohort of which 8 cases demonstrated AMVL-tip restriction (1.39%, 95%, CI 0.70–2.71) and 65 cases demonstrated “slow bow” (11.27%, 95%, CI 8.94–14.11). There were no cases of AMVL-tip restriction observed in the LR-cohort and 35 cases of “slow-bow”(9.62%, 95%, CI 7–13.08). A. “Slow bow”; B. “Distal tip restriction”. Conclusion Our results support the hypothesis that “slow-bow” AMVL restriction is a common variant of the AMVL amongst South African school children and unrelated to the RHD process. Further research is required to investigate the exact mechanism underlying this form of AMVL restriction. Acknowledgement/Funding Edwards Lifescience EHM grant

INTRAESOPHAGEAL PHONOCARDIOGRAPHY IN THE DIAGNOSIS OF OCCULT RHEUMATIC MITRAL VALVE DISEASE

PEDIATRICS ◽  
1966 ◽  
Vol 38 (5) ◽  
pp. 892-896
Author(s):  
Choompol Vongprateep ◽  
Ronald M. Lauer ◽  
Antoni M. Diehl
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Rheumatic Heart Disease ◽  
Mitral Valve Disease ◽  
Clinical Findings ◽  
Normal Individuals ◽  
Mitral Disease ◽  
Rheumatic Patients ◽  
Rheumatic Heart

Twenty-nine rheumatic subjects and 16 normal individuals have been studied by intraesophageal phonocardiography. In the normal group no unusual sounds or murmurs were discovered by this technique. However, in rheumatic patients with clinical mitral regurgitation the esophageal phonocardiogram more clearly recorded the murmur than the surface phonocardiogram. In five patients murmurs of mitral disease were recorded by the intraesophageal technique that were not discernible by clinical examination or surface phonocardiography. Intraesophageal phonocardiography is particularly valuable in clinical situations wherein rheumatic heart disease is suspected and the typical clinical findings of mitral regurgitation are absent or equivocal.

The polymorphism at the microRNA-155 binding site in AGTR1 gene is not significantly associated with rheumatic heart disease in Saudi Arabia population

MicroRNA ◽  
2020 ◽  
Vol 09 ◽  
Author(s):  
S. Justin Carlus ◽  
Fiona Hannah Carlus ◽  
Mazen Khalid Al-Harbi ◽  
Abdulhadi H Al-Mazroea ◽  
Khalid M Al- Harbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Clinical Features ◽  
Left Ventricular ◽  
Genotype Distribution ◽  
Allelic Discrimination ◽  
Children And Young Adults ◽  
And Control ◽  
Rheumatic Heart

Background: Rheumatic heart disease (RHD) remains a major cause of cardiovascular diseases and the most devastating effects are on children and young adults. RHD is caused due to the interaction between microbial, environmental, immunologic, and genetic factors. The renin-angiotensin aldosterone system (RAAS) has been strongly implicated as the susceptibility pathway in the pathogenesis of cardiovascular disease. Objective: The present study investigated the modulating effect of Angiotensin II type 1 receptor (AGTR1) 1166A>C polymorphism on the RHD and its clinical features in Saudi Arabia. Methods: AGTR1 1166A>C polymorphism was genotyped in 96 echocardiographically confirmed RHD patients and 142 ethnically matched controls by TaqMan allelic discrimination method. Results: Genotype distribution of the AGTR1 1166A>C polymorphism was not significantly different between RHD and control groups. Further, AGTR1 1166A>C genotypes are not associated with the clinical features of RHD. These data support that there was no evidence for an association between AGTR1 1166A>C polymorphism and RHD in Saudi Arabia. Conclusion: To our knowledge, this is the first study that has investigated the possible association between AGTR1 1166A>C polymorphism and susceptibility to RHD and its clinical features. Even though AGTR1 gene is 1166A>C (rs5186) was reported to be associated with hypertension, left ventricular hypertrophy and coronary heart disease. Present study did not find any association between AGTR1 1166A>C polymorphism and RHD in Saudi Arabia. Further studies are needed to confirm our findings.

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
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