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

Screening for rheumatic heart disease: The reliability of anterior mitral valve leaflet thickness measurement

2020 ◽  
Vol 37 (6) ◽  
pp. 808-814
Author(s):  
Luke D. Hunter ◽  
Carl J. Lombard ◽  
Mark J. Monaghan ◽  
Guy W. Lloyd ◽  
Brandon M. Franckeiss ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Thickness Measurement ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Rheumatic Heart

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

scholarly journals Screening for subclinical rheumatic heart disease: Addressing borderline disease in a real-world setting

2021 ◽  
Author(s):  
L D Hunter ◽  
A J K Pecoraro ◽  
A F Doubell ◽  
M J Monaghan ◽  
G W Lloyd ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Real World ◽  
Large Scale ◽  
Western Cape ◽  
Mitral Valve Leaflet ◽  
Screening Programs ◽  
Systematic Identification ◽  
Rheumatic Heart

Abstract Introduction The World Heart Federation (WHF) criteria identify a large borderline rheumatic heart disease (RHD) category that has hampered the implementation of population-based screening. Inter-scallop separations (ISS) of the posterior mitral valve leaflet (PMVL), a recently described normal variant of the mitral valve, appears to be an important cause of mild mitral regurgitation (MR) leading to misclassification of cases as WHF ‘borderline RHD’. This study aims to report the findings of the Echo in Africa project (EIA), a large-scale RHD screening project in South Africa and determine what proportion of borderline cases would be re-classified as normal if there were a systematic identification of ISS-related MR. Methods A prospective cross-sectional study of underserved secondary schools in the Western Cape was conducted. Participants underwent a screening study with a handheld (HH) ultrasound device. Children with an abnormal HH study were re-evaluated with a portable laptop echocardiography machine. A mechanistic evaluation was applied in cases with isolated WHF ‘pathological’ MR (WHF ‘borderline RHD’). Results 5255 participants (mean age 15± years) were screened. 3439 (65.8%) were female. 49 cases of WHF ‘definite RHD’ (9.1 cases/1000 [95% CI, 6.8-12.1 cases/1000]) and 104 cases of WHF ‘borderline RHD’ (19.5 cases/1000[95% CI,16.0-23.7 cases/1000]) were identified. ISS-related MR was the underlying mechanism of MR in 48/68 cases classified as WHF ‘borderline RHD’ with isolated WHF ‘pathological’ MR (70.5%). Conclusion In a real-world, large-scale screening project, the adoption of a mechanistic evaluation based on the systematic identification of ISS-related MR markedly reduced the number of WHF ‘screen-positive’ cases misclassified as WHF ‘borderline RHD’. Implementing strategies that reduce this misclassification could reduce the cost- and labour-burden on large scale RHD screening programs.

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

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.

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