scholarly journals Randomised controlled trial into the role of ramipril in fibrosis reduction in rheumatic heart disease: the RamiRHeD trial protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048016
Author(s):  
Ade Meidian Ambari ◽  
Budhi Setianto ◽  
Anwar Santoso ◽  
Basuni Radi ◽  
Bambang Dwiputra ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Chronic Inflammation ◽  
Rheumatic Heart Disease ◽  
Transforming Growth Factor ◽  
Controlled Trial ◽  
Mitral Valve Stenosis ◽  
Valve Tissue ◽  
Cardiovascular Morbidity And Mortality ◽  
Rheumatic Heart

IntroductionRheumatic heart disease (RHD) is a major burden in developing countries and accounts for 80% of all people living with the disease, where it causes most cardiovascular morbidity and mortality in children and young adults. Chronic inflammation and fibrosis of heart valve tissue due to chronic inflammation in RHD will cause calcification and thickening of the impacted heart valves, especially the mitral valve. This fibrogenesis is enhanced by the production of angiotensin II by increased transforming growth factor β expression and later by the binding of interleukin-33, which is known to have antihypertrophic and antifibrotic effects, to soluble sST2. sST2 binding to this non-natural ligand worsens fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would improve rheumatic mitral valve stenosis.Methods and analysisThis is a single-centre, double-blind, placebo-controlled, randomised clinical trial with a pre–post test design. Patients with rheumatic mitral stenosis and valve dysfunction will be planned for cardiac valve replacement operation and will be given ramipril 5 mg or placebo for a minimum of 12 weeks before the surgery. The expression of ST2 in the mitral valve is considered to be representative of cardiac fibrosis. Mitral valve tissue will be stained by immunohistochemistry to ST2. Plasma ST2 will be measured by ELISA. This study is conducted in the Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiac Center Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019.Ethics and disseminationThe performance and dissemination of this study were approved by the ethics committee of National Cardiovascular Center Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018.Trial registration numberNCT03991910.

scholarly journals PERUBAHAN MORFOLOGI KATUP MITRAL PADA DEMAM REMATIK AKUT DAN PENYAKIT JANTUNG REMATIK

2020 ◽  
Vol 5 (2) ◽  
pp. 455
Author(s):  
Dede Jumatri Tito ◽  
Mefri Yanni
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Cardiac Involvement ◽  
Mitral Valve Stenosis ◽  
Chordae Tendineae ◽  
Industrial Countries ◽  
Heart Damage ◽  
Rheumatic Heart

<p><em>Rheumatic fever and rheumatic heart disease remains a significant cause of cardiovascular disease in the world, especially in industrial countries and developing countries. Rheumatic heart disease is the most serious complication of rheumatic fever which is characterized by the occurrence of heart valve defects are most of the mitral valve, aortic and tricuspid followed. Valvulitis or inflammatory process in the tissue of the mitral valve causing edema of the valve leaflets and chordae tendineae, causing disruption valve closure is causing mitral regurgitation. Eventually fibrosis and calcification of the valve that causes stiffness and the valve leaflets into mitral valve stenosis. The earliest possible introduction of cardiac involvement in rheumatic heart disease is an important part in the prevention of further heart damage. </em></p>

scholarly journals P1363 Risk factors of severe tricuspid regurgitation after left-sided valve surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Horita ◽  
K Mahara ◽  
Y Izumi ◽  
M Terada ◽  
K Kishiki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Mitral Valve Stenosis ◽  
Tricuspid Valve Repair ◽  
Icd Implantation ◽  
Rheumatic Heart

Abstract Background Tricuspid regurgitation (TR) sometimes deteriorate late after left-sided valve surgery. The recent guidelines recommend tricuspid valve repair at the same time as the left-sided valve surgery. However, little is known about the pathophysiology that leads to severe TR after left-sided valve surgery. Purpose To clarify the risk factors of the patients with severe TR after left-sided valve surgery. Methods We retrospectively investigated consecutive 526 patients diagnosed as severe TR from January 2004 to December 2018 at our hospital. Clinical background, echocardiographic parameters were evaluated. Demographic information and clinical data (including age, electrocardiograms, type of left-sided valve surgery, underlying valve diseases and history of pacemaker or ICD implantation) were obtained by chart review. Results Of the 526 patients with severe TR, 107 patients were after a left-sided valve surgery. Patients developed severe TR at a mean of 14.8 ± 8 years after surgery.The surgical indications were as follows: mitral valve stenosis (74 patients, 69%), mitral valve regurgitation (43 patients, 40%), aortic valve stenosis (37 patients, 35%) and aortic regurgitation (28 patients, 26%), respectively. The mean age at diagnosis of severe TR was 74 ± 10 years and 75 were female (70%). Among those patients, 32 patients (30%) had a tricuspid annuloplasty (TAP) with the first left-sided valve surgery. Ninety-five patients (88%) had atrial fibrillation (AF), 75 patients (70%) were diagnosed as rheumatic heart disease, 64 patients (60%) had pulmonary artery hypertension (PH) and 28 patients (26%) had a permanent pacemaker or ICD implantation. There were only 12 patients who had severe TR without AF. Eight of 12 patients without AF had PH, and permanent pacemakers were implanted in remaining 4 patients. Conclusions Almost all patients with severe TR after left-sided valve surgery present with AF and prevalence of rheumatic heart disease were about 70 percent. These two factors may be one of the important risk factors for severe TR after left-sided valve surgery.

scholarly journals Controlled Trial of Sulfinpyrazone in Rheumatic Heart Disease. Preliminary Results

1977 ◽  
Author(s):  
Peter Steele ◽  
Joseph Rainwater ◽  
Edward Genton
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Survival Time ◽  
Rheumatic Heart Disease ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Controlled Trial ◽  
Preliminary Results ◽  
History Of ◽  
Rheumatic Heart

Platelet survival time (SURV) has correlated with a history of thromboembolism (TE) in patients with rheumatic heart disease (RHD). A controlled trial of sulfinpyrazone (SFP) in RHD is in progress and 138 patients have been entered. SURV (51Chromium labelling) was shortened (2.3 ± 0.08 days; AVE t 1/2 ± SEM; normal 3.7 ± 0.04 days) in 40 of 41 (98%) with a history of TE and in 76 of 97 (78%) (2.9 ± 0.07 days; P<0.001) of those without a history of TE. One hundred sixteen with shortened SURV have been randomized to SFP or placebo and 67 have either completed four years (N=37), undergone mitral valve replacement (N=18) (ave 19 months; range 6-32 months), had definite TE (N=8) (average 14 months; range 8-23 months) or died (N=4) (average 15 months; range 5-22 months). Definite TE (prolonged neurologic deficit) occurred in one on SFP and in seven on placebo (all with shortened SURV) (X2 = 4.31; NS). SFP increased SURV (2.4 ± 0.12 to 2.7 ± 0.13 days; N=23; P<0.001) and 12 (52%) had an increase in SURV of >0.02 days. The patient on SFP with new TE had no change in SURV (2.3 to 2.3 days). Placebo did not alter SURV (2.4 ± 0.15 to 2.5 ± 0.08 days; N=26; NS) and two (8%) had an alteration of SURV by > 0.02 days. SURV was not altered in patients with normal SURV (3.7 ± 0.08 to 3.6 ± 0.08 days; N=12; NS) and no patient with normal SURV has had shortened SURV on subsequent yearly measurement. Patients with normal SURV were not randomized. Results suggest that SURV is shortened in patients with RHD who have had or will have TE, that SFP increases SURV and may prevent TE in these patients.

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

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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