Pattern of Heart Valve Involvement in Rheumatic Heart Disease

Rheumatic heart disease is the most important consequence of acute rheumatic fever. Both are common cardiovascular problems in Nepal. Echocardiographic detection of rheumatic heart disease is important to establish the diagnosis. The involvement of valves and their severity guides the therapeutic options. A total of 133 valvular heart disease cases attended in Dhulikhel Hospital between July 2008 to June 2009 were analyzed. Fifty-one patients, in whom the problems were rheumatic in origin were studied. Among them, 12% (6) had isolated aortic valve involvement, 35%(18) had isolated mitral valve and 53%(27) ahd mixed involvement. Severe mitral stenosis accounts for 24% of all mitral stenosis and severe aortic stenosis is 20% fo all aortic stenosis. The rates for severe mitral regurgitation and severe aortic regurgitaiton are 30% and 28% respectively. Although the study population has a high number of female patients, the differences in the rates of involvement of aortic or mitral valve in both genders are statistically insignificant. The study, although small, confirms that in this population, females are more commonly affected, that the mitral valve is the most commonly damaged valve and that disease affecting multiple valves is marginally more common than isolated valve disease. The detection of valvular involvement at different stages can guide the therapeutic options.

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Valvular heart disease

10.1093/med/9780199643219.003.0003 ◽

2012 ◽

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Rheumatic Fever ◽

Aortic Regurgitation ◽

Valvular Heart Disease ◽

Mitral Valve Prolapse ◽

Mitral Stenosis ◽

Acute Rheumatic Fever

General considerations 144Acute rheumatic fever 146Mitral stenosis: clinical features 150Mitral stenosis: investigations 152Mitral stenosis guidelines 156Mitral regurgitation 158Mitral regurgitation guidelines 161Mitral valve prolapse 162Aortic stenosis 164Management of aortic stenosis 168Aortic regurgitation 170Aortic regurgitation guidelines ...

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Prevalence and Involvement of Different Valves in Rheumatic Heart Disease- An Observational Echocardiographic Study in a Tertiary Care Centre, Bengaluru, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/50182.15288 ◽

2021 ◽

Author(s):

S Lalitha ◽

Vijay Sai ◽

Prajith Pasam ◽

V Bhargavi

Keyword(s):

Developing Countries ◽

Heart Disease ◽

Mitral Valve ◽

Rheumatic Heart Disease ◽

Tertiary Care ◽

Valve Disease ◽

Care Centre ◽

Tertiary Care Centre ◽

Study Population ◽

Rheumatic Heart

Introduction: Rheumatic Heart Disease (RHD) is a non suppurative sequelae of group A beta haemolytic streptococci, resulting from inadequately treated streptococcal sore throat or scarlet fever and leading to valvular heart disease. Rheumatic heart disease is a major cause of morbidity and mortality in younger population in developing countries. The present study was done at a tertiary care medical college hospital with the objective of establishing prevalence and involvement of different valve patterns by Echocardiography (ECHO). Aim: To analyse the valvular pattern of RHD over a period of four years in a tertiary care centre and highlight the importance of ECHO in the definitive diagnosis of RHD, and to know the continuing burden of RHD. Materials and Methods: This was a hospital based retrospective observational study conducted at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. A total of 518 cases of RHD were selected as a study population among the ECHO performed between January 2016 and January 2020 after an exclusion criterion of degenerative mitral and aortic valve disease, congenital aortic and mitral valve disease, myxomatous mitral valve disease, trivial and functional regurgitation. Analysis of valvular pattern was performed. Data analysis was done by tables, charts, percentages and ratio. Results: A total of 518 patients were diagnosed to have RHD by 2-Dimensional ECHO. Among them 276 (53%) were females and 242 (47%) were males. The average age was 41.9 years. The most common valve involved independently and in combined lesions was the mitral valve. Of the study population, 446 patients had Mitral Stenosis (MS) and 393 had Mitral Regurgitation (MR). Aortic Stenosis (AS) was found among 111 patients and 304 patients had Aortic Regurgitation (AR). Tricuspid Stenosis (TS) (organic) was found in seven cases. Multiple valves were involved in 204 cases. Among them 104 of the cases had MS, MR and AR, 69 cases had MS, MR, AS and AR, 21 cases had MS, AS and AR, seven cases had MR, AS and AR and three cases had MS, AS, AR and TS. Though aortic valve was involved in multi valvular lesions, significant AR (moderate and severe) was seen in 109 patients and significant AS (moderate and severe) was seen in 67 patients. Conclusion: RHD continues to be a major burden to population in developing countries. In the present study, various patterns of valvular involvement were noted. Drastic measures are to be taken primary and secondary prevention of RHD.

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Abstract 14578: Transcatheter Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis in Rheumatic Heart Disease: Analysis of the National Inpatient Sample Database (2012-2017)

Circulation ◽

10.1161/circ.142.suppl_3.14578 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jelani Grant ◽

Bertrand Ebner ◽

Jennifer Maning ◽

Louis Vincent ◽

Amanda Fernandes ◽

...

Keyword(s):

Heart Disease ◽

Length Of Stay ◽

Aortic Stenosis ◽

Hospital Mortality ◽

Rheumatic Heart Disease ◽

Severe Aortic Stenosis ◽

Hospital Length Of Stay ◽

Paravalvular Leak ◽

Baseline Characteristics ◽

Rheumatic Heart

Introduction: TAVR is widely accepted for the management of symptomatic severe aortic stenosis (AS), but its use in rheumatic heart disease has been limited. We sought to investigate the in-hospital outcomes of patients undergoing TAVR for symptomatic severe rheumatic AS. Methods: This is a retrospective NIS Database search from 2012 to 2017 to identify patients with ICD-9 and10 procedure codes for TAVR and for rheumatic AS. We compared baseline characteristics, procedure characteristics, in-hospital mortality and length of hospitalization based on the presence or absence of rheumatic AS. Results: From a total of 32,273 patients who underwent TAVR, the incidence of non-rheumatic severe AS was 6.54%. Baseline characteristics are displayed in Table 1. All-cause mortality was similar between both groups (2.3% vs. 2.4%, p=0.780) but length of stay (days) was significantly higher in the rheumatic AS group (6.1 ± 7 vs. 5.8 ± 6.4, p<0.001). Rates of Paravalvular Leak (1.1% vs. 0.7%, p<0.05) and post-procedure ischemic stroke (5.3 vs. 2.0%, p<0.001) were higher in patients with non-rheumatic AS. Using a multivariate logistic regression model, this cohort did not reveal increased odds of in hospital mortality based on the presence of severe rheumatic AS after adjusting for confounders (OR-0.97, 95% CI 0.69 to 1.37, p=0.867). Conclusions: This retrospective cohort demonstrated that TAVR may be feasible for rheumatic severe AS. Despite an older population than reported in the literature, mortality rates, complications and hospital length of stay was comparable to patients undergoing TAVR for calcific aortic disease. Further randomized studies are needed to support these findings.

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