Effect of Mitral Regurgitation on Systemic Coagulation Activity in Rheumatic Heart Disease as Assessed by D-dimer Levels

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.

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Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽

10.1542/peds.70.3.506 ◽

1982 ◽

Vol 70 (3) ◽

pp. 506-507

Author(s):

Bernard Boxerbaum

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Secondary Prophylaxis ◽

Benzathine Penicillin ◽

Childrens Hospital ◽

Rheumatic Heart

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

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Anaesthetic Management Of A Patient With Giant Cell Tumour Of Mandible With Rheumatic Heart Disease With Mitral Regurgitation With Epilepsy For Excision

The Internet Journal of Anesthesiology ◽

10.5580/7a4 ◽

2009 ◽

Vol 20 (2) ◽

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Giant Cell ◽

Rheumatic Heart Disease ◽

Giant Cell Tumour ◽

Anaesthetic Management ◽

Cell Tumour ◽

Rheumatic Heart

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A Case Presentation on Rheumatic Heart Disease with Mitral Regurgitation

Journal of Health and Allied Sciences NU ◽

10.1055/s-0039-1692033 ◽

2019 ◽

Vol 09 (01) ◽

pp. 28-30

Author(s):

Jayasudha A. ◽

Sreerenjini B. ◽

Kaveri P. ◽

Anitha P.

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Heart Disease ◽

Heart Valves ◽

Multidisciplinary Approach ◽

Well Being ◽

Case Presentation ◽

The Right ◽

Rheumatic Heart ◽

Increased Pressure

AbstractDuring any pregnancy there is an increase in blood volume of 30 to 50% resulting in increased pressure on the heart valves. For women with rheumatic heart disease this increased pressure presents increased maternal and/or fetal risks. Counseling of women with rheumatic heart disease gives appropriate surveillance of maternal and fetal well-being, as well as planning and documentation of the management of elective and emergency delivery. The care of pregnant women with rheumatic heart disease thus requires a multidisciplinary approach, involving obstetricians, cardiologists, and anesthetists. However, many women with rheumatic heart disease have healthy pregnancies and healthy babies with the right medical care.

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Rheumatic heart disease and endomyocardial fibrosis: Distinguishing the etiology of mitral regurgitation in low-resourced areas

SA Heart ◽

10.24170/14-1-1866 ◽

2017 ◽

Vol 14 (1) ◽

Author(s):

Ana Olga Mocumbi ◽

Geoffrey Madeira ◽

Andrea Beaton

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Heart Disease ◽

Endomyocardial Fibrosis ◽

Rheumatic Heart

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Effect of anaemia on the diagnosis of rheumatic heart disease using World Heart Federation criteria

Cardiology in the Young ◽

10.1017/s1047951119000404 ◽

2019 ◽

Vol 29 (7) ◽

pp. 862-868

Author(s):

Jennifer H. Klein ◽

Andrea Beaton ◽

Alison Tompsett ◽

Justin Wiggs ◽

Craig Sable

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Heart Disease ◽

Inclusion Criteria ◽

Normal Children ◽

Convenience Sample ◽

Future Studies ◽

Gender And Age ◽

Study Inclusion ◽

Rheumatic Heart

AbstractBackground:There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.Objective:To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.Method/Design:A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.Results:Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).Conclusion:Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.

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