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

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.

Download Full-text

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

Nepalese Heart Journal ◽

10.3126/njh.v15i1.19713 ◽

2018 ◽

Vol 15 (1) ◽

pp. 29-33 ◽

Cited By ~ 1

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

Download Full-text

Association of IL-4 (intron 3) and IL-10 (-1082) gene polymorphisms with risk of mitral valve disease in children with rheumatic heart disease

Cardiology in the Young ◽

10.1017/s1047951115002413 ◽

2015 ◽

Vol 26 (7) ◽

pp. 1290-1296 ◽

Cited By ~ 3

Author(s):

Sherif M. Yousry ◽

Yasser Sedky ◽

Alaa Sobieh

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Rheumatic Heart Disease ◽

Mitral Valve Disease ◽

Gene Polymorphisms ◽

Cardiac Tissue ◽

Valve Disease ◽

Egyptian Children ◽

Significant Difference ◽

Rheumatic Heart

AbstractAimRheumatic heart disease is an inflammatory disease of cardiac tissue. The underlying pathogenic mechanisms highlight a complex interplay of immunological, genetic, and environmental factors. The aim of the present study was to investigate whether IL-4 (intron 3) and IL-10 (-1082) gene polymorphisms could be associated with susceptibility and/or severity of rheumatic heart disease among patients from the Egyptian population.Materials and methodsA cohort of 140 Egyptian children with rheumatic heart disease and 100 healthy controls were enrolled in this case–control study. Genotyping for IL-4 (intron 3) and IL-10 (-1082) gene polymorphisms was carried out for all patients using a polymerase chain reaction-based analysis.ResultsNo significant difference in the distribution of genotypes and allelic frequencies between rheumatic heart disease cases and controls for IL-4 (intron 3) (p=0.17; OR 1.07, 95% CI 0.82–3.74) and IL-10 (-1082) (p=0.49; OR 1.03, 95% CI 0.65–2.71) gene polymorphisms was observed. Further categorisation of patients into mitral valve disease and combined valve disease subgroups showed that cases with mitral valve disease have significantly higher frequency of the RP2 allele of IL-4 (intron 3) (p=0.03; OR 2.98, 95% CI 1.93–6.15) and the G allele of IL-10 (-1082) (p=0.04; OR 2.14, 95% CI 1.62–4.95) when compared with controls.DiscussionOur study shows that IL-4 (intron 3) and IL-10 (-1082) gene polymorphisms are not significantly associated with susceptibility to rheumatic heart disease, but they might play a role in the pathogenesis of patients with mitral valve disease.

Download Full-text

Contemporary Pattern of Pediatric Infective Endocarditis from Tertiary Care Centre of Northern India: A Single Centre Experience

Journal of Child Science ◽

10.1055/s-0041-1735881 ◽

2021 ◽

Vol 11 (01) ◽

pp. e250-e254

Author(s):

Dinesh Kumar ◽

Shikha Garg ◽

Dheeraj D. Bhatt

Keyword(s):

Heart Disease ◽

Infective Endocarditis ◽

Rheumatic Heart Disease ◽

Tertiary Care ◽

North India ◽

Normal Heart ◽

Tertiary Care Centre ◽

Duke Criteria ◽

Culture Negative ◽

Rheumatic Heart

AbstractWith an increasing number of children with congenital heart disease (CHD) undergoing corrective treatments, improved pediatric intensive care, better antimicrobial treatments, and a relative decrease in rheumatic heart disease over the years, the epidemiology of pediatric infective endocarditis in India may be undergoing a change. The study was done in the department of pediatrics of a tertiary care teaching hospital of North India. A retrospective analysis of case records of children (<12 years) admitted with a diagnosis of infective endocarditis (IE) from January 2013 to April 2019 was performed. Modified Duke's criteria were used to diagnose IE. There were 21 children diagnosed with infective endocarditis during this period. The mean age at presentation was 70 months (range: 2.5–144 months). CHD (n = 13/21, 61.9%) was the most common predisposing condition. A total of 28% (6/21) patients had no preexisting structural heart disease. Nine percent (2/21) had rheumatic heart disease. Staphylococcus aureus was the most common etiological agent in those with a structurally normal heart. Most patients had blood culture–negative infective endocarditis (n = 12, 57.1%). Only one patient fulfilled Duke's major microbiological criteria. Six patients (28.57%) died during the hospital stay. Increasingly younger children are being diagnosed with infective endocarditis in India and a significant number of them are in the setting of a structurally normal heart. In view of high percentage of culture-negative endocarditis, the Duke criteria may need to be revised to retain their sensitivity in such settings.

Download Full-text

A study of pregnancy outcome in patients with cardiac disease

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184977 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5111

Author(s):

Pradnya D. Kamble ◽

Amarjeet Kaur Bava

Keyword(s):

Heart Disease ◽

Cardiac Disease ◽

Tertiary Care ◽

Cardiac Complications ◽

Care Centre ◽

Tertiary Care Centre ◽

Mortality And Morbidity ◽

Lower Segment Caesarean Section ◽

Maternal Mortality And Morbidity ◽

Rheumatic Heart

Background: Cardiac disease is a leading cause of maternal mortality and morbidity. Timely diagnosis and appropriate management can significantly improve the maternal and perinatal outcome.Methods: This prospective observational study was performed over a period of 18 months at a tertiary care centre in Mumbai. A total of 100 women with heart disease were included in the study. The subjects were followed up during the antenatal, intrapartum and postpartum period to study the maternal and perinatal outcome.Results: Out of 14791 confinements 100 consenting patients were included in the study. The incidence of heart disease came out to 0.9%. Rheumatic heart disease (RHD) was seen more commonly as compared to congenital heart disease (CHD) and peripartum cardiomyopathy. 64% patients delivered vaginally out of which 8% had instrumental delivery and 28% underwent a lower segment caesarean section (LSCS). 21% patients had cardiac complications like pulmonary edema, arrhythmias, sepsis, DIC etc. and there were 3 maternal mortalities. 58% of the babies were born low birth weight, 90.9% of the babies had an Apgar score of >7. 60% of the babies were born at term whereas 26% had a preterm delivery.Conclusions: Patients of cardiac disease with pregnancy need to be managed at a tertiary care centre by a multidisciplinary team of doctors. Early diagnosis of heart disease and stringent management of complication is of utmost importance. Vaginal delivery is favourable and LSCS should be performed for an obstetric indication. Maternal heart disease leads to an increased incidence of preterm delivery and hence a joint care of neonatologist is mandatory in managing these patients.

Download Full-text

Pattern of Heart Valve Involvement in Rheumatic Heart Disease

Nepalese Heart Journal ◽

10.3126/njh.v6i1.18449 ◽

2017 ◽

Vol 6 (1) ◽

pp. 17-22

Author(s):

Rajendra Koju ◽

R Gurung ◽

P Pant ◽

B Pokharel ◽

TRS Bedi

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Aortic Stenosis ◽

Rheumatic Heart Disease ◽

Mitral Stenosis ◽

Acute Rheumatic Fever ◽

Severe Aortic Stenosis ◽

Therapeutic Options ◽

Study Population ◽

Rheumatic Heart

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.

Download Full-text