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e Tricuspid Stenosis (AS [ Aortic Stenosis, MR [ Mitral Regurgitation, MS [ Mitral Stenosis, RA [ Right Atrial, TR [ Tricuspid Regurgitation, TS [ Tricuspid Stenosis).
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Background
Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and...
Context in source publication
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OBJECTIVES
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Citations
... Risk factors for degenerative calcific AS include advanced age, hypertension, hypercholesterolemia, diabetes mellitus, and smoking [6]. In patients with unrelieved aortic valve obstruction, the onset of symptoms predicts a poor outcome with medical therapy [7,8]. ...
... Around 33 million individuals suffer from rheumatic heart disease globally, accounting for 275,000 annual fatalities 1 The situation is even worse in underdeveloped countries, like Pakistan. 2 Mitral valve (MV) is the most frequent valve to be affected in rheumatic carditis, with mitral stenosis (MS) being the most frequent presentation. 2,3 Accurate diagnoses of MV stenosis and its severity are essential for treatment and prognosis assessment. The current gold standard for MS diagnosis and severity assessment is twodimensional (2D) Doppler echocardiography. ...
... Despite significant reduction in the developed world, rheumatic MS is still responsible for significant morbidity as well as premature mortality in the developing countries. 12 A meta-analysis from South Asia showed that Pakistan had the highest prevalence (8 per 1000) of rheumatic heart disease (RHS) with predominant MS. 2,3 Ascertaining MS severity is crucial for disease management and to determine prognosis. Echocardiography is the gold standard for MS evaluation. 4 The customary echochardiography parameter for measuring MVA are planimetry, PHT, proximal isovolumetric surface area(PISA) and continuity equation, with the first two being the more standardised and commonly used techniques. ...
Objective: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis. Method: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets. Pearson correlation coefficient was computed for mitral leaflet separation index and mitral valve area. Receiver operating characteristic curve was used to determine the cut-off value of the mitral leaflet separation indexto categorise mitral stenosis. Data was analysed using SPSS 19. Results: Of the 277 patients, 205(74%) were females and 72(26%) were males. The overall mean age was 39.93±11.22 years. The mean mitral leaflet separation index value was 7.65±2.23. The correlation was significant and strong between mitral leaflet separation index and mitral valve area on planimetry (p<0.001), and was significant and moderate when measured by pressure half-time (p< 0.001). Mitral leaflet separation index cut-off value <8.625mm and <8.25mmcould predict severe mitral stenosis with 84% and 86.3% sensitivity and 84.6% and 78.3% specificity on planimetry and pressure half-time, respectively. Conclusion: The mitral leaflet separation index was found to be an independent, reliable and simple measure for assessing mitral stenosis severity. Key Words: Echocardiography, Mitral stenosis, Mitral leaflet separation index, Pressure half-time, Planimetry.
... A notable sex disparity persists in mitral valve pathology, with females exhibiting a higher prevalence of RHD compared to males [31]. Among patients with RHD, mitral stenosis stands out as the most prevalent heart lesion [32], which is important because the higher mortality rate in females could also be explained by significantly more frequent involvement of the mitral valve in females versus in males, in whom aortic valve involvement is more frequent [33]. In general, the trajectory for CRHD mortality in both males and females headed in the same direction, which is downwards, although females displayed a steeper decline. ...
Background
Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities.
Materials and methods
This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period.
Results
The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33).
Conclusions
Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.
... Rheumatic heart disease mostly affects the young age group and therefore has significant impact on the overall productivity with significant economic burden to the society. 5 There are various tools to evaluate the RHD. Echocardiography has established itself as an easy, cost effective, non-invasive tool for the evaluation of presence and to grade the severity of the valvular involvement in RHD. ...
... . RC Kafle et al showed 63.4%.6 In a study done by CN Manjunath et al the multivalvular lesion in 60% of cases.5 The commonest combined lesion was MS+MR, followed by AR+MR followed by MS+AR. ...
BACKGROUND AND AIMS Rheumatic heart disease (RHD) is a preventable but chronic debilitating sequela to the acute rheumatic fever. It takes several years for manifestations, however can present early in places with high prevalence. Most common valve involved are mitral and aortic. Echocardiography is simple tool to diagnose the presence as well as quantify the valvular lesion. This study aims at identifying the pattern of valvular involvement in RHD in community heart center in western Nepal. METHODS This was a retrospective analysis of the patients presenting with Rheumatic heart disease over the period of two years from July 2020 to July 2022. RESULTS Altogether 563 echocardiograms with diagnosis of RHD were recorded over the period of two years. The mean age was 33.59±12 years. The commonest age group involved was 21-40years (56.66%). Overall, there was female preponderance over male, 77.4% vs 22.6%. Isolated MR was the commonest among the isolated lesion (64.44%). Multivalvular lesion was more common than isolated lesions 76.03% vs 23.97%. Isolated mitral stenosis (MS) and isolated mitral regurgitation (MR) was more common in female 82.1% and 758% respectively whereas isolated aortic regurgitation (AR) was more common in male (55%). Involvement was in the order of MS+MR>AR+MR>MS+AR>AS+AR>MS+AS>AS+MR in the cases of multivalvular lesion. Mean mitral valve area was .2±0.39 cm2. Among the MS, 65(19.69%) had mild, 145(43.93%) had moderate and 120(36.36%) had severe lesion and all were common in female and the age group 21-40years. Mild, moderate and severe MR was more common in female while severe AR was found only in male. Overall, 271(48.13%) had pulmonary hypertension and was more common in severe MS. CONCLUSION Valvular heart disease is common and the most common lesion is RHD in developing country like ours. This study shows that RHD is more common in female and middle age group. Multivalvular lesion is more common than the isolated lesions.
... [8] Mitral regurgitation will occur two decades earlier than mithan stenosis and become the most common valve lesion in children under 18 years old. [9] The global shift towards urbanization and changing economic activities has exposed more individuals to various cardiovascular risk factors, both traditional and non-traditional. Factors such as smoking, hypertension, obesity, diabetes, air pollution, and stress are strongly associated with VHD, particularly calcific aortic stenosis (AS). ...
Background: Valvular heart disease and pulmonary hypertension (PH) are two distinct but often interconnected cardiac conditions that can affect children and encompass abnormalities of the heart's valves such as the aortic, mitral, tricuspid, and pulmonary valves, and can present with symptoms such as chest pain, fatigue, and dyspnea. In contrast, PH refers to elevated blood pressure in the pulmonary arteries. Routine screening for these conditions is needed for prompt diagnosis and management. This study was conducted to obtain data on children with valvular heart disease or PH who participated in the Community Service Program of the Department of Cardiology and Vascular Disease, Universitas Sumatera Utara. Method: This study was a descriptive study conducted through a cross-sectional study design. Data was collected from interviews and on-the-spot examination with validated measurement tools. Data was analyzed using SPSS version 26. Categorical variables were presented using frequency (n) and percentage (%), and numerical variables with normally distributed data were presented with mean and standard deviation (SD). In non-normally distributed data, numerical variables were presented using the median and interquartile range. Results: There were 157 children included in this study. Most subjects were female (n=94, 59.9%) in the age range 12 to 16 years old. Most subjects (n=152, 96.8%) had normal mitral valves, three subjects had anterior mitral valve prolapse (1.9%), one subject (0.6%) had anterior mitral valve thickening and one subject (0.6%) had mild mitral regurgitation. 10 subjects (5.7%) had pulmonary regurgitation. Two subjects had tricuspid regurgitation (1.2%). No subjects had any aortic abnormalities. No subjects had a PH. Conclusion: In the children population in Rantau-Prapat City, most subjects with valve abnormalities had mitral and pulmonary valve abnormalities. No subjects had aortic valve abnormalities or PH.
... The finding was nearly comparable with the study conducted in Southwest Ethiopia, which was 32.8%. 12 However, the higher rate was reported from Bangalore, South India, 13 which was 60.2%, and Southwest Nigeria, 14 which was 67.7%. In addition, a lower rate of RHD was reported from several studies like North Ethiopia, 15 Southwest Cameroon, 16 and Rural Pakistan, 17 in which the rates were 11.8%, 6.7%, and 5.7%, respectively. ...
... In the United States, an estimated percentage of adults suffer from aortic valve problems, which include functional regurgitation. 1 Of the vast majority of those who suffer from rheumatic heart disease worldwide, the incidence of aortic valve is almost one-third of the total. 2,3 This type of disease, which involves the narrowing of the aorta and the insufficiency of the aorta, is usually related to atherosclerosis. Attempts to treat aortic valve disease have failed to achieve much in the field of medicine. ...
We examined whether small incision aortic root replacement could reduce the amount of blood transfusion during operation and the risk of postoperative complications. An extensive e‐review of the 4 main databases (PubMed, Cochrane, Web of Science and EMBASE) was carried out to determine all the published trials by July 2023. The search terms used were associated with partial versus full sternotomy and aortic root. This analysis only included the study articles that compared partial and full sternotomy. After excluding articles based on titles or abstracts, selected full‐text articles had reference lists searched for any potential further articles. We analysed a total of 2167 subjects from 10 comparable trials. The minimally invasive aortic root graft in breastbone decreased the duration of hospitalization (MD, −2.58; 95% CI, −3.15, −2.01, p < 0.0001) and intraoperative red blood cell transfusion (MD, −1.27; 95% CI, −2.34, −0.19, p = 0.02). However, there were no significant differences in wound infection (OR, 0.88; 95% CI, 0.16, 4.93, p = 0.88), re‐exploration for bleeding (OR, 0.96; 95% CI, 0.60, 1.53, p = 0.86), intraoperative blood loss (MD, −259.19; 95% CI, −615.11, 96.73, p = 0.15) and operative time (MD, −7.39; 95% CI, −19.10, 4.32, p = 0.22); the results showed that the microsternotomy did not differ significantly from that of the routine approach. Small sternotomy may be an effective and safe substitute for the treatment of the aorta root. Nevertheless, the wide variety of data indicates that larger, well‐designed studies are required to back up the current limited literature evidence showing a benefit in terms of complications like postoperative wound infections or the volume of intraoperative red blood cell transfusion.
... Although true isolated aortic valve disease is rare in RHD, approximately one third of RHD patients have aortic valve involvement in combination with mitral valve disease (13,50). In these patients, AR is much more common than AS. ...
Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent. Is it time to consider less invasive alternatives to conventional valve surgery? Several anatomical and pathological differences exist between degenerative and rheumatic valves, including percutaneous valve landing zones. These are poorly documented and may require dedicated solutions when considering percutaneous intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for severe mitral stenosis (MS) but is reserved for patients with suitable valve anatomy without significant mitral regurgitation (MR), the commonest lesion in RHD. Valvuloplasty also rarely offers a durable solution for patients with rheumatic aortic stenosis (AS) or aortic regurgitation (AR). MR and AR pose unique challenges to successful transcatheter valve implantation as landing zone calcification, so central in docking transcatheter aortic valves in degenerative AS, is often lacking. Surgery in young RHD patients requires mechanical prostheses for durability but morbidity and mortality from both thrombotic complications and bleeding on Warfarin remains excessively high. Also, redo surgery rates are high for progression of aortic valve disease in patients with prior mitral valve replacement (MVR). Transcatheter treatments may offer a solution to anticoagulation problems and address reoperation in patients with prior MVR or failing ventricles, but would have to be tailored to the rheumatic environment. The high prevalence of MR and AR, lack of calcification and other unique anatomical challenges remain. Improvements in tissue durability, the development of novel synthetic valve leaflet materials, dedicated delivery systems and docking stations or anchoring systems to securely land the transcatheter devices, would all require attention. We review the epidemiology of RHD and discuss anatomical differences between rheumatic valves and other pathologies with a view to transcatheter solutions. The shortcomings of current RHD management, including current transcatheter treatments, will be discussed and finally we look at future developments in the field.
... A previous prospective cohort research in Spain monitored participants with a median age of 30 years for one year and discovered a roughly 18% 1-year death rate, as well as very high rates of overall morbidity, with 35% having heart failure and 63.7% acquiring atrial fibrillation. Many studies are focused on short-term results and, especially on adults with RHD, while data on the outcomes that affect kids with RHD in endemic locations is scarce [WHO, 2001-Manjunath, C. N. et al., 2014. This paper aims to diagnosis and knowledge of the impact of rheumatic heart disease on Iraqi adults and adolescents. ...
Background: RHD presents as the major factor who acquired valvular heart disease for adults and adolescents. Almost of children with RHD they had got of complications of the disease. Aim: This paper aims to Diagnosis and gain knowledge of the impact of rheumatic heart disease on Iraqi adults and adolescents. Patients and method: This study was conducted in different hospitals in Iraq from 5 th July 2021-8 th October 2022 as a cross-sectional to diagnosis and knowledge of the impact of rheumatic heart disease on Iraqi adults and adolescents. This study was collected data from databases of 50 cases with RHD for children who Over 11 years old. This study was analysed and designed databases outcomes by the SPSS program. Results and discussion: Mitral valve involvement was found to be the most prevalent in both children, followed by aortic and pulmonary valve involvement. Our results indicated that the mitral valve was the most prevalent in children, which included (17) 34%, followed by the bilateral valve, which appeared on the formation of aortic regurgitation (11) 22%. Conclusion: In summary, our results found that the Mitral valve was the most predominant lesion who effect on the children then, followed by Aortic regurgitations. As a result, aortic and pulmonary valves are involved in the commonly advanced stage of the disease. Also, On the contrary, our study found a preponderance of girls over boys, where boys occupied (62%) and females (38%). Furthermore, malnourished people are at a greater risk of mortality than those with appropriate nutritional conditions.
... Our study found no correlation between valve size, age, or body surface area. This could be attributed to the lack of small valve sizes, and the adjustments of the valve size for different ages and 3 weights were made by the choice of valve position . ...
Aim: To evaluate clinical outcomes in Mitral valve replacement in the adult population for 5years in high volume single centre and identify factors affecting the outcomes. Materials and Methods: We performed a retrospective study including patients who underwent Mitral Valve Replacement (MVR) at our centre, between January 2018 and August 2022. We collected the peri operative and postoperative data from electronic and paper medical records. Follow-up period was until December 2022. Study Data: We included patients aged 12 years and above, with isolated mitral valve pathology, who underwent MVR with a Mechanical prosthetic valve during the study period. Patients with combined valvular pathology were excluded. Among sample size of n=418, patients were grouped <20years - 18, 21-35years - 110, 35-50years - 198, and >50years - 92 of which 38.75% were males. Results: The primary cardiac diagnosis was Rhematic Heart Disease (RHD) - 87.55%, IE - 4%, Degenerative - 7.65% and Ischemic - 3.2%. The mean Euro SCORE II risk prole was 3.7 ± 3.6%. The Median age was 41.2 years. The lesions were Mitral regurgitation - 10%, Mitral Restenosis Stenosis (MRS) in 4.3%, Mitral stenosis - 27.1%, MRS -14.3% and combined lesion- 41.4%. Bi-leaet mechanical prosthetic valves were most commonly implanted in 57.15%. The average mitral valve annulus size was 35.12 mm with a median of 34 mm. The Peak Mitral gradient average was 17.16 and the mean Gradient average was 8.92 which were postoperatively 8.97 and 4.44 respectively. The average cross-clamp duration was 52.4 min. The median follow-up duration was 19.4months (95% CI 11.6 to 17.8). The major paravalvular leak was observed in 12 patients, with linearized ratio was 0.53%/patient-year (95 CI, 0.36%-0.75%). Twenty two patients died during the immediate postoperative period and 12 during the study period, CVA-12 and reoperation-7. Survival rates at 1, 3 and 5years were 97.8 ± 1.0%, 92.4 ± 1.7%, and 88.4 ± 2.2% respectively. Conclusion: This study provides short and long-term results of mitral valve replacement in a large cohort of patients. Mitral valve repair can be carried out with satisfactory results in centres with a dedicated interest
