Pattern of Rheumatic Heart Disease: An Echocardiographic Study

Author : G. Aditya, T. N. P. Adityaputra, I. B. R.Wibhuti, K. B.Nadha
Upload Date : 19-04-2018

Background: While acute rheumatic fever is declining in the developing countries, there are still a large number of chronic rheumatic heart disease (RHD) cases, often complicated by chronic congestive heart failure and recurrent thrombo-embolic phenomena. We report on the pattern of valve involvement in RHD using echocardiography from our center.

Methods: In this retrospective study, transthoracic echocardiography (TTE) data were collected from patient medical records at policlinic integrated cardiovascular service Sanglah General Hospital, Bali for 3 months (April 2017 to June 2017). Information obtained from the records including age, gender, and echocardiography findings. Echocardiography RHD diagnosis was based on the World Heart Federation Criteria. The data were analyzed using 23 version SPSS.

Results: A total of 61 patients had an echocardiography diagnosis of RHD. There were 15 males and 46 females (ratio 1:3.06) and their ages ranged from twelve to 70 years old. Mitral stenosis (MS) was the most common echocardiographic diagnosis detected in 60 patients (98%). Of them 44 (73,3%) suffered from severe MS and 16 (26,7%) suffered from moderate MS. Mitral regurgitation (MR) found in 27 (44%) patients, with 17 (27,9%) patients with mild MR, 4 (6,6%) with moderate MR and  6 (9,8%) with severe MR. Aortic stenosis found in 10 (16,4%) patients and 38 (62,3%) patients with aortic regurgitation. Eight (13,1%) patients had mixed mitral disease and 53 (86,9%) had mixed aortic and mitral valve disease. Fifty-three (86,9%) patients had normal ejection fraction and 8 (13,1%) with decrease systolic LV function. Most of the patients (95,1%) had left atrium dilatation. Spontaneous echo contrast found in 24 (39,3%) patients and thrombus found in 3 (4,9%) patients. Twenty (32,8%) patients had low probability of Pulmonary Hypertension (PH), 24 (39,3%) patients with intermediate probability of PH and 17 (27,9%) patients with high probability of PH.

Conclusion: Most of the patients had mixed valvular lesion. These lesions predominated on the mitral valve, were commonly associated with aortic regurgitation. Most of the patients had normal ejection fraction, LA dilatation and intermediate probability of PH.

KEYWORDS : Rheumatic Heart Disease, Mitral Stenosis, Mitral Regurgitation, Aortic Regurgitation, Aortic Stenosis, Echocardiography

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