Clinical Presentation and Pattern of Cardiac Involvement in Patients with Rheumatic Heart Disease: A Prospective Observational Study

Abstract

Context: Rheumatic heart disease (RHD). Aim: The aim of the study was to study the clinical presentation and pattern of cardiac involvement in adult patients with RHD. Settings and Design: This was a prospective observational study from a tertiary care hospital in South India. Subjects and Methods: Consecutive adult patients diagnosed with and treated for RHD in our tertiary care teaching hospital in Tirupati were screened for inclusion. In all patients, details of appropriate laboratory and imaging investigations that have been carried out were noted. Statistical Analysis Used: Descriptive statistics (frequencies, mean standard deviation, and median [interquartile range (IQR)]) were reported. Results: A total of 120 patients were enrolled. Their mean age was 45.7–12.2 years; there were 79 females. The median (IQR) follow-up was 364 (156–702) weeks. Single-valve disease was seen in 51.7% (n = 62); others (n = 58) had multivalvular disease (mitral stenosis [MS] + aortic regurgitation [AR] [n = 47, 81%] and mitral regurgitation + AR [n = 11, 19%]). Among patients with single-valve involvement, 58 (93.5%) had mitral valve disease. Overall, 116 of 120 (96.6%) patients had mitral valve involvement. Among patients with mitral valve disease (n = 116), MS was severe in 62 (51.6%). Atrial fibrillation was evident in 59 (49.2%) patients; of these, 8 had cardioembolic strokes. Forty-four (36.7%) had undergone percutaneous transvenous mitral commissurotomy. Prosthetic mitral valve obstruction was observed in 2/20 patients who had undergone mitral valve replacement or double-valve replacement. Conclusions: In patients with RHD, mitral valve involvement (either alone or in combination with the aortic valve) was most common; MS was most common.