Percutaneous Balloon Mitral Valvuloplasty

Abstract

Several diseases have been acknowledged as pathological causes for mitral valve stenosis (MS), of which rheumatic heart disease is the most prevalent. Rheumatic heart disease is a chronic manifestation of rheumatic carditis, which occurs in 60% to 90% of cases of rheumatic fever. Rheumatic fever is a late sequela to Group A β-hemolytic streptococcal infection of the throat. The initial rheumatic fever results only in an edematous inflammatory process, leading to the fibrinoid necrosis of the connective tissue and cellular reactions. The initial valvulitis results in verruciform deposition of fibrin along the closing portion of the leaflets. Although all of the cardiac valves may be involved by this rheumatic process, the mitral valve is involved most prominently. The endocardial lesion most often leaves permanent sequela resulting in valvular regurgitation, stenosis, or both. Stenosis of this valve occurs from leaflet thickening, commissural fusion, and chordal shortening/fusion due to the above described pathological process. The decrease of the incidence of rheumatic heart disease in developed countries had already begun in 1910, and it is now below 1.0 per 100 000. On the other hand, the occurrence rate of rheumatic heart disease in developing countries remains substantial. Because the decline in the prevalence of rheumatic fever in industrialized nations started even before the era of penicillin and thus was related to improved living standards, the continued prevalence of rheumatic heart disease in undeveloped or developing countries is related not only to the limited availability of penicillin but to their socioeconomic status (ie, overpopulation, overcrowding, poverty, and poor access to medical care). According to the annual report by the World Heart Federation, an estimated 12 million people are currently affected by rheumatic fever and rheumatic heart disease worldwide, and high incidence rates are reported in the Southern Pacific Islands. Several studies were conducted on …