Treatment Of Rheumatic Heart Disease Research Articles

Determination of the upper limit of normal for serum anti-streptolysin-O titre in primary school children in Southern Nigeria; A model for other low resource settings

The prevention and treatment of Rheumatic Heart disease is hinged on antibiotic administration in children with Group A Streptococcal (GAS) pharyngitis and Acute Rheumatic Fever (ARF). The Upper Limit of Normal (ULN) for serum Anti-streptolysin O titre (ASOT) has been employed as proof of antecedent GAS pharyngitis to fulfil the Jones’ criteria for diagnosis of ARF. This value has not been generated among West African children. Generalization of values from Caucasians (200 IU/ml) is likely to result in over-diagnosis, owing to higher GAS pharyngitis incidence in Africa. We aimed to determine the serum ASOT and its ULN in apparently healthy school-aged children in Egor Local Government Area (LGA), south-south Nigeria and to determine their relationship with socio-demographic characteristics.We recruited 384 apparently healthy school-aged pupils across eleven schools. Serum ASOT was determined by turbidimetry. Statistical analysis was done using student's t-test and Analysis of Variance (ANOVA). Level of significance was set at p < 0.05.The mean age was 8.53 ± 1.97(range 6–12) years and male-female ratio was 1.1:1. The ULN and geometric mean serum ASOT were 390.76 IU/ml and 230.04 ± 1.86 IU/ml respectively. No significant correlation was found between serum ASOT and age (r-value of −4.8%). The ULN did not vary significantly with gender, socio-economic class and the presence/absence of over-crowding in homes. The ULN for serum ASOT in apparently healthy school-aged children in Egor LGA is higher than the currently used international value. Clinicians in West Africa should consider applying higher cut-off values for the diagnosis of ARF.

The Importance of Early Diagnosis for the Treatment of Rheumatic Heart Disease

The Importance of Early Diagnosis for the Treatment of Rheumatic Heart Disease

Myocardial fibrosis in rheumatic heart disease: emerging concepts and clinical implications.

Rheumatic heart disease (RHD) remains a significant cardiovascular burden in the world even though it is no longer common in affluent countries. Centuries of history surrounding this disease provide us with a thorough understanding of its pathophysiology. Infections in the throat, skin, or mucosa are the gateway for Group A Streptococcus (GAS) to penetrate our immune system. A significant inflammatory response to the heart is caused by an immunologic cascade triggered by GAS antigen cross-reactivity. This exaggerated immune response is primarily responsible for cardiac dysfunction. Recurrent inflammatory processes damage all layers of the heart, including the endocardium, myocardium, and pericardium. A vicious immunological cycle involving inflammatory mediators, angiotensin II, and TGF-β promotes extracellular matrix remodeling, resulting in myocardial fibrosis. Myocardial fibrosis appears to be a prevalent occurrence in patients with RHD. The presence of myocardial fibrosis, which causes left ventricular dysfunction in RHD, might be utilized to determine options for treatment and might also be used to predict the outcome of interventions in patients with RHD. This emerging concept of myocardial fibrosis needs to be explored comprehensively in order to be optimally utilized in the treatment of RHD.

Heart valve treatment in rheumatic heart disease and plausible role of stem cell therapy

Rheumatic heart disease (RHD) is a global health concern and is a neglected disease relative to its prevalence in developing nations. RHD is a result of recurrent ARF episodes and the abnormal immune response against the host proteins. The primary and secondary interventions are highly recommended for patients with ARF but the patients with a confirmed diagnosis and chronic case of RHD undergo either valve repair or depending on the severity of the cases. According to the reports, surgical intervention has been the mainstay in the treatment of chronic cases of rheumatic heart disease. The fundamental issue with the current treatment strategy is the lack of fast-paced degradation due to the lack of self-renewing cells. The promising solution to this challenge can the tissue-engineered cardiac valves by combining stem cells and biomaterials. Although tissue engineering has been explored for valve repair and replacement in severe cardiac disease, this strategy has not been studied and explored in RHD. In this review, we have discussed the plausible role of stem cells and tissue-engineered cardiac valves in the treatment of RHD.

Medical Treatment for Rheumatic Heart Disease: A Narrative Review.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.

Development of a core outcome set on Traditional Chinese Medicine and Western Medicine for rheumatic heart disease: a study protocol

IntroductionGlobally, rheumatic heart disease (RHD) is an important cause of acquired heart disease in children and adolescents. Clinical trials on RHD treatment with Traditional Chinese Medicine (TCM) or integrated medicine...

Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients.

Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results. There were seven patients with a mean age of 33 years and predominantly female (n=5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months. Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.

Evaluation of a nurse-led intervention to improve adherence to secondary prevention of rheumatic heart disease

Background/Aims Rheumatic heart disease is a major health concern in India. Secondary prevention following acute rheumatic fever can prevent disease escalation, but adherence rates are often low. This study evaluated whether a nurse-led intervention could effectively increase adherence rates to secondary prevention and reduce rheumatic symptoms in this patient group. Methods A total of 60 patients were randomly assigned to either an intervention or control group. The control group received standard treatment, while the intervention group received a 25-minute education session with a nurse, along with text message or phone call reminders before they were due for treatment. Participants also completed a rheumatic morbidity index scale survey over 12 months to record their symptoms. A two-way sample t-test was used to compare adherence rates and symptom incidence in both groups. Results Patients in the intervention group had significantly better adherence rates to their medication, receiving 11–17 of the total 18 injections over the 12-month period, compared to 6–12 in the control group. They were also less likely to experience symptoms of rheumatic heart disease or require emergency hospitalisation. Conclusions A nurse-led intervention is an effective method of reducing pressure on hospital services and increasing treatment adherence among patients receiving secondary prevention treatment for rheumatic heart disease.

Analysis of outcome indexes in randomized controlled trials of traditional Chinese medicine for rheumatic heart disease

The present study analyzed the efficacy evaluation indexes of the randomized controlled trials(RCTs) of Chinese medi-cine in the treatment of rheumatic heart disease to lay the foundation for the construction of the corresponding core outcome index set. Clinical RCTs with a definite diagnosis of rheumatic heart disease were retrieved from CNKI, Wanfang, VIP, Sino Med, Pub Med, EMbase, and Cochrane Library from January 1, 2010, to December 31, 2020. Thirty-five RCTs were included, involving 3 314 patients and 41 efficacy evaluation indexes, which covered seven domains [traditional Chinese medicine(TCM) symptoms/syndromes, symp-toms/signs, physical and chemical examination, quality of life, long-term prognosis, economic evaluation, and safety events]. Physi-cal and chemical examination(56. 91%) and symptoms/signs(29. 27%) were the more frequently applied. The number of indexes used in a single trial ranged from 1 to 15, with an average of 4. The measurement time points of the top five indexes in the frequency of use were as follows: total response rate was reported at five measurement time points, ranging from 14 days to 6 months; left ventri-cular ejection fraction was measured at eight time points ranging from 5 days to 6 months; left ventricular end systolic diameter was measured at six time points, ranging from 5 days to 6 months; interleukin-2(IL-2) and tumor necrosis factor-α(TNF-α) were repor-ted 28 days after treatment. At present, there are many problems in the efficacy outcome indexes of RCTs in the treatment of rheumatic heart disease with TCM, such as large difference in quantity, unclear primary and secondary indexes, unreasonable selection of &quot; surro-gate indexes&quot;, insufficient attention to long-term prognostic indexes and safety event indexes, non-standard application of composite in-dexes, long measurement period, and lack of TCM characteristics. It is urgent to establish the core outcome set for TCM treatment of rheumatic heart disease.

A Unique Approach to Treat Rheumatic Heart Disease by Using In Silico Modeling With Polymeric Nanoparticles

Rheumatic heart disease (RHD) and its antecedent rheumatic fever (RF) is a serious health issue which targets mainly the elderly residing in developing countries. The main causative organism of RHD id group-A, β- hemolytic streptococci (GAS). It is basically an autoimmune disease triggered by GAS infection which damage the heart valve tissue, resulting in chest discomfort and pain. Both Diltiazem, a benzothiazepine class of voltage gated L-type Ca2+ channel blocker and Norfloxacin, a fluroquinolone class of drug, are active against hemolytic streptococci (GAS) class of pathogen. These drugs show no kind of drug interaction when used together. So, combination of both these to drugs can be used in the treatment of RHD. A polymeric nanoparticle formulation is very useful in formulating a combination of drugs, as, nano formulation increases the bioavailability of the drugs in systemic circulation, and they did not hinder each other’s absorption in the GIT. In this article we have developed and evaluated the polymeric nanoparticle formulation of norfloxacin and diltiazem combination, using chitosan as a polymer.

Using community‐led development to build health communication about rheumatic heart disease in Aboriginal children: a developmental evaluation

ObjectiveA high prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Aboriginal children in northern Australia is coupled with low understanding among families. This has negative impacts on children's health, limits opportunities for prevention and suggests that better health communication is needed. MethodsDuring an RHD echocardiography screening project, Aboriginal teachers in a remote community school created lessons to teach children about RHD in their home languages, drawing on principles of community‐led development. Access to community‐level RHD data, previously unknown to teachers and families, was a catalyst for this innovative work. Careful, iterative discussions among speakers of four Aboriginal languages ensured a culturally coherent narrative and accompanying teaching resources. ResultsThe evaluation demonstrated the importance of collective work, local Indigenous Knowledge and metaphors. As a result of the lessons, some children showed new responses and attitudes to skin infections and their RHD treatment. Language teachers used natural social networks to disseminate new information. A community interagency collaboration working to prevent RHD commenced. Conclusions and implications for public healthAction to address high rates of RHD must include effective health communication strategies that value Indigenous Knowledge, language and culture, collaborative leadership and respect for Indigenous data sovereignty.

Evaluation of the Effect of Irbesartan Combined with PMA on Arrhythmia and Cardiac Function in Patients with Rheumatic Heart Disease

Objective: To investigate the clinical effect of irbesartan combined with potassium magnesium aspartate (PMA) in the treatment of rheumatic heart disease. Methods: A total of 316 patients with rheumatic heart disease who were treated in our hospital during the period of March 2018 to January 2021 were selected as the research objects. According to the different treatment methods, they were divided into group A (treatment with irbesartan only) and group B (Using Irbesartan combined with PMA treatment), analyze and compare the cardiac function, diastolic blood pressure, systolic blood pressure, heart rate and clinical treatment effect of the two groups of patients after treatment. Results: After treatment, the left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), and left ventricular end-diastolic diameter (LVEDD) of the two groups were significantly lower than before treatment, and left ventricular ejection fraction (LVEF) was significantly higher than after treatment, (P&lt;0.05), and the improvement of the above indicators in group B was significantly better than that of group A, (P&lt;0.05). After treatment, the diastolic blood pressure, systolic blood pressure and heart rate of group B were significantly lower than those of group A, (P?0.05); the total effective rate of treatment in group B (87.4%) was higher than that of group A (76.3%), (P?0.05). Conclusion: Irbesartan combined with PMA in the treatment of rheumatic heart disease has a better clinical effect than irbesartan alone. It can promote the reconstruction of ventricular function, improve the clinical symptoms of patients, prevent heart failure, and can effectively promote the recovery of cardiac function in patients.

Evaluating Vitamin D levels in Rheumatic Heart Disease patients and matched controls: A case-control study from Nepal.

Diagnosis and treatment for Rheumatic Heart Disease (RHD) is inaccessible for many of the 33 million people in low and middle income countries living with this disease. More knowledge about risk factors and pathophysiologic mechanisms involved is needed in order to prevent disease and optimize treatment. This study investigated risk factors in a Nepalese population, with a special focus on Vitamin D deficiency because of its immunomodulatory effects. Ninety-nine patients with confirmed RHD diagnosis and 97 matched, cardiac-healthy controls selected by echocardiography were recruited from hospitals in the Central and Western region of Nepal. Serum 25(OH)D concentrations were assessed using dried blood spots and anthropometric values measured to evaluate nutritional status. Conditional logistic regression analysis was used to define association between vitamin D deficiency and RHD. The mean age of RHD patients was 31 years (range 9-70) and for healthy controls 32 years (range 9-65), with a 4:1 female to male ratio. Vitamin D levels were lower than expected in both RDH and controls. RHD patients had lower vitamin D levels than controls with a mean s-25(OH)D concentration of 39 nmol/l (range 8.7-89.4) compared with controls 45 nmol/l (range 14.5-86.7) (p-value = 0.02). People with Vitamin D insufficiency had a higher risk (OR = 2.59; 95% CI: 1.04-6.50) of also having RHD compared to people with Vitamin D concentrations >50 nmol/l. Body mass index was significantly lower in RHD patients (22.6; 95% CI, 21.5-23.2) compared to controls (24.2; 95% CI, 23.3-25.1). RHD patients in Nepal have lower Vitamin D levels and overall poor nutritional status compared to the non-RHD controls. Longitudinal studies are needed to explore the causality between RHD and vitamin D level. Future research is also recommended among Nepali general population to confirm the low level of vitamin D as reported in our control group.

Surgical Algorithm for Rheumatic Tricuspid Disease

Rheumatic involvement of the tricuspid valve frequently occurs in patients with mitral and aortic valve disease. Inadequate attention to tricuspid valve function can lead to increased morbidity and may necessitate reoperation. A surgical algorithm is developed and presented for treatment of rheumatic heart disease. Seventy-four patients underwent tricuspid valve repair. Competent tricuspid valve (not more than mild tricuspid regurgitation) could be achieved in all of these patients.

Needle temperature and pain perception in the treatment of rheumatic heart disease

Aim: Patients with rheumatic heart disease (RHD) are committed to lifelong secondary prophylaxis with antibiotics. The study was conducted to evaluate the effect of cold needle to decrease the pain associated with this injection. Material and methods: A randomised crossover single-blinded study was conducted among 100 patients receiving penicillin with room-temperature needle and cold needle (0–2oC) in random order. Pain was evaluated using numerical pain rating scale and bio-physiological measures. Results: There was a significant decrease in subjective pain score when cold needle was used as compared to room-temperature needle (3.37 ±1.75 vs 5.58 ±1.68, P≤0.0001). Conclusion: Cold needle decreased pain perception of patients receiving intramuscular injection of benzathine penicillin. Pain-reducing technique may be useful in improving compliance of patients receiving benzathine penicillin.

The Cape Town Declaration on Access to Cardiac Surgery in the Developing World.

Twelve years after cardiologists and cardiac surgeons from all over the world issued the 'Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa', calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.

The Cape Town declaration on access to cardiac surgery in the developing world.

Twelve years after cardiologists and cardiac surgeons from all over the world issued the ‘Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa’, calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.

The Cape Town Declaration on Access to Cardiac Surgery in the Developing World.

Twelve years after cardiologists and cardiac surgeons from all over the world issued the ‘Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa’, calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.

The Cape Town Declaration on Access to Cardiac Surgery in the Developing World

Twelve years after cardiologists and cardiac surgeons from all over the world issued the ‘Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa’, calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.

Correction to: Lessons learned in the development of sustained release penicillin drug delivery systems for the prophylactic treatment of rheumatic heart disease (RHD)

Jürgen B. Bulitta's name was misspelled in the original version of the article. It is correct as reflected here. The original article has been revised.