Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients (original) (raw)
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R Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients
Background: Mitral stenosis, one of the grave consequences of rheumatic heart disease, was generally considered to take decades to evolve. However, several studies from the developing countries have shown that mitral stenosis follows a different course from that seen in the developed countries. This study reports the prevalence, severity and common complications of mitral stenosis in the first and early second decades of life among children referred to a tertiary center for intervention. Methods: Medical records of 365 patients aged less than 16 and diagnosed with rheumatic heart disease were reviewed. Mitral stenosis was graded as severe (mitral valve area < 1.0 cm 2 ), moderate (mitral valve area 1.0-1.5 cm 2 ) and mild (mitral valve area > 1.5 cm 2 ). Results: Mean age at diagnosis was 10.1 ± 2.5 (range 3-15) years. Of the 365 patients, 126 (34.5%) were found to have mitral stenosis by echocardiographic criteria. Among children between 6-10 years, the prevalence of mitral stenosis was 26.5%. Mean mitral valve area (n = 126) was 1.1 ± 0.5 cm 2 (range 0.4-2.0 cm 2 ). Pure mitral stenosis was present in 35 children. Overall, multi-valvular involvement was present in 330 (90.4%). NYHA functional class was II in 76% and class III or IV in 22%. Only 25% of patients remember having symptoms of acute rheumatic fever. Complications at the time of referral include 16 cases of atrial fibrillation, 8 cases of spontaneous echo contrast in the left atrium, 2 cases of left atrial thrombus, 4 cases of thrombo-embolic events, 2 cases of septic emboli and 3 cases of airway compression by a giant left atrium. Conclusion: Rheumatic mitral stenosis is common in the first and early second decades of life in Ethiopia. The course appeared to be accelerated resulting in complications and disability early in life. Echocardiography-based screening programs are needed to estimate the prevalence and to provide support for strengthening primary and secondary prevention programs.
Profile and prediction of severity of rheumatic mitral stenosis in children
Medical Journal of Indonesia, 1996
Di negara-negara berkembang seperti Indonesia, penyakit jantung reumatik (PJR) masih merupakan masalah kesehatan masyarakat. Stenosis mitral rewnatik (SMR) dapat terjadi dengan cepat dan SMR berat dapat timbul pada umur sedini 15 tahun di negara Asia-Afrika. Pemeriksaan fisik tidak culcup akarat untuk menentukan derajat berat SMR Penelitian ini untuk nengetahui gambaran klinis SMR pada analç gambaran EKG dan foto Roentgen dada yang mungkin dapat memperkirakan derajat berat SMR sesuai ekolcardiografi. Telah dilakuknn penelitian 'cross-sectional' pada 28 pasien SMR di Bagian IJnu Kesehatan Anak RSCM. Ilnur rata-rata adolah I 3,5 tahun Dua pasien tidak dapat disertakan dalan uji diagnostik karena peneriksaan yang belutn lengknp. Derajat berat SMR berdasarkan pengukuran luos latup mitral dcngan ekolurdiografi 2 D digolongl<nn dalant derajat ringan, sedang dan berat masing-rnasing terdapat pada 1, 15 dan 1O pasien. Prakiraan derajat berat SMR berdasarlcan RVH dan MD pada EKG tnenunjukan spesifisitas 75% dan nilai duga negatif 85,7%. Prakiraan derajat berat SMR berdasarl<an analisis foto Roentgen dada tnenunjuklran sercitifitas 80%, spesifisitas 81,2% sedangkan nilai duga negatif adatah 86,7%. Konbinasi peneriksaan EKG atau Foto Roentgen dada menuniulan sensitifitas yang tinggi yaim 9O%, yang berguna untuk menapis pasien SMR di daerah yang tidak nenpunyai fasilitas ekolcardiografi. Nilai duga negatif peneriksaan lambinasi adalah 92%, yang berarti bila tidak didapatkan tanda SMR bera pada EKG atauloto Roentgen dada, l<emungkinan besar bukan SMR berat-
Critical Mitral Stenosis: A Rare Presentation of Pediatric Rheumatic Heart Disease
Journal of Evolution of medical and Dental Sciences, 2015
Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to be a major health hazard in most developing countries. Paediatric and juvenile mitral stenosis (MS), upto the age of 12 and 20yr respectively, severe enough to require operative treatment was documented. These negate the belief that patients of RHD become symptomatic ≥20 years after RF as well as the fact that congestive cardiac failure in childhood indicates active carditis and RF.
Youngest documented rheumatic mitral stenosis with regurgitation in a 28-month-old girl
2019
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are the leading causes of acquired diseases in children and young adults in developing countries carrying considerable morbidity and mortality. Rheumatic fever (RF) commonly affects children between 5-15 years old and is rarely seen in < 5 years old. Mitral stenosis (MS) is the most common sequela, as it bears maximum onslaught. In India, few patients follow an unusually rapid course in developing severe MS because of its fulminant nature following attack of ARF. CASE REPORT Our patient was a 28-month-old girl who had developed severe MS, mitral regurgitation (MR), and pulmonary hypertension (PH) as the sequelae of ARF which she had suffered at the age of 18 months old. CONCLUSION To the best of our knowledge, this is the youngest reported case of rheumatic MS following ARF after extensive search in the literature. This case highlights the fact that very young population is not immune to ARF contrary to prio...
Cardiovascular Journal of Africa, 2021
Background: Recent evidence suggests that there is a change in the profile of rheumatic mitral regurgitation (MR) in South Africa to a pattern of chronic fibrotic valvular disease. Objective: This study describes the clinical profile of patients with rheumatic MR in the province of KwaZulu-Natal (KZN). Methods: A retrospective chart review was performed on patients seven years and older with moderate to severe rheumatic MR referred to Inkosi Albert Luthuli Central Hospital from 2006 to 2015. Results: There were 320 patients meeting the study criteria (mean age 22.2 ± 15.8 years, male:female 1:2). Severe dyspnoea was present in 45.9% of patients, heart failure in 117 (36.6%) and atrial fibrillation in 13.8%. Three patients were diagnosed with active carditis at initial presentation and a further 31 had evidence of carditis during follow up. Of the 216 patients who underwent surgery, over one-third (37%) had prolapse of the anterior mitral leaflet, which was due to chordal elongation (n = 63, 29.2%) and/or ruptured chordae (n = 41, 19%). There were 32 deaths (10%) and of these, 27 (8.4%) patients died prior to surgery. Conclusion: Rheumatic MR in KZN predominantly affects the young, with concomitant carditis resulting in high morbidity and mortality rates.
A 3 Year Old Case of Juvenile Mitral Stenosis- the Youngest Case Reported
Journal of Cardiology & Cardiovascular Therapy, 2017
Rheumatic heart disease is a well-known entity in the developing world. The commonest sequelae of rheumatic carditis are mitral stenosis (MS). MS can present at a very young age with severe symptoms. We describe here a case of juvenile rheumatic MS in a 3 year old child with severe pulmonary hypertension.
Risk Stratification and Mortality in Mitral Stenosis Patients
ACI (Acta Cardiologia Indonesiana)
Background: Rheumatic mitral stenosis is the most common valvular abnormalities found in developing countries. Mortality risk in those populations was poorly investigated. In addition, hemodynamic, morphological, and mechanical factors that influence or predict outcome of rheumatic mitral stenosis have not been identified. Aims: To determine predictive factors affecting outcome in rheumatic mitral stenosis patients. Method: This retrospective cohort study was conducted at the National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. The study recruited patients from the Valvular Heart Disease Registry from May 2014 to November 2020. New York Heart Association (NYHA) functional classification, invasive or surgical treatment, and incidence of death were recorded. The baseline rhythm from electrocardiography (ECG) was categorized as sinus rhythm and atrial fibrillation or atrial flutter. Based on the findings of trans thoracal echocardiography (TTE), subjects who had moderate to s...
Annals of Tropical Paediatrics: International Child Health, 2001
This study aimed to evaluate the impact of improved socioeconomic conditions and health care on chronic mitral valve complications of rheumatic heart disease in Al Baha in the Kingdom of Saudi Arabia. Altogether, 190 cases of acute rheumatic fever (ARF) seen between 1982 and 1996 and 146 cases of symptomatic mitral stenosis seen between 1984 and 1996 were analysed. 2-D/Doppler echocardiography was used to evaluate the severity and progression of mitral regurgitation (MR)/mitral stenosis (MS). Of 90 cases of ARF who presented initially with MR, the murmur remained unchanged in 40%, increased in 30% and had decreased or disappeared in 30%. In cases with recurrence of ARF, mitral incompetence deteriorated in 16 of 26 cases (61.5%) and remained stable in ten (38%). Severe MS developed during follow-up in three cases of ARF, all aged less than 20 years. Seven of 50 cases (14%) of severe MS studied were aged 20 years or less. The 43% (25 of 58 cases) of severe cases of MS aged 20 years or less reported from King Faisal Hospital, Riyadh in 1981 compared with 14% of severe cases aged 20 years or less in this study indicates a signi cant slowing down of the rate of progression of MS following an attack of ARF in this region. Among individuals with MR during an ARF attack who reliably take their antibiotic prophylaxis, 70% will lose that murmur within 5 years of follow-up. In this series, only 30% showed a decrease or loss of MR and this probably re ects the degree of non-compliance with secondary antibiotic prophylaxis in our cases. The rate of default from antibiotic prophylaxis was 32.6%.