Pattern of Rheumatic valvular involvement and its contribution towards valvular malfunction in young adults

Objective

To study the different patterns of valvular malfunction in Rheumatic heart disease (RHD) and assess the factors contributing towards it.

Methods

This is an observational study among patients with chronic RHD. One hundred patients (female 81 and 19 males) within ages 12 to 40 years (Mean age 27.3) were analyzed. A relevant clinical history including that of an initial episode of acute rheumatic fever (ARF) and recurrent episodes was obtained. 2D echo assessment of the cardiac valves was performed with an estimation of Wilkins score for the mitral valve (MV).

Results

Among the study population female: male ratio was 4:1. 30% had recurrent episodes of ARF. Only 60% had at least some evidence of ARF at any time in their life. The posterior mitral valve appears to be affected more than the anterior leaflet giving an average Wilkins score of 9.7 and 6.7 respectively. The total score had a positive correlation with Mitral stenosis (MS) (p <0.05). MV involvement was noted in 97%. 44% had significant mitral valve prolapse (MVP) but no statistical correlation was noted with mitral regurgitation (MR) (p>0.05). A regurgitant grade of 2 or more was found in 41%. High sensitive C reactive protein of more than 1mg/dl was noted in 55% of patients.  

Conclusion

Chronic rheumatic MV disease can exist as MS, MR, MVP or simply an elevated valve score. Apart from recurrent streptococcal infections and chronic sub clinical inflammation, a number of different components of valve damage contribute towards the end result.