Rheumatic Mitral Valve Disease: Current Surgical Status

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Rheumatic heart disease is the most serious sequelae of rheumatic fever occurring in approximately 30% of rheumatic fever patients. Patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve disease, heart failure, and pericarditis. Worldwide, rheumatic heart disease remains a major health problem although its prevalence in the developed countries is much reduced. Involvement of the mitral valve results in mitral regurgitation and/or stenosis. Where surgery is indicated, mitral valve replacement is usually necessary although in some cases, mitral valve repair is possible.

Section snippets

Diagnosis

The diagnosis of rheumatic mitral valve disease is made by clinical history, examination, and echocardiography.16, 23 Transthoracic echocardiography enables evaluation of the extent of leaflet and commissural restriction, fusion, and calcification, as well as the severity of stenosis or regurgitation.24, 25, 26, 27, 28, 29, 30, 31, 32

Management

The management of patients with rheumatic mitral valve disease is the same as that for other causes of mitral stenosis or regurgitation. Significant mitral stenosis can be treated by percutaneous balloon mitral valvuloplasty in the absence of significant calcification or regurgitation.33 When this is not possible, surgery is indicated and usually involves mitral valve replacement although commissurotomy can also be performed (Fig 1).34, 35, 36, 37, 38, 39 The involvement of the entire valvular

Conclusion

Rheumatic mitral valve disease continues to be a major problem particularly in the developing world. Mitral valve repair is more challenging and controversial in this condition compared to degenerative mitral valve disease. There is a higher probability of valve replacement compared to valve repair. The durability of mitral valve repair is also limited in this condition due to its progressive nature.

References (47)

  • FawzyM.E. et al.

    Immediate and long-term results of mitral balloon valvotomy for restenosis following previous surgical or balloon mitral commissurotomy

    Am J Cardiol

    (2005)
  • TalwarS. et al.

    Mitral valve repair in children with rheumatic heart disease

    J Thorac Cardiovasc Surg

    (2005)
  • ChoudharyS.K. et al.

    Open mitral commissurotomy in the current era: indications, technique, and results

    Ann Thorac Surg

    (2003)
  • OkitaY. et al.

    Analysis of left ventricular motion after mitral valve replacement with a technique of preservation of all chordae tendinae. Comparison with conventional mitral valve replacement or mitral valve repair

    J Thorac Cardiovasc Surg

    (1992)
  • De SantoL.S. et al.

    Mitral mechanical replacement in young rheumatic women: Analysis of long-term survival, valve-related complications, and pregnancy outcomes over a 3707-patient-year follow-up

    J Thorac Cardiovasc Surg

    (2005)
  • ChowdhuryU.K. et al.

    Mitral valve replacement with and without chordal preservation in a rheumatic population: serial echocardiographic assessment of left ventricular size and function

    Ann Thorac Surg

    (2005)
  • KuwakiK. et al.

    Mitral valve repair versus replacement in simultaneous mitral and aortic valve surgery for rheumatic disease

    Ann Thorac Surg

    (2007)
  • KabbaniS.S. et al.

    The mitral pulmonary autograft: assessment at midterm

    Ann Thorac Surg

    (2004)
  • VeasyG. et al.

    A new look at acute rheumatic mitral regurgitation

    Cardiol Young

    (2005)
  • LeeG.M. et al.

    Changing epidemiology of acute Rheumatic fever in the United States

    Clin Infect Dis

    (2006 February 15)
  • VeasyL.G. et al.

    Resurgence of acute rheumatic fever in the intermountain area of the United States

    N Engl J Med

    (1987)
  • EssopM.R. et al.

    Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa

    Circulation

    (2005)
  • GuilhermeL. et al.

    Molecular pathogenesis of rheumatic fever and rheumatic heart disease

    Expert Rev Mol Med

    (2005)
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