ASSOCIATION OF TRICUSPID REGURGITATION AND SEVERITY OF MITRAL STENOSIS IN PATIENTS WITH RHEUMATIC HEART DISEASE
Abstract
Background: Rheumatic heart disease is a common ailment in Pakistan and Mitral stenosis is its flag bearer Severity of mitral stenosis is the key factor in deciding for mitral valve surgery. Methods: This case series study was conducted at Ayub Teaching Hospital .Cases of Rheumatic heart disease with mitral stenosis were diagnosed clinically. 2D echocardiography was used to find severity of mitral stenosis. Data was entered into SPSS-17.0 and results were recorded and analysed. Pearson’s two tailed correlation was used to find the correlation between presence of tricuspid regurgitation in patients with severe mitral stenosis, p was <0.05. Results: A total 35 patients with pure mitral stenosis were included in study, out of which 8 were male and 27 were females. Mean age in males was 34.5±15.85 years while in females it was 31±8 years. Twenty-two out of 35 (62.86%) patients had tricuspid regurgitation while 13 out 35 (37.14%) had no tricuspid regurgitation. Mean (MVA) mitral valve area in patients with tricuspid regurgitation was 0.84±0.3 cm2 while mean (MVA) mitral valve area in patients without tricuspid regurgitation was 1.83±0.7 cm2. Mean left atrial (L.A) size was 45.23±1.5mm2 in patients with tricuspid regurgitation, while it was 44.13±6.14mm2 in patients without tricuspid regurgitation. Mean RSVP was 57.5mmHg in patients with tricuspid regurgitation while RSVP could not be calculated in patients without tricuspid regurgitation. Conclusions: It was concluded that tricuspid regurgitation was strongly associated with severe mitral stenosis as almost all patients with severe mitral stenosis had tricuspid regurgitation and none of the patients with mild mitral stenosis had tricuspid regurgitation.Keywords: Rheumatic heart disease, Mitral Stenosis, Tricuspid regurgitation, Mitral Valve Area, Right Ventricular Systolic Pressure.References
Carapetis JR. Rheumatic heart disease in developing countries. N Engl J Med 2007;357(5):439–41.
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis 2005;5(11):685–94.
Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet 2005;366(9480):155–68.
Bahadur KC, Sharma D, Shrestha MP et al. Prevalence of rheumatic and congenital heart disease in school children of Khatmandu Valley in Nepal. Indian Heart J 2003;55(6):615–8.
Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of rheumatic heart disease in rural Pakistan. Heart 2004;90(4):394–9.
Nkomo VT. Epidemiology abd prevention of valvular heart disease and infective endocarditis in Africa. Heart 2007;93(12):1510–19.
Movahed MR, Ahmadi-Kashani M, Kasravi B, Saito Y. Increased prevalence of mitral stenosis in women. J Am Soc Echocardiogr 2006;19(7):911–3.
Marijon E, Ou p, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, et al. Prevelance of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007;357:470–6.
Sagie A, Freitas N, Chen MH, Marshall JE, Weyman AE, Levine RA. Echocardiographic assessment of mitral stenosis and its associated valvular lesion in 205 patients and lack of association with mitral valve prolapsed. J Am Soc Echocardiogr 1997;10(2):141–8.
Boyaci A, Gokce V, Topaloglu S, Korkmaz S, Goksel S. Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Angiology 2007;58(3):336–42.
Sagie A, Schawmmenthal E, Newell JB, Harrell L, Joziatis TB, Weyman AE, et al. Significant Tricuspid Regurgitation Is A Marker For Adverse Outcome In Patients Undergoing Percutaneous Ballon Mitral Vavuplasty. J Am Coll Cardiol 1994;24(3):696–702.
Patel DA, Lavie CJ, Millani RV, Shah S, Gilliland Y. Clinical Implications of left atrial enlargement. A review. Ochsner J 2009;9(4):191–6.
Hirata T, Wolfe SB, Popp RL, Helman CH, Feigenbaum H. Estimation of left atrial size using ultrasound. Am Heart J 1969;78(1):43–52.
Keren G, Etzion T, Sherez J, Zelcer AA, Megidish R, Miller HI, et al. Atrial fibrillation and atrial enlargement in patients with mitral stenosis. Am Heart J 1987;114(5):1146–55.
Ahmed R, Awan ZA. Atrial Clots and their correlation with various denominators, a study of 26 cases. Pak J Med Sci 2005;21(2):210–2.
Omran AS, Arifi AA, Mohamed AA. Echocardiography in mitral stenosis. J Saudi Heart Assoc 2011;23(1):51–8.
Ahmed S, Hayat U, Naz H. Frequency of severe mitral stenosis in young female patients having pure mitral stenosis secondary to rheumatic heart disease. J Ayub Med Coll 2010;22(4):19–22
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.