From the Guidelines
The mitral valve is the most commonly affected valve in Rheumatic Heart Disease (RHD). Approximately 65-70% of RHD cases involve mitral valve damage, either as isolated mitral stenosis or regurgitation, or in combination with other valve involvement.
Key Points
- The mitral valve is particularly susceptible to damage from the autoimmune response triggered by group A streptococcal infection, which is the underlying cause of rheumatic fever 1.
- This autoimmune reaction causes inflammation, scarring, and fibrosis of the valve leaflets, leading to thickening, fusion of the commissures, and shortening of the chordae tendineae.
- The aortic valve is the second most commonly affected valve, often occurring in conjunction with mitral valve disease.
- Tricuspid valve involvement is less common, and isolated pulmonary valve disease is rare in RHD, with primary tricuspid regurgitation observed in up to 10% of rheumatic MS patients 1.
- Early detection through echocardiography and appropriate antibiotic prophylaxis are essential in managing patients with RHD to prevent progression of valve damage. Some key considerations in the management of RHD include:
- Mitral balloon valvuloplasty (PMBV) should only be performed in patients with rheumatic MS and in the presence of suitable mitral valve anatomy as assessed by echocardiography 1.
- If both MS and AS are severe, double valve surgery, or TAVR with PMBV should be considered 1.
From the Research
Valve Involvement in Rheumatic Heart Disease
- The most common valve involvement in Rheumatic Heart Disease (RHD) is the mitral valve, with mitral stenosis being a major complication 2, 3.
- Mitral regurgitation is also a common valve abnormality in RHD, often associated with stenosis 4.
- The mitral valve is affected in approximately 90% of patients with RHD, with the majority having mitral stenosis or regurgitation 5.
Mitral Valve Disease
- Mitral valve disease is common in RHD, with rheumatic disease being the number one cause of mitral stenosis worldwide 2.
- Percutaneous balloon mitral valvuloplasty is the therapy of choice for mitral stenosis when indicated and in anatomically eligible patients 2.
- Mitral valve repair and replacement are also treatment options for patients with RHD, with repair being a preferred option for select patients 5, 6.