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Rheumatic heart disease in the past decade: an autopsy analysis
Jaya Deshpande1, Pradeep Vaideeswar, Gayathri Amonkar
1Department of Pathology, TN Medical College, Mumbai. atharnas@yahoo.com
Insights
Rheumatic heart disease remains a significant concern in India, particularly affecting young adults. Autopsy findings reveal no decrease in disease incidence or severity over 25 years, with a notable increase in post-surgical valve dysfunction.
Area of Science:
- Cardiology
- Pathology
- Public Health
Background:
- Rheumatic heart disease (RHD) poses a persistent cardiac challenge, predominantly impacting India's youth.
- Despite available prophylaxis and treatments for valvar pathology, high mortality and morbidity persist, with limited autopsy data.
- Autopsy studies are crucial for understanding the epidemiology and pathology of RHD.
Purpose of the Study:
- To analyze autopsy data of RHD cases over a five-year period.
- To assess changes in RHD incidence, severity, and patient demographics.
- To identify trends in valve involvement and causes of death in RHD patients.
Main Methods:
- Retrospective autopsy analysis of 434 RHD cases from 1993 to 1997.
- Detailed examination of 178 heart valves, focusing on mitral and aortic valve pathology.
- Review of patient history, including previous cardiac surgeries and causes of death.
Main Results:
- The majority of RHD cases (434) occurred in individuals aged 16-40 years.
- The mitral valve was overwhelmingly involved (174/178 cases), often with severe subvalvar pathology.
- Congestive cardiac failure was the primary cause of death in both operated and unoperated patients.
Conclusions:
- No reduction in RHD incidence or severity observed over 25 years at the institute.
- A significant shift in RHD presentation noted, with increased cases of post-surgical valve dysfunction.
- RHD management requires ongoing attention due to persistent disease burden and evolving clinical patterns.
Background:
Rheumatic heart disease continues to be an important cardiac problem, afflicting the young population of India. Though prophylaxis and various treatment modalities are available for the valvar pathology, mortality and morbidity continue to be high. Autopsy data are scarce.
Methods And Results:
This is an autopsy analysis of rheumatic heart disease as seen at a large teaching hospital over a period of 5 years in the past decade. Four hundred thirty-four cases were autopsied in a five-year period from 1993 to 1997. The majority of cases were between 16 and 40 years of age. Fifty cases showed the presence of Aschoff bodies indicating a recent attack of rheumatic carditis. One hundred seventy-eight valves were examined in detail--in 174, the mitral valve was involved. In 4 cases, only the aortic valve was affected. The mitral valve showed significant disease with a severe degree of subvalvar pathology. One hundred thirty-eight patients had already undergone some form of previous surgery and presented with valve dysfunction. Most of these patients were in the third and fourth decades of life. The most frequent cause of death in operated and unoperated cases was congestive cardiac failure.
Conclusions:
There is no decrease in the incidence or severity of rheumatic heart disease over a period of 25 years as seen at our institute. The pattern of the disease has changed, with patients who had a previous surgery now returning with valve dysfunction or related problems.