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Rheumatic Heart Disease in India in 2020: Advances in Diagnostic and Therapeutic Options
A K Pancholia1, I B Vijaylakshmi2, Prasanna Simha Mohan Rao3
1Convener CSI-RHD Council, Head of clinical & preventive cardiology, Arihant Hospital, Indore, Madhya Pradesh; Corresponding Author.
Insights
Rheumatic Fever and Rheumatic Heart Disease remain significant health burdens, especially in low-income regions. Advanced echocardiography and mitral valve repair offer improved diagnosis and treatment strategies for affected patients.
Area of Science:
- Cardiology
- Immunology
- Public Health
Background:
- Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) stem from an autoimmune response to streptococcal pharyngitis, causing cardiac valve damage.
- While rare in developed nations, RF/RHD disproportionately affects children and young adults in low-income countries and areas with socioeconomic disparities.
- Historical underdiagnosis of Acute Rheumatic Fever (ARF) and RHD led to missed secondary prophylaxis, resulting in severe complications and mortality.
Purpose of the Study:
- To highlight the persistent global burden of Rheumatic Heart Disease.
- To emphasize the role of advanced echocardiography in accurate diagnosis and management.
- To discuss the benefits of mitral valve repair over replacement in RHD patients.
Main Methods:
- Review of current understanding of RF/RHD pathogenesis and epidemiology.
- Analysis of the diagnostic capabilities of advanced echocardiography.
- Evaluation of outcomes associated with mitral valve repair versus replacement.
Main Results:
- Echocardiography advancements aid in preventing both under- and over-diagnosis of ARF/RHD.
- Mitral valve repair, though complex, yields acceptable results in experienced centers.
- Valve repair is preferable to replacement, avoiding anticoagulation and prosthesis-related risks.
Conclusions:
- Accurate diagnosis through echocardiography is crucial for effective RF/RHD management.
- Mitral valve repair represents a significant advancement, offering better long-term outcomes for RHD patients.
- Addressing socioeconomic factors is vital to reduce the burden of RF/RHD globally.
Abstract:
Rheumatic Fever (RF)/ Rheumatic Heart Disease (RHD) is the result of autoimmune response triggered by group A Beta-haemolytic streptococcal pharyngitis leading to immune-inflammatory injury to cardiac valves. It is practically disappeared in developed countries. However, it continues to be a major cause of disease burden among children, adolescents, and young adults in low-income countries and even in high-income countries with socioeconomic inequalities. For decades, many cases of Acute Rheumatic Fever (ARF) and RHD were missed and were denied the secondary prophylaxis, as a result these patients used to end up with complications and untimely death. Advanced understanding of the echocardiography can prevent both under diagnosis and over diagnosis and thus help in management strategy. Another new advancement in recent past is the mitral valve repair, which is technically demanding, and the results are acceptable in experienced cardiac surgical units. Whenever feasible, valve repair should be preferred over valve replacement since it precludes the need for anticoagulation and future risks of prosthesis dysfunction.
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