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Follow up study of acquired valvular heart disease
Insights
Long-term follow-up of acquired valvular heart disease reveals varied outcomes, including spontaneous recovery and delayed stenosis. Rheumatic fever is no longer the leading cause of death in younger patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Clinical Medicine
Background:
- Acquired valvular heart disease (AVHD) often requires long-term monitoring.
- Early detection through school cardiac examinations is crucial for managing AVHD.
- Understanding the natural history and long-term prognosis of AVHD is essential.
Purpose of the Study:
- To analyze the long-term follow-up data of patients with acquired valvular heart disease.
- To investigate the outcomes of AVHD from school detection through adulthood.
- To identify changes in disease type and mortality trends over time.
Main Methods:
- Retrospective analysis of follow-up data for 343 patients with AVHD.
- Data collected during school years and after high school graduation up to age 38.
- Assessment of mortality, disease progression, improvement, spontaneous recovery, and surgical treatment.
Main Results:
- Among 343 patients followed, 5.2% died, 4.7% deteriorated, 46.4% remained unchanged, 11.7% improved, 5.2% recovered spontaneously, and 9.7% had surgery.
- Spontaneous recovery was noted in 8.4% with mitral regurgitation and 3.6% with mitral stenosis-regurgitation.
- Delayed onset of mitral or aortic valve stenosis was observed in some patients years after graduation.
- The mean annual death rate (age 6-38) was 0.65%, peaking at 15-17 years.
- Fatality rates have decreased in recent years, with no recent deaths in younger patients attributed to rheumatic fever recurrence.
Conclusions:
- Acquired valvular heart disease exhibits diverse long-term trajectories, including spontaneous recovery and late-onset stenosis.
- Mortality rates have declined, and the primary cause of death has shifted from rheumatic fever in juvenile patients.
- Continued long-term surveillance is important for managing acquired valvular heart disease and understanding its evolving natural history.
Abstract:
In patients with acquired valvular heart disease detected by group cardiac examinations at school, we analyzed follow-up data obtained during school days as well as after graduation from senior high school. Of the 343 patients followed up after graduation from senior high school up to an age range of 20-38 years (mean: 29.3 years), 18 (5.2%) died, 16 (4.7%) deteriorated, 159 (46.4%) remained unchanged, 40 (11.7%) improved, 18 (5.2%) spontaneously recovered and 30 (9.7%) were treated surgically. Of patients who showed spontaneous recovery after graduation from senior high school, 16 cases (8.4%) had mitral regurgitation and 2 (3.6%) had mitral stenosis-regurgitation. In some patients, the disease type changed many years after graduation from senior high school. In particular, the appearance of stenosal lesions in the mitral or aortic valve was often delayed. The mean annual death rate for patients with acquired valvular heart disease (age range: 6-38 years) between April 1962 and March 1983 was 0.65%. The rate peaked at the 15-17 years age range. In recent years, the fatality rate has been falling and no deaths are seen in younger patients. In the past, the leading cause of death in juvenile patients with acquired valvular heart disease was the recurrence of rheumatic fever. For the past ten years, however, no death attributable to the recurrence of rheumatic fever has been registered.