The changing spectrum of rheumatic mitral regurgitation in Soweto, South Africa

• Published in: Cardiovascular Journal of Africa Vol. 28; no. 4; pp. 215 - 220
• Main Authors: Peters, Ferande, Libhaber, Elena, Mohammed, Rafique Essop, Meel, Ruchika
• Format: Journal Article
• Language: English
• Published: South Africa Clinics Cardive Publishing 01.07.2017
• Subjects: Adult; Cross-Sectional Studies; Echocardiography; Echocardiography - methods; Female; Humans; Incidence; Male; Mitral Valve - diagnostic imaging; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - epidemiology; Mitral Valve Insufficiency - etiology; Prospective Studies; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - diagnosis; Rheumatic Heart Disease - epidemiology; Rheumatic mitral regurgitation; South Africa - epidemiology
• ISSN: 1995-1892; 1680-0745
• DOI: 10.5830/CVJA-2016-086

Objectives: To determine the clinical and echocardiographic characteristics of contemporary patients with rheumatic mitral regurgitation (MR) at Chris Hani Baragwanath Academic Hospital.Methods: This prospective, cross-sectional study included 84 patients with isolated moderate or severe rheumatic MR who underwent clinical and echocardiographic assessment.Results: Mean age of the patients was 44 ± 15.3 years (84% females). Acute rheumatic fever was rare. Hypertension and HIV were present in 52 and 26%, respectively. Echocardiography showed leaflet thickening and calcification, restricted motion and subvalvular disease in 41, 25 and 34%, respectively. Carpentier IIIa leaflet dysfunction occurred in 80% of patients and leaflet prolapse was seen in only 20%. These findings contrast with the previous literature, where patients were younger, they had rheumatic carditis and there were no co-morbidities. Leaflets were pliable, isolated leaflet prolapse was common and commissural fusion was absent.Conclusion: Contemporary patients with rheumatic MR were older, fewer had rheumatic fever and there were more co-morbidities. Echocardiographic features had evolved to greater leaflet thickening, calcification and reduced motion with minimal prolapse. These findings may have important implications for surgical management of this disease.