Most common valvular lesion in rheumatic heart disease
Most common valvular lesion in rheumatic heart disease Rheumatic heart disease (RHD) remains a significant cause of acquired heart valve pathology worldwide, particularly in developing countries. It primarily results from rheumatic fever, an inflammatory condition triggered by group A streptococcal infections. This autoimmune response leads to chronic valvular damage, which progressively impairs cardiac function. Among the various valvular lesions associated with RHD, the most common and characteristic is mitral stenosis, which often occurs as a sequela of recurrent rheumatic attacks.
The pathophysiology of rheumatic valvular lesions involves an autoimmune process where immune-mediated inflammation damages the valvular tissue, primarily affecting the atrioventricular valves. The mitral valve is most vulnerable due to its anatomical and hemodynamic features. Over time, repeated episodes of rheumatic fever cause fibrosis, thickening, and fusion of the valve leaflets, leading to stenosis. The leaflet thickening and commissural fusion result in a narrowed mitral orifice, impeding blood flow from the left atrium to the left ventricle. Most common valvular lesion in rheumatic heart disease
Most common valvular lesion in rheumatic heart disease Clinically, mitral stenosis manifests through symptoms such as exertional dyspnea, orthopnea, pulmonary congestion, and in advanced cases, atrial fibrillation due to left atrial enlargement. The characteristic physical signs include a loud first heart sound (S1), a diastolic murmur best heard at the apex with the patient in the left lateral decubitus position, and a “opening snap” reflecting the stiffened valve leaflets. Over time, the increased pressure in the pulmonary circulation can lead to pulmonary hypertension and right-sided heart failure.
While mitral stenosis is the most common lesion, rheumatic involvement can also affect other valves. The mitral regurgitation may develop due to leaflet perforation or chordal rupture, while the aortic valve may be involved, causing aortic regurgitation or stenosis. However, these lesions are less prevalent compared to mitral stenosis. The progression of valvular damage is often insidious, with many patients remaining asymptomatic for years until significant stenosis or regurgitation develops. Most common valvular lesion in rheumatic heart disease
Diagnosis relies heavily on echocardiography, which reveals leaflet thickening, commissural fusion, and decreased valve mobility in mitral stenosis. Doppler studies quantify the pressure gradients and valve area, guiding management decisions. In resource-limited settings, clinical examination and auscultation remain vital. Preventive strategies, including prompt treatment of streptococcal infections and secondary prophylaxis with penicillin, are crucial to mitigate disease progression. Most common valvular lesion in rheumatic heart disease
Management of rheumatic valvular lesions depends on severity. Mild cases may be managed conservatively with medications such as diuretics, beta-blockers, or calcium channel blockers to relieve symptoms. Severe stenosis or regurgitation often requires surgical intervention, including valve repair or replacement. Balloon valvotomy has become a preferred minimally invasive option for suitable cases of mitral stenosis, especially in developing nations.
In conclusion, while rheumatic heart disease can affect multiple valves, mitral stenosis remains the most common valvular lesion in RHD. Its recognition, early diagnosis, and appropriate management are essential to prevent complications and improve quality of life for affected individuals. Most common valvular lesion in rheumatic heart disease
