Features of rheumatic mitral valves and a grading system to identify suitable repair cases in China

Luo, Tiange; Han, Jie; Xu, Meng

doi:10.21037/jtd.2017.08.121

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…In total, we identified 3,212 records among which 83 studies were finally included (Supplementary Figure 1) [ 8 9 10 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 ...…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease

Noubiap

Nyaga²,

Ndoadoumgue

et al. 2020

Global Heart

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Objective: To estimate the incidence, prevalence, and correlates of atrial fibrillation (AF) in a global population with rheumatic heart disease (RHD). Methods: Bibliographic databases were searched to identify all published studies providing data on AF in patients with RHD. Random-effects meta-analysis method was used to pool estimates. Results: Eighty-three studies were included, reporting data from 75,637 participants with RHD in 42 countries. The global prevalence of AF in RHD was 32.8% (range: 4.3%-79.9%). It was higher in severe valvular disease (30.8% vs 20.7%, p = 0.009), in severe mitral valve disease compared to severe aortic disease (30.4% vs 6.3%, p = 0.038). The global cumulative incidence of AF in patients with RHD was 4.8%, 11.4%, 13.2%, and 30.8% at 1, 2, 5, and 10 years of follow-up, respectively. From comparison between patients with and without AF, AF was associated with increased age (mean difference [MD]: 9.5 years; 95% CI: 7.8-1.3), advanced heart failure (odds ratio [OR]: 4.4; 95% CI 2.1-9.3), tricuspid valve involvement (OR: 4.

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Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease

Noubiap

Nyaga²,

Ndoadoumgue

et al. 2020

Global Heart

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“…In most late cases, the valve commissures are fused and often endothelium surface erosion is observed. Chordae tendineae show fusion and shortening ( Figure 1B ), which may reduce subvalvular chordal space ( 12 , 13 ). Calcification occurs in some cases of RHVD ( Figures 1C,D ), however fibrosis and inflammation are major findings ( Figures 2A–C ) ( 14 , 15 ).…”

Section: Pathology Of Rhvdmentioning

confidence: 99%

Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms

Passos

Nunes

Aïkawa

2021

Front. Cardiovasc. Med.

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Rheumatic heart valve disease (RHVD) is a post-infectious sequel of acute rheumatic fever resulting from an abnormal immune response to a streptococcal pharyngitis that triggers valvular damage. RHVD is the leading cause of cardiovascular death in children and young adults, mainly in women from low and middle-income countries. It is known that long-term inflammation and high degree of fibrosis leads to valve dysfunction due to anatomic disruption of the valve apparatus. However, since public and private investments in RHVD studies are practically inexistent the number of publications is scarce. This disease shows different natural history and clinical presentations as compared to other degenerative heart valve diseases. Although more than five decades passed after the pioneering studies on the pathogenesis of RHVD, it is still unclear how self-tolerance mechanisms fail in this disease, and how humoral and cellular inflammatory responses are interconnected. Despite that pathological mechanisms have been already proposed for RHVD, none of them are able to explain the preferential involvement of the mitral valve. This review focuses on pathophysiology and underlying mechanisms of RHVD.

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“…Three problems concern cardiac surgeons regarding this topic (14,15): long-term follow-up results (8,16), repair technique (13,17), and pathological features that can indicate the requirements for repair (18,19). Interestingly, satisfactory follow-up results have been reported at our centre (13) and other cardiac centres (7,12).…”

Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 81%

“…However, the performance of other repair techniques has also been reported (21). The lack of established pathological features in this field has been the main impediment to popularising and advancing the rheumatic MVP surgical technique (18,21). Our clinicopathological classification provides a step-by-step path for rheumatic MVP in China.…”

Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 98%

Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Luo¹,

Xu²

2021

J Thorac Dis

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Background: There is a lack of established pathological indications for rheumatic valve repair. Therefore, we summarized the pathological classifications of rheumatic heart diseases and their correlations with the surgical strategies. Methods: This observational study enrolled patients with rheumatic heart diseases who underwent mitral valve repair (MVP) or replacement at our centre between January 2017 and January 2019. Mitral leaflet, mitral commissural, and sub-valvular apparatus were classified into three grades from mild to severe, according to their degree of pathological damage. Based on certain principles and the grade of mitral leaflet, mitral commissural, and sub-valvular apparatus damage, three pathological types were identified (types I to III), based on which all patients were classified. The features of each pathological type were summarised.Differences between the three pathological types were analysed using chi-square test of tendency. These data were used to propose a clinico-pathological classification of rheumatic mitral valve damage in Chinese patients. Results: Of 398 patients, 284 (70%) underwent MVP for rheumatic mitral valve diseases. There were 58 type I (15%) patients in the study, all of whom underwent repair (repair rate, 100%). Preoperative moderateto-severe regurgitation with mild pathological lesions was observed in 64% of these patients. In 260 type II (65%) patients, the repair rate was 76% (197/260); preoperative moderate-to-severe stenosis was observed in 88% of these patients. In 80 type III (20%) patients, the repair rate was 36% (29/80); the preoperative rates of extremely severe stenosis and moderate-to-severe regurgitation in these patients were 50% and 40%, respectively. Several preoperative parameters show the change in trend with the increase in the pathological classification severity. Conclusions: Our clinico-pathological classification of rheumatic mitral valve damage is applicable to MVP. Considering that the classification principles are based on the possibility of mitral repair, it provides a phased and achievable target ratio for MVP and a principle of screening patients who should undergo rheumatic MVP.

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Features of rheumatic mitral valves and a grading system to identify suitable repair cases in China

Cited by 12 publications

References 22 publications

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease

Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms

Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

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