Gallbladder condition in patients with rheumatic fever and acquired valve defects of rheumatic origin

Abstract

Gallbladder (GB) and heart are linked by viscero-visceral reflexes, but little is known about the connections between GB and heart in patients with acute and chronic rheumatic heart disease. Purpose of the study. To assess the GB condition in patients with acute and chronic rheumatic disease and the difference in structural and functional sonographic parameters of heart in dependence of GB condition. Materials and methods. We examined 136 patients including 58 patients with active rheumatism (mean age 36,72 ± 3,00 years), 44 patients with chronic rheumatic heart disease (CRHD), who underwent surgical correction of the valvular defect (mean age 54,00 ± 3,69 years), and 34 patients with CHD, who were treated as inpatients withour surgery (mean age 61,48 ± 4,50 years). Results. Among 136 patients with acute and chronic forms of rheumatic heart disease, GB changes were significantly more common than intact GB (62,5 ± 4,1% vs. 37,5 ± 4,1%, p < 0,05). The incidence of GB disorders was the highest in patients with CRHD, who underwent drug treatment (76,5 ± 7,3% vs. 58,7 ± 6,5% and 50,0 ± 7,5%, both p < 0,05), which were characterized by older age. No significant differences in the incidence of various pathological conditions of GB were revealed between acute and chronic rheumatic heart disease groups. The most common pathological GB changes included signs of cholecystitis, biliary sludge and cholesterosis, cholelithiasis, the least common – GB removal due to cholelithiasis. Patients with biliary autonomic viscero-visceral cardioneuropathy differed from those with intact GB by the thickening of the interventricular septum and posterior wall of the left ventricle, which correlated with the increased duration of inpatient treatment, diastolic hypertension and lower alanine aminotransferase. Conclusions. In patients with acute and chronic forms of rheumatic heart disease, the GB condition is often changed. These changes affect heart condition, blood pressure and carbohydrate metabolism. Keywords: gallbladder, chronic rheumatic heart disease, valvular defects, rheumatic fever, echocardiography.