Repair of the rheumatic mitral valve: Is the controversy over?

Antunes, Manuel J.

doi:10.1177/0218492320927316

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…9 10 Surgical reports from the pre-1994 era reported significant morbidity and mortality of up to 8% per year, especially in the young. 11 A 2015 systematic review on RHD in SA found that the overall crude incidence of symptomatic RHD was 24.7 per 100 000 (95% CI 22.1 to 27.4) population per annum among adults (aged >13 years) in Soweto, while the prevalence of asymptomatic echocardiographic RHD in schoolchildren was 20.2 cases per 1000 children (95% CI 15.3 to 26.2) in Cape Town. 12 The 60-day mortality after admission with acute heart failure due to RHD was 24.8% (95% CI 13.6% to 42.5%) and 180-day mortality was 35.4% (95% CI 21.6% to 54.4%).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Earlier data from Johannesburg (1976) and Cape Town (1981), SA showed a prevalence of approximately 7 per 1000 in school-aged children by cardiac auscultation 9 10. Surgical reports from the pre-1994 era reported significant morbidity and mortality of up to 8% per year, especially in the young 11. A 2015 systematic review on RHD in SA found that the overall crude incidence of symptomatic RHD was 24.7 per 100 000 (95% CI 22.1 to 27.4) population per annum among adults (aged >13 years) in Soweto, while the prevalence of asymptomatic echocardiographic RHD in schoolchildren was 20.2 cases per 1000 children (95% CI 15.3 to 26.2) in Cape Town 12.…”

Section: Introductionmentioning

confidence: 98%

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Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol

et al. 2023

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IntroductionRheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease. Despite significant cost to the health system and estimates from 2015 indicating both high incidence and prevalence of RHD in South Africa, no cohesive national strategy exists. An updated review of national burden of disease estimates, as well as literature on barriers to care for patients with RHD, will provide crucial information to assist in the development of a national RHD programme.Methods and analysisUsing predefined search terms that capture relevant disease processes from Group A Streptococcal (GAS) infection through to the sequelae of RHD, a search of PubMed, Scopus, ISI Web of Science, Sabinet African Journals, SA Heart and Current and Completed Research databases will be performed. All eligible studies on RHD, acute rheumatic fever and GAS infection published from April 2014 to December 2022 will be included. Vital registration data for the same period from Statistics South Africa will also be collected. A standardised data extraction form will be used to capture results for both quantitative and qualitative analyses. All studies included in burden of disease estimates will undergo quality assessment using standardised tools. Updated estimates on mortality and morbidity as well as a synthesis of work on primary, secondary and tertiary prevention of RHD will be reported.Ethics and disseminationNo ethics clearance is required for this study. Findings will be disseminated in a peer-reviewed journal and submitted to national stakeholders in RHD.PROSPERO registration numberCRD42023392782.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol

et al. 2023

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“…46 For younger patients, there are a number of surgical repair techniques available. 44,47 Antunes et al 48 , with a long experience in RHD surgery in South Africa, Mozambique, and Portugal, emphasize that rheumatic mitral valve disease remains a challenge with regard to surgical repair versus valve replacement. 48 Part of this is related to younger patients (20-30 years) with a persistent rheumatic inflammatory process that continues beyond surgery, and requires antibiotic prophylaxis following surgery and continued lifelong.…”

Section: Valve Surgerymentioning

confidence: 99%

“…44,47 Antunes et al 48 , with a long experience in RHD surgery in South Africa, Mozambique, and Portugal, emphasize that rheumatic mitral valve disease remains a challenge with regard to surgical repair versus valve replacement. 48 Part of this is related to younger patients (20-30 years) with a persistent rheumatic inflammatory process that continues beyond surgery, and requires antibiotic prophylaxis following surgery and continued lifelong. Several pathological and clinical RHD areas need to be understood, 48 notably that rheumatic mitral regurgitation is caused by elongated anterior leaflet chordae that causes prolapse of the leaflet, which is usually small and retracted, as is the posterior leaflet, and that the annulus is dilated in most cases, along with commissural fusion.…”

Section: Valve Surgerymentioning

confidence: 99%

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

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Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low‐ and middle‐income countries (LMICs) and among indigenous and disenfranchised populations in high‐income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub‐Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

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“…We are particularly delighted that Drs. Tirone David 7 and Manuel Antunes 8 generously provided their constructive insights and advice in the current special issue.…”

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confidence: 99%

Mitral valve surgery at the oriental crossroad

Wan

2020

Asian Cardiovasc Thorac Ann

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Repair of the rheumatic mitral valve: Is the controversy over?

Cited by 7 publications

References 14 publications

Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol

Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol

Rheumatic heart disease: The role of global cardiac surgery

Mitral valve surgery at the oriental crossroad

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