Rheumatoid Arthritis with severe Aortic lnsufficiency and Prolapse of the Mitral Valve

Abstract

The valvular lesions caused by rheumatoid arthritis have been known for a long time. The valves may be affected by unspecific inflammatory changes or, specifically, by rheumatoid granulomas identical with subcutaneous nodules that lead to the malfunctioning of the aortic or the mitral valve. We present a patient affected by a classical seropositive rheumatoid arthritis accompanied by a severe aortic insufficiency and a prolapse of the mitral valve with rheumatoid involvement of the histologic granulomatous type, in whom both valves were replaced in two phases. The hemodynamic results were good for a period of time. Replacement of the valve by a prosthesis is the ideal treatment. There is no experience with treatment such a medication with immunosuppressive drugs.

The Inter-Relationship of Periostin, TGFβ, and BMP in Heart Valve Development and Valvular Heart Diseases

“…Histologic findings of myxomatous valvular disease include highly fragmented collagen within the valve fibrosa and excess accumulation of GAGs, which causes billowing of the valve leaflets, with or without prolapse and regurgitation of mitral or aortic valves [11,12,13]. Regardless of the classification of valve disease, the valve thickening is often an early and major clinical complication of cardiac valve dysfunction in neonatal/infantile and adult patients with inherited (bicuspid aortic valve or congenital polyvalvular disease) or acquired conditions, including Marfan syndrome-like disorders, Noonan syndrome, isolated non-syndromic X-linked myxomatous valvular dystrophy, rheumatic arthritis, and anti-Parkinson's disease drug-induced (dopamine agonists, i.e., pergolide and cabergoline) valvular disease [14,15,16,17,18,19,20]. At the molecular and genetic levels, periostin and transforming growth factor beta (TGF) and bone morphogenetic protein (BMP) ligands have emerged as important players in heart valve formation and remodeling, and valvular heart diseases in mammals [21,22,23,24,25] ( Fig.…”

Unusual Cause of a Stroke in a Patient with Seronegative Rheumatoid Arthritis

“…Histology shows the presence of either distinct granulomas identical to subcutaneous nodules or a non-specific inflammatory reaction [3]. The process is slow, yet rapidly progressive aortic valve disease followed by acute onset of valve incompetence has been reported in seropositive patients [4][5][6]. However, the patient described here was seronegative without evident signs of active arthritis.…”

“…In severe rheumatoid aortic incompetence, valve replacement is the treatment of choice. Concomitant pericardectomy has been recommended to prevent future complications from rheumatoid pericarditis and fluid collection [4]. This case suggests that the same indications as for vegetations should apply for granulomas regarding surgical intervention.…”

Prevalence of Mitral Valve Prolapse in Saudi Sickle Cell Disease Patients in Dammam — A Prospective-Controlled Echocardiographic Study

“…17 There was also no significant difference in BSA of the two groups of patients studied by Lippman et al 11 The ease of diagnosis of MVP by echocardiography and the wave of interest that followed its initial description resulted in numerous case reports and small clinical studies claiming association of MVP with a wide variety of conditions. [6][7][8][9][10][11][12][13][14][15][16] A good example is Marfan syndrome, which has been variously reported to be associated with MVP. 6,7 This is a rare condition occurring in one per 10,000 population.…”

“…3 A wide range of conditions have been reported to be associated with MVP. [6][7][8][9][10][11][12][13][14][15][16] Many of these conditions are in themselves rare and the reports are based mostly on case reports and small clinical studies. 3 With an MVP prevalence of 2.5% to 5% in the general population, 3,17 many of these reported associations appear weak.…”