Valvular aspects of rheumatic heart disease

Reményi, Boglarka; ElGuindy, Ahmed; Smith, Sidney C.; Yacoub, Magdi H.; Holmes, David R.

doi:10.1016/s0140-6736(16)00547-x

Cited by 127 publications

(92 citation statements)

References 90 publications

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“…However, few studies have explored the prognostic value of baseline platelet counts in patients who underwent VRS, especially in the context of RHD. Patients with RHD frequently experience cardiac insufficiency, in which the platelets are overactivated and then aggregate 1, 9. Excessive consumption would cause a decrease in platelet counts.…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia as a Preoperative Risk Assessment Tool in Patients With Rheumatic Heart Disease Undergoing Valve Replacement Surgery

Wei

Jiang

Liu

et al. 2017

JAHA

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BackgroundPostoperative thrombocytopenia has been reported to be correlated with adverse events, but the prognostic value of baseline thrombocytopenia is unclear. This study was undertaken to evaluate the relationship between preoperative thrombocytopenia and adverse outcomes in patients with rheumatic heart disease who underwent valve replacement surgery.Methods and ResultsA total of 1789 patients with rheumatic heart disease undergoing valve replacement surgery were consecutively enrolled and postoperatively followed up for 1 year. Patients were stratified on the basis of presence (n=495) or absence (n=1294) of thrombocytopenia (platelet count, <150×109/L), according to hospital admission platelet counts. During the hospitalization period, 69 patients (3.9%) died. The in‐hospital all‐cause mortality rate was significantly higher in the thrombocytopenic group (6.9% versus 2.7%; P<0.001). Multivariate analyses revealed that thrombocytopenia was independently associated with in‐hospital all‐cause mortality (odds ratio, 2.21; 95% confidence interval, 1.29–3.80; P=0.004). Platelet counts could predict in‐hospital all‐cause mortality for patients both with and without previous atrial fibrillation (areas under the curve, 0.708 [P<0.001] and 0.610 [P=0.025], respectively). One‐year survival was significantly lower in patients with thrombocytopenia compared with controls (91.3% versus 96.1%; log‐rank=14.65; P<0.001). In addition, thrombocytopenia was an independent predictor for postoperative 1‐year all‐cause mortality in multivariate Cox regression analysis.ConclusionsPlatelet counts, as simple and inexpensive indexes, were reliable to be used as a preoperative risk assessment tool for patients with rheumatic heart disease undergoing valve replacement surgery.

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Section: Introductionmentioning

confidence: 99%

Thrombocytopenia as a Preoperative Risk Assessment Tool in Patients With Rheumatic Heart Disease Undergoing Valve Replacement Surgery

Wei

Jiang

Liu

et al. 2017

JAHA

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“…Rheumatic mitral regurgitation is characterized by some degree of commissural fusion, but chordal fusion and shortening and leaflet retraction are more prominent findings. 18 Similar pathology is noted in post-radiation mitral regurgitation. 19 In type IIIb, the mitral regurgitation is due to myocardial ischemia and/or ventricular remodeling, while the leaflets appear anatomically normal, with reduced mobility during systole.…”

Section: Mechanisms and Causes Of Mitral Regurgitationmentioning

confidence: 74%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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“…Rheumatic heart disease is the most common cause of valve disease in the developing nations (10,11). Chronic inflammation during the rheumatic process may cause narrowing of the valves resulting in decreased blood flow through the heart or leakage of the valves causing blood to flow in the wrong direction.…”

Section: Discussionmentioning

confidence: 99%