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PubMed2003

Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.

Adult↗
PubMed1976

[Circulatory disorders in rheumatic fever and rheumatic heart disease].

Proceeding from many years of observations of rheumatic heart diseases patients the authors analyse the peculiarities of circulatory disorders in them. The problems of diagnosis of an active rheumatic process that is often masked by decompensation signs are reflected. On the basis of 337 clinical and morphological comparisons and the examination of 145 patients recommendations were developed as to the diagnosis of several symptoms and the arrangement of a set of immunological tests (humoral and cellular factors of the body's natural resistance and immunopathological reactions). Electroradiokymography (213 patients) revealed the peculiarities of the disorders in the contractile function of the heart in early stages of circulatory disorders.

Conjunctiva↗
PubMed1992

Rheumatic heart disease prevalence among schoolchildren of an Ethiopian rural town.

Rheumatic heart disease (RHD) is the most important cardiovascular disease in hospital practice in Ethiopia. However, the prevalence rate of RHD at the community level remains unknown. The current survey was undertaken to estimate its prevalence among schoolchildren of a central Ethiopian rural town (Butajira). Accordingly, 92.8% of the entire schoolchildren (n = 3.235) in the town were screened. Their mean age was 13.4 +/- 3.5 years. Fifteen children, accounting for a rate of 4.6/1,000, were noted to have findings consistent with RHD. Females and older children were more frequently affected. Only 2 of the 15 students were aware of their disease, and neither of them were on regular secondary prophylaxis. Our finding is consistent with the hospital-based reports that showed RHD to be a common disorder in clinical practice. At the same time, the lack of awareness about their disease noted among the cases is worrisome and deserves serious attention.

Adolescent↗
PubMedDate not supplied

Prevalence of rheumatic fever and rheumatic heart disease in school children of Kathmandu city.

To find out the prevalence of rheumatic fever/rheumatic heart disease in an urban area, a survey of school children aged between 5 to 16 years studying in randomly selected government schools in Kathmandu city was done. Out of 4984 students enrolled in the study 4736 were examined, the percentage of absentees being five. Revised Jones Criteria (1992) was used for the diagnosis of rheumatic fever. Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases. A total of six cases of definite rheumatic heart disease (out of 13 suspected cases) were identified giving overall prevalence rate of 1.2 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in most earlier studies from developing countries but it is similar to that reported from rural Kathmandu in 1991. It is concluded that there is some downward trend in rheumatic fever/rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented overdiagnosis in the present study. We feel that there is an urgent need to launch a National Programme for the control of rheumatic fever/rheumatic heart disease in Nepal with emphasis on primary and secondary prophylaxis of the disease.

Adolescent↗
PubMed1990

Streptococcal antibody cross-reactivity with HLA-DR4+VE B-lymphocytes. Basis of the DR4 associated genetic predisposition to rheumatic fever and rheumatic heart disease?

B-lymphocytes obtained from patients with either rheumatic fever or rheumatic heart disease and from normal subjects were reacted with serum obtained from rabbits immunized with streptococcal cell wall antigen. The presence of cytotoxicity was sought using an inverted phase microscope after differential uptake of eosin dye. The serum was found to be significantly more cytotoxic to HLA-DR4 containing cells of both patients and normals compared with DR4 negative cells (P less than 0.0001).

Antibodies, Bacterial↗
PubMed1999

Valvular heart disease--repair or replacement?

An estimated 3 million patients in India need treatment for valvular heart disease. Rheumatic heart disease continues to be the major aetiologic factor. The mitral valve is best conserved with valvotomy or repair. The aortic valve is difficult to repair and is best replaced by a biological substitute (autograft or homograft). The tricuspid valve can be repaired in all patients. Prosthetic valves offer good long term durability but introduce additional risks to the patients. Experience over the past three decades suggests that conservation of natural valve mechanism is currently the best option.

Cardiovascular Surgical Procedures↗
PubMed1995

Immune response factors in rheumatic heart disease: meta-analysis of HLA-DR associations and evaluation of additional class II alleles.

OBJECTIVES: This study used a meta-analysis to examine HLA-DR frequencies in rheumatic heart disease and prospectively examined other class II allelic disease associations. BACKGROUND: Studies of rheumatic heart disease have reported HLA class II allelic associations, but these are inconsistent. METHODS: A meta-analysis combined all known (n = 10) studies to determine disease risk associated with HLA-DR antigen expression. Meta-analysis of studies grouped by ethnic derivation of subjects was also performed. The present study also examined DQA, DQB and DPB allele frequencies by DNA-based strategies. RESULTS: Meta-analysis showed a significant negative disease association with DR5 (odds ratio [OR] 0.67, p < 0.00003) for all combined studies. Among black patients, DR1 was increased (OR 2.80, p < 0.004); DR6 was increased (OR, 2.03, p < 0.003); and DR 8 was decreased (OR 0.32, p < 0.02). Among Eastern Indian patients, DR3 was increased (OR 2.44, p < 0.00003), with decreased expression for DR2 (OR 0.31, p < 0.00001) and DR5 (OR 0.52, p < 0.05). DR4 was increased among American whites (OR 1.74, p < 0.03), although there was significant heterogeneity among studies of whites. DQA, DQB and DPB allele frequencies were similar for control subjects and patients. CONCLUSIONS: Our findings support an association between major histocompatibility complex class II alleles and risk for rheumatic heart disease. However, heterogeneity in associations was observed among different ethnic and racial groups; regional and temporal differences in streptococcal outbreaks may compound this heterogeneity. Further studies are necessary to elucidate the respective contributions of these variables.

Alleles↗
PubMed1988

Immunohistochemical characterisation of Aschoff nodules and endomyocardial inflammatory infiltrates in left atrial appendages from patients with chronic rheumatic heart disease.

Fifty left atrial appendages collected fresh during closed mitral valvotomy in patients with chronic rheumatic heart disease, were analysed to determine the frequency of Aschoff nodules and characteristics of mononuclear inflammatory infiltration. Fifty-six percent of specimens demonstrated Aschoff nodules with no clinical or laboratory evidence of acute rheumatic activity in the patients undergoing surgery. Endomyocardial infiltration contained predominantly T cells and occasionally B cells. The relative proportions of T helper-inducer, T suppressor-cytotoxic lymphocytes and macrophages were 45.1 +/- 7.6, 23.5 +/- 4.8 and 29.3 +/- 9.6%, respectively. Frequent presence of Aschoff nodules and heavy mononuclear infiltrates in chronic rheumatic heart disease suggests a possibility of subclinical ongoing carditis.

Adolescent↗
PubMed1987

Lymphocyte subpopulations in rheumatic heart disease.

Monoclonal antibodies and indirect immunofluorescence techniques were used to compare the distribution of lymphocyte subpopulations of tonsil and peripheral blood from patients with rheumatic heart disease and age and socioeconomically matched patients undergoing tonsillectomy for chronic recurrent tonsillitis, but who had no evidence of rheumatic fever or rheumatic heart disease. The proportions of B cells (BA-1+), total T cells (Lyt-3), inducer/helper T cells (T4+) and cytotoxic/suppressor T cells (T8) were determined. No significant differences were apparent between rheumatic heart disease and control groups in resting cells from tonsils or blood. Cells undergoing proliferation in response to streptococcal blastogen A were identified by similar techniques. These tonsillar preparations from patients with rheumatic heart disease generated a smaller proportion of T8+ cultured cells and a greater T4/T8 ratio of cultured cells in response to group A streptococcal blastogen A than did nonrheumatic subjects.

Adenoids↗
PubMed1990

Rheumatic heart disease in schoolchildren in western district, Saudi Arabia.

The prevalence of rheumatic heart disease was assessed among schoolchildren aged between 6-15 years in the Western District. A sample size of 9,418 (10% of the target population) underwent cardiac evaluation. The prevalence of rheumatic heart disease was 24 per 10,000 schoolchildren (6-15 years). The prevalence was higher in rural areas and in females. This survey revealed that the carrier rate of beta-hemolytic streptococci was 34%.

Adolescent↗
PubMed1987

Variations in mortality of the coloured white and Asian population groups in the RSA, 1978-1982. Part III. Rheumatic heart disease.

An analysis was undertaken of mortality from rheumatic heart disease in the RSA between 1978 and 1982 in whites, coloureds and Asians. This article details the age-specific mortality rates (MRs) for each group and also comparisons between groups based on age-standardised MRs. The rates for Asians and coloureds markedly exceed those for whites, particularly in the lower age groups (under 45 years).

Adolescent↗