Clinical spectrum of chronic rheumatic heart disease in India

Background and aim of the study: The study aim was to determine prevalence and patterns of chronic rheumatic heart disease (RHD) in developing countries, where it remains a major cause of mortality and morbidity. The incidence of different valvular lesions and complications in chronic RHD were analyzed. Methods: The study design was a retrospective case series analysis in the setting of a tertiary care institution in southern India. Participants were consecutive patients registered under 'chronic RHD' in the cardiology department of the authors' institution over the past 20 years. Data are presented for 10,000 cases in two age groups: group I, aged less than or equal to18 years (n=2,910); and group II, aged >18 years (n=7,090). Results: Mitral regurgitation was the single most common lesion (n=1,007) in group I, while the dominant lesion in group II was mitral stenosis (n=2,943). Isolated aortic valve disease was seen in 130 (4.5%) and 195 (2.8%) cases in groups I and II, respectively. Tricuspid stenosis was seen in 45 cases, and rheumatic involvement of all four cardiac valves was documented in four cases. Pulmonary hypertension was present in 42.4% and 80.8% in groups I and II, respectively, and functional tricuspid regurgitation in 38.9% and 77.2%, respectively. Overall, 5.9% of patients had atrial fibrillation, 0.9% had left atrial thrombus (seen on transthoracic echocardiography) and 0.4% had embolic cerebrovascular events. Pericardial effusion was present in 0.7% cases, and infective endocarditis was noted at presentation in 0.6%. Conclusion: Chronic RHD in developing countries is associated with major complications and high mortality. The critical evaluation of individual lesions must be combined with frequent overall clinical evaluation in order to time appropriate medical and surgical interventions.