ABSTRACT
Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically corrected by prosthetic heart valve were -11 (37.9%). In CRHD total corrected cases, by prosthetic heart valve and percutaneous balloon mitral valvotomy (PBMV) account for 51.7%. One patient had PBMV procedure during 5th month of present pregnancy i/v/o severe mitral stenosis with mitral valve area -0.8 cm2 and another patient had PBMV during her first pregnancy. In this study 42% were in NYHA class I. 14% were in NYHA class IV. CHF was seen in 10%. Termination of pregnancy was necessary in 6 with CHD and 5 with CRHD. There were 39 deliveries with one set of twins. All the babies were alive. Maternal mortality was confirmed in one case with Eisenmenger’s syndrome + HELLP syndrome. Live birth rate was higher in cases with NYHA class I/II than in those with NYHA class III/IV (82.8% versus 66.60%).Conclusions: Management by a pregnancy heart team as per guidelines would reduce mortality.
ABSTRACT
Rheumatic heart disease & rheumatic fever is important public health issue. overall incidence and prevalence of acute rheumatic fever is in downtrend in Bangladesh. But exact incidence & prevalence of chronic rheumatic heart disease (CRHD) is unknown. Objective: We wanted to find out prevalence of CRHD among adult patients undergoing echocardiography in a tertiary level hospital of Bangladesh. Methods: The study was conducted in the department of cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between January 2018 to December 2018. Echocardiography was done with VividE9® machine. Patients who underwent echocardiography for various indication on indoor and outdoor basis were screened for this study. Among them 1000 male & female patients, age between 18-65 years who had their echo done by the investigators were enrolled for analysis. CRHD was defined as per latest echocardiography guideline. Frequency & pattern of CRHD were calculated. Results: Out of 1000 patients 74 cases were diagnosed as CRHD (7.4%), among them 52 patients were female. Mitral stenosis (MS) was found in 28.3% cases, Isolated mitral regurgitation (MR) in 5.4%, MS with MR in 18.9%, Aortic stenosis (AS) in 8.1%, Aortic regurgitation (AR) in 10.85%, AS with AR in 13.5%, involvement of both aortic & mitral valve in 27%, involvement of mitral, aortic & tricuspid valve in 1.3%. Conclusion: Findings of the study will help to set public health programs for primary & secondary prevention of CRHD. Further population-based study is required to know the exact prevalence of the disease.