ABSTRACT
La fiebre reumática aguda es una enfermedad con baja incidencia en nuestra región. Sus complicaciones conllevan una elevada morbi-mortalidad. El diagnóstico es un desafío en la actualidad, teniendo la clínica un rol preponderante; permitiéndonos mantener una alta sospecha a pesar de su baja incidencia. Se presenta el caso clínico de un paciente sexo masculino cuyo diagnóstico fue un reto para el equipo de salud.
Acute rheumatic fever is a disease with low incidence in our region. Its complications involve high morbidity and mortality. Its diagnosis is currently a challenge, with clinical presentation playing a predominant role, allowing us to maintain a high diagnostic suspicion despite its low incidence. The clinical case of a male patient is presented, whose diagnosis posed a challenge for the healthcare team.
A Febre reumática aguda é uma doença com baixa incidência em nossa região. Suas complicações envolvem alta morbidade e mortalidade. Seu diagnóstico é atualmente um desafio, com a apresentação clínica desempenhando um papel predominante, permitindo-nos manter uma alta suspeita diagnóstica apesar de sua baixa incidência. É apresentado o caso clínico de um paciente do sexo masculino, cujo diagnóstico representou um desafio para a equipe de saúde.
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O diagnóstico etiológico de quadros coréicos é amplo e algumas características da apresentação auxiliam no raciocínio diagnóstico, como o tempo de instalação do quadro (agudo/crônico), a distribuição corporal (focal/generalizada) e sintomas associados. Na infância, a principal causa da forma aguda é a coreia de Sydenham. Descrevemos o caso de uma paciente do sexo feminino de 13 anos que apresentou hemicoreia de instalação aguda relacionada a febre reumática, sendo a manifestação dimidiada atípica nesta condição.
There are numerous causes of chorea, and some characteristics of the presentation of this symptom help in the diagnosis reasoning, such as the onset time of the condition (acute/chronic), body distribution (local/generalized), and associated symptoms. In childhood, the main cause of acute chorea is Sydenham chorea. In childhood, the main cause of the acute form is Sydenham chorea. We report a case of a 13-year-old female patient who presented with acute onset hemichorea, being diagnosed with Sydenham's chorea.
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In patients with Chronic Rheumatic Carditis, active carditis is an often underdiagnosed condition. Rheumatic attacks promote the aggravation of existing lesions, leading to a deterioration of the patient's clinical condition. Thus, reducing the morbidity and mortality of the disease depends, in part, on controlling relapses through secondary prophylaxis. Underdiagnosis is due in part to the occurrence of subclinical rheumatic attacks. This study was carried out with data from patients who were diagnosed with Chronic Rheumatic Carditis and who underwent cardiac surgery for valve replacement or repair, without clinical or laboratory evidence of rheumatic outbreak. A fragment of myocardium was sent for histopathological analysis. Data on the frequency of histopathological alterations compatible with a rheumatic outbreak were analyzed. After analysis, 80% of patients showed changes compatible with inflammatory activity. Of these, 87.5% had lymphocytic infiltrate; 25% had Aschoff's nodules. The most frequent histopathological findings of chronic disease were myocardial hypertrophy in 56.7% of patients and fibrosis in 53.3% (AU).
Nos pacientes com Cardite Reumática Crônica, a cardite em atividade é uma condição frequentemente subdiagnos-ticada. Os surtos reumáticos promovem o agravamento das lesões já existentes, levando a uma deterioração da condição clínica do paciente. Dessa forma a redução da morbimortalidade da doença depende, em parte, do contro-le de recidivas a partir da profilaxia secundária. O subdiagnóstico deve-se em parte a ocorrência de surtos reumáti-cos subclínicos. Este estudo foi realizado com dados dos pacientes que tiveram o diagnóstico de Cardite Reumática Crônica e foram submetidos à cirurgia cardíaca para troca ou plastia valvar, sem evidência clínica ou laboratorial de surto reumático. Um fragmento de miocárdio foi enviado para análise histopatológica. Foram analisados os dados de frequência de alterações histopatológicas compatíveis com surto reumático. Após análises, 80% dos pacientes apresentaram alterações compatíveis com atividade inflamatória. Desses, 87,5% apresentavam infiltrado linfocitá-rio; 25% apresentavam nódulos de Aschoff. Os achados histopatológicos de doença crônica mais frequentes foram hipertrofia miocárdica em 56,7% pacientes e fibrose em 53,3% (AU).
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Rheumatic Fever , MyocarditisSubject(s)
Humans , Male , Child , Rheumatic Heart Disease/complications , Endocarditis, Bacterial/complications , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/diagnostic imaging , Pediatrics , Echocardiography/methods , Radiography, Thoracic/methods , Cardiomegaly/complications , Diagnosis, Differential , Electrocardiography/methods , Heart Valves/abnormalities , Mitral Valve/surgeryABSTRACT
Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.
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SUMMARY OBJECTIVE: Coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in the frequency of many diseases. In this study, we aimed to investigate the changes in the frequency and clinical features of acute rheumatic fever (ARF) in this period and determine the effect of health measures taken against COVID-19 on this change. METHODS: The cases with initial attack of ARF between January 2016 and March 2022 in Ataturk University, Division of Pediatric Cardiology, were determined from the clinic's database, and case per month ratios were calculated for each period, retrospectively. Also the frequency of the clinical manifestations was compared among patients before and during the outbreak. RESULTS: Frequency of the major clinical manifestations among patients before and during the outbreak was similar. On average, the number of cases reported per month in the years 2016, 2017, 2018, and 2019 are, respectively, 1.75, 2, 2.25, and 2.58. In the first 3 months of 2020, the average number of cases reported per month was 3.67. After the advent of the pandemic, in the period from April to December 2020 and from January to September 2021, an average of 0.56 and 0.22 cases were reported per month, respectively. The frequency of clinical features between patients diagnosed before and during the outbreak was similar. CONCLUSIONS: Our results indicated an important decrease in frequency of ARF, but no change in the clinical features of the disease during the COVID-19 pandemic. It is thought that this is the result of health measures taken for COVID-19. Children with an increased risk of acute rheumatic fever should be encouraged in terms of wearing mask, social distance, and cleaning, especially during the seasons when upper respiratory tract infections are common. Thus, a permanent decrease in the incidence of ARF and its recurrences may be achieved.
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Background: Rheumatic fever principally influences kids in developing states, particularly where deficiency is common. Atrial fibrosis is a mutual characteristic of clinical atrial fibrillation (AF) and is accompanying with AF in a diversity of experiment sittings, Aim and Objectives: The current work aimed to assess whether there are any clinical or echo-cardiographic parameters that expect the existence of AF among cases with rheumatic mitral valve disorder (RMVD), Subjects and Methods: The current study was a comparative cross-sectional was conducted on 100 RMVD cases at cardio-vascular medicine department Tanta university hospitals within 6-mths starting from September 2019. Cases have been allocated into 2 groups: Group-I: 50 cases with sinus rhythm. Group-II: 50 cases with AF, Results: A significant change was found among study groups regarding Fibrosis characteristics, There is a highly significant difference between the three different types regarding mitral valve area (MVA), LA-diameter, LA volume, LA-diameter/BSA and LA volume index, Age, area of mitral valve, LA-diameter and LA volume were found to be significant predictors for AF, Conclusion: Echo-cardiography factors could recognize cases at higher danger of advancing AF among RMVD cases who may benefit from preventive measures.
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Objective:To investigate the clinical manifestations, pathological characteristics, treatment and prognosis of pediatric rheumatic carditis with the initial symptom of acute heart failure, and to improve the clinical understanding of the disease.Methods:The clinical data, laboratory examination results, imaging findings, treatment and prognosis data of 10 cases with acute rheumatic carditis were collected and analyzed retrospectively.The patients pre-sented with acute heart failure as the first symptom and were treated in Shenzhen Children′s Hospital from January 2015 to February 2022.Results:There were 4 males and 6 females in this study.The mean age was 9.1 years (3 years and 1 month to 11 years and 3 months), and the average onset age was (9.3 ± 3.2) days (4-14 days). All the 10 cases had circulation symptoms.Besides, 4 cases were also complicated with joint symptoms, 3 cases with neurological symptoms and 2 cases with skin symptoms.Echocardiography revealed mitral valve diseases in all cases.More specifically, combined valve diseases were found in 5 cases, pure mitral regurgitation in 3 cases, and mixed mitral valve diseases (mitral regurgitation complicated with mitral stenosis) in 2 cases.After receiving antibiotic therapy, anti-infection treatment and anti-heart failure therapy, symptoms improved in all patients and valve lesions were alleviated.All patients were followed up for 6 months to 6 years.Six cases had persistent rheumatic heart disease during the follow up.Conclusions:Pediatric rheumatic carditis with the initial symptom of acute heart failure is characterized by early onset and the typical manifestation of rheumatic fever.Mitral valve disease is the commonest lesion.Echocardiography is of great value for the early diagnosis of the disease.Medical treatment is effective, but the incidence of chronic rheumatic heart disease is still high.
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ABSTRACT Objective: To evaluate the importance attributed to tonsillitis by guardians and their level of knowledge about the disease, correlating their management with their schooling and socioeconomic profiles. Methods: A quantitative, descriptive and observational cross-sectional study involving students aged 5 to 17 years from state-owned and private schools. A questionnaire was applied on management of tonsillitis and knowledge about rheumatic fever, addressing demographic and socioeconomic data. Results: A total of 323 students were included, predominantly females (61.3%), from state-owned schools (77.1%), with a mean age of 9.7±0.3 years. Among the guardians, 48.6% completed high school. Among the students 75.2% had at least one episode of odynophagia in the previous 12 months. Considering the previous 2 years, 89.8% reported this symptom. There was no collection of bacteriological specimens in 67.8%, and in 83% if taking into account only the last episode, despite the search for medical care in most cases (92.6%). The use of anti-inflammatory drugs was very frequent (43.0% "always" and 42.4% "sometimes"). Among the guardians, 81.7% denied being aware of the relation between rheumatic fever and inappropriate treatment of odynophagia; 85.8% said they wished they had received more information. Conclusion: Although it is quite common in schoolchildren, tonsillitis is neglected by many guardians and health professionals, and the ignorance of its relation with rheumatic fever is practically universal, which may contribute to its high prevalence.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Students , Tonsillitis/epidemiology , Schools , Brazil/epidemiology , Cross-Sectional StudiesSubject(s)
Humans , Rheumatic Heart Disease , Sulfhydryl Compounds , Biomarkers , Risk Factors , HomeostasisABSTRACT
RESUMEN Fundamento: la fiebre reumática tiene una incidencia alta en los países en vías de desarrollo. Es un padecimiento inflamatorio que afecta el tejido celular subcutáneo, sistema nervioso, piel y corazón, donde el bloqueo auriculoventricular de segundo grado Mobitz tipo 1 como expresión de una fiebre reumática es poco frecuente. Su diagnóstico constituye un gran desafío. Objetivo: presentar el caso de un adolescente sin historia de manifestaciones clínicas cardiovasculares de un bloqueo auriculoventricular de segundo grado Mobitz tipo Presentación del caso: paciente de 17 años de edad, masculino, sin antecedentes de amigdalitis reciente, al cual se le realizó un electrocardiograma como parte del seguimiento de la hipertensión arterial diagnosticada en el 2016, confirmándose un bloqueo auriculoventricular de segundo grado Mobitz tipo 1 en la consulta de Cardiología, sin manifestaciones clínicas cardiovasculares ni aumento de volumen en las articulaciones. Conclusiones: se debe sospechar en un paciente con un bloqueo auriculoventricular de segundo grado Mobitz tipo 1 sin manifestaciones clínicas cardiovascular en una carditis subclínica en el paciente pediátrico. Se observó que no hay progresión del bloqueo auriculoventricular de segundo grado Mobitz tipo 1 luego de comenzar con la benzatina.
ABSTRACT Background : rheumatic fever had a high incidence in developing countries. It is an inflammatory disease that affects the subcutaneous tissues, the central nervous system, the skin and the heart. The atrioventricular block second degree Mobitz type 1 as expression of rheumatic fever is unusual. Its diagnosis is a big challenge today. Objective : to present the case of a teenager with no previous history of cardiovascular manifestations of atrioventricular block second degree Mobitz type 1. Case report: 17- years-old male patient, without background of recent tonsillitis, who received an electrocardiogram as part of the checking of hypertension diagnosed in 2016, where atrioventricular of second degree a blockage Mobitz type 1, without clinical manifestations neither increase of volume in the articulations, was diagnosed in Cardiology consult. Conclusions: an atrioventricular block Mobitz type 1 without clinical cardiovascular manifestations could be suspected in a subclinical carditis in pediatric patients. The treatment with specific antibiotics avoids the progression of the disease.
ABSTRACT
Resumo Fundamentos: Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos. Objetivo: O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos. Métodos: Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares. Ocorreu fibrose moderada a acentuada mais frequentemente em válvulas reumáticas do que em válvulas controle (100% vs. 29%; p<0,001). Ocorreu calcificação em 35% das valvas reumáticas, principalmente entre as valvas estenóticas, associada à área valvar mitral (p=0,003). Conclusões: Apesar do intenso grau de fibrose, o processo inflamatório permanece ativo na valva mitral reumática, mesmo em doença tardia com disfunção valvar. A calcificação predominou em valvas estenóticas e em pacientes com disfunção ventricular direita.
Abstract Background: The underlying mechanisms by which rheumatic heart disease (RHD) lead to severe valve dysfunction are not completely understood. Objective: The present study evaluated the histopathological changes in mitral valves (MV) seeking an association between the pattern of predominant valvular dysfunction and histopathological findings. Methods: In 40 patients who underwent MV replacement due to RHD, and in 20 controls that underwent heart transplant, histological aspects of the excised MV were analyzed. Clinical and echocardiographic data were also collected. Histological analyses were performed using hematoxylin-eosin staining. Inflammation, fibrosis, neoangiogenesis, calcification and adipose metaplasia were determined. A p value<0.05 was considered to be statistically significant. Results: The mean age of RHD patients was 53±13 years, 36 (90%) were female, whereas the mean age of controls was 50±12 years, similar to the cases, with the majority of males (70%). The rheumatic valve endocardium presented greater thickness than the controls (1.3±0.5 mm versus 0.90±0.4 mm, p=0.003, respectively), and a more intense inflammatory infiltrate in the endocardium (78% versus 36%; p=0.004), with predominance of mononuclear cells. Moderate to marked fibrosis occurred more frequently in rheumatic valves than in control valves (100% vs. 29%; p<0.001). Calcification occurred in 35% of rheumatic valves, especially among stenotic valves, which was associated with the mitral valve area (p=0.003). Conclusions: Despite intense degree of fibrosis, the inflammatory process remains active in the rheumatic mitral valve, even at late disease with valve dysfunction. Calcification predominated in stenotic valves and in patients with right ventricular dysfunction.
Subject(s)
Humans , Male , Female , Adult , Aged , Rheumatic Heart Disease/diagnostic imaging , Calcinosis/diagnostic imaging , Mitral Valve Insufficiency , Mitral Valve Stenosis/diagnostic imaging , Middle Aged , Mitral Valve/diagnostic imagingABSTRACT
Objetivo: analisar informações presentes na literatura sobre a citada patologia com enfoque odontológico, baseando-se em evidências atuais, a fim de estruturar uma conduta clínica, métodos preventivos e terapêuticos. Revisão de literatura: executou-se busca na literatura em dezembro de 2020, por meio dos descritores pré-estabelecidos, nos bancos de dados LILACS e PubMed/MEDLINE, além de complementações utilizando o Google Scholar. Foram encontrados 563 artigos, refinados em 10, juntamente ao uso de 3 livros. Considerações finais: a partir dos achados, constatou-se que a realização de uma anamnese criteriosa durante a primeira consulta faz-se imprescindível, por auxiliar na compreensão dos aspectos fisiopatológicos do paciente, os quais irão determinar o emprego ou não de fármacos, principalmente antes de procedimentos invasivos. Em contrapartida, verificou-se a negligência desse assunto no âmbito odontológico, pelo fato de existirem poucos estudos relacionados ao manejo clínico de pacientes com Febre Reumática (FR), sendo necessárias maiores pesquisas, com o fito de construir-se uma conduta clínica adequada, reduzindo-se os riscos e a incidência de tal enfermidade.(AU)
Objective: to analyze information in the literature about mentioned pathology with a dental focus, based on current evidence in order to structure a clinical conduct, preventive and therapeutic methods. Literature Review: literature searches were performed in December 2020, using pre-established descriptors, in the databases LILACS and PubMed/MEDLINE, in addition to complementations using Google Scholar. About 563 articles were found, refined in 10, along with the use of 3 books. Final Considerations: From the findings, it was found that the performance of a careful anamnesis during the first consultation is essential, as it helps to understand the patient's pathophysiological aspects, which will determine the use of drugs, mainly, before invasive procedures. On the other hand, this matter was neglected in the Dental field, due to the fact that there are few studies related to the clinical management of patients with Rheumatic Fever (RF), and further research is necessary, with the aim of building an adequate clinical conduct, reducing the risks and the incidence of such a disease.(AU)
Subject(s)
Humans , Rheumatic Fever/physiopathology , Practice Patterns, Dentists' , Rheumatic Fever/diagnosis , Risk Factors , Dental ProphylaxisABSTRACT
Abstract Background: Mortality from cardiovascular diseases has reduced in Brazil in recent decades, but this phenomenon is not clear in the northeast region of the country. Objectives: To describe the mortality trends from cardiovascular disease in Bahia from 2000-2015, in total population and by sex and age groups, and by specific causes (ischemic heart disease, cerebrovascular diseases, rheumatic heart disease and heart failure). Methods: This was a time series study. Data were obtained from SIM-DATASUS and IBGE, and the 10th revision of the ICD used for disease classification. Mortality rates (per 100,000 inhabitants) were calculated from total cardiovascular disease and specific causes, by sex and age groups. Direct standardization was used to adjust for age, using the population of 2010 as reference. Linear regression models estimated percentage variation. The significance level of 5% was adopted. Results: In Bahia, crude mortality rates from cardiovascular disease increased in the period; however, after standardization by age, mortality rates became stable for the total and female populations, with a slight reduction for the male population. An increase in mortality rates from cardiovascular disease was found in the elderly groups. For ischemic heart disease, a progressive increase in adjusted mortality rates was observed: 43%, 24% and 29% for the total, male, and female population, respectively. There was a progressive reduction in crude and age-standardized mortality rates from heart failure in all groups, a modest reduction in age-adjusted mortality rates from cerebrovascular diseases, and a slight reduction in age-standardized mortality rate from rheumatic heart disease, especially in the subgroup <40 years. Conclusions: Mortality from cardiovascular disease in Bahia did not follow the decreasing trend of other Brazilian states, especially in relation to ischemic heart disease, which showed an increase in mortality rates.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Rheumatic Heart Disease/mortality , Cerebrovascular Disorders/mortality , Myocardial Ischemia/mortality , Heart Failure/mortality , Time Factors , Brazil , Cardiovascular Diseases/mortality , Age Factors , Ecological StudiesABSTRACT
An 8-year-old female child presented with simultaneous symptoms of post infectious glomerulonephritis and acute rheumatic fever. The child was treated with penicillin V, Aspirin and she responded well to the treatment. However, this co presentation of acute rheumatic fever and post infectious glomerulonephritis in a child is rare and hence authors report the case. This sequela of streptococcal autoimmunity are considered to be pathogenetically distinct.
ABSTRACT
Rheumatic chorea (RC*) is a movement disorder seen in young children and adolescents with a recent history of incompletely treated group A beta-hemolytic streptococcal (GABHS) pharyngitis. Although, it rarely presents as the first manifestation of the rheumatic fever, physicians should be aware of the disease, so that early diagnosis and prompt treatment may lead to elimination of the pathogen and prevent further disease progression. We present a case of a 12-year-old female child who presented with only RC as the first clinical sign.
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Resumen Objetivo: Revisar las características demográficas, clínicas y ecocardiográficas, así como el abordaje quirúrgico de pacientes con fiebre reumática menores de 18 años, durante un periodo de diez años. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyeron pacientes menores de 18 años, con diagnóstico de fiebre reumática entre los años 2006 a 2016. Resultados: Se incluyeron 22 niños con edades entre los 10 a los 14 años, de los cuales 59% (13/22) eran mujeres; 13,6% (3/22) provenían de Arauca y el 18,1% (4/22) eran indígenas. Se diagnosticó carditis en el 63,6% (14/22) seguido de poliartralgia y fiebre en un 59% (13/22) y 54% (12/22) respectivamente; así mismo, se detectó corea de Sydenham y eritema marginado 4,5% (1/22). Se determinó compromiso severo de válvula mitral en el 72,7% (16/22). 15 pacientes fueron llevados a cirugía; se realizó reemplazo valvular mitral en 13,3% (2/15), plastia mitral y tricúspide en el 40% (6/15), plastia mitral, tricúspide y aórtica en el 6,66%(1/15) y reemplazo aórtico en el 5,2% (1/15). Un paciente requirió oxigenación por membrana extracorpórea. La mortalidad fue del 0% (0/22). Conclusiones: Se observó que la fiebre reumática ocasionó grave compromiso cardiaco, que requirió un alto grado de intervención quirúrgica. Las poblaciones rurales e indígenas se beneficiarían notablemente de una prevención primordial, primaria y secundaria, al igual que de un diagnóstico y tratamiento oportunos.
Abstract Objective: The aim of this study is to review the demographic, clinical, and cardiac ultrasound characteristics, as well as the surgical approach, of patients less than 18 years-old with rheumatic fever. Materials and methods: A descriptive, retrospective study was conducted that included patients less than 18 years-old diagnosed with rheumatic fever between the years 2006 to 2016. Results: The study included a total of 22 children with ages between 10 and 14 years, of whom 59% were female. It was recorded that 13.6% (3/22) were from Arauca Department (Colombia), and 18.1% (4/22) were indigenous. Carditis was diagnosed in 63.6% (14/22), followed by polyarthralgia and fever in 59% (13/22) and 54% (12/22), respectively. Sydenham's chorea and marginal erythema was also detected in 4.5% (1/22). The severity of mitral valve involvement was determined in 72.7% (16/22). Of the 15 patients that had surgery, 13.3% (2/15) had a mitral valve replacement, mitral and tricuspid repair in 40% (6/15), mitral, tricuspid, and aortic repair in 6.66%, respectively (1/15), and aortic replacement in 5.2% (1/15). One patient required extracorporeal membrane oxygenation. There was no mortality. Conclusions: It was observed that rheumatic fever led to serious cardiac compromise that required a high rate of surgical interventions. Rural and indigenous population would notably benefit from basic, primary, and secondary prevention, as well as a timely diagnosis and treatment.
Subject(s)
Humans , Male , Adolescent , Rheumatic Heart Disease , Myocarditis , Arthritis , Rheumatic Fever , Mitral Valve InsufficiencyABSTRACT
RESUMEN Introducción: La valvuloplastia mitral percutánea con balón actualmente es el primer procedimiento terapéutico que se contempla en el mundo desarrollado para los pacientes con estenosis mitral reumática e indicación para ello, y se realiza en el Cardiocentro de Santiago de Cuba desde julio de 2008. Objetivos: Describir los resultados de la valvuloplastia mitral percutánea con balón en los pacientes estudiados. Método: Se realizó un estudio observacional y descriptivo, unicéntrico, que incluyó a 91 pacientes tratados mediante este procedimiento en el Cardiocentro de Santiago de Cuba, desde julio de 2008 hasta junio de 2019. Se evaluaron variables clínico-epidemiológicas, ecocardiográficas y hemodinámicas, así como el resultado inmediato del procedimiento. Resultados: Predominaron los pacientes jóvenes (60,4% entre 15-44 años), del sexo femenino (86,8%), con antecedentes de fiebre reumática (48,4%), en clase funcional III (64,8%) de la NYHA (New York Heart Association) y en ritmo sinusal (86,8%). Se logró un aumento promedio del área valvular de más del doble (0,99 vs. 2,12 cm2) del valor inicial y una reducción de la presión auricular mayor de 50% (25,0 vs.11, 76 mmHg), lo que permitió evaluar de satisfactorio el tratamiento en el 95,6% de los pacientes. Se identificó una asociación significativa (Prueba de Fisher ≤ 0,05) entre la puntuación de Wilkins ≤ 8 y el resultado satisfactorio del procedimiento. Conclusiones: Los resultados de la aplicación de la valvuloplastia mitral percutánea con balón en el centro fueron satisfactorios y congruentes con los referidos nacional e internacionalmente.
ABSTRACT Introduction: Percutaneous balloon mitral valvuloplasty has flourished as a mainstream therapy (mostly in developed countries) for treating patients with medical indication and those suffering from rheumatic mitral stenosis. This procedure is performed at the Cardiocentro in Santiago de Cuba since July 2008. Objectives: To describe the results of percutaneous balloon mitral valvuloplasty in the study participants. Methods: A descriptive, single-centered and observational study including 91 patients treated by this procedure was conducted at the Cardiocentro in Santiago de Cuba from July 2008 to June 2019. Clinical/epidemiological, echocardiographic and hemodynamic variables were assessed, as well as immediate procedure outcomes. Results: Young individuals (60.4% between 15-44 years), female (86.8%), with a history of rheumatic fever (48.4%), NYHA (New York Heart Association) functional class III (64.8%) and sinus rhythm (86.8%) predominated. An average increase in valve area of over double (0.99 vs. 2.12 cm2) the initial value and a reduction in atrial pressure of more than 50% (25 vs. 11.76 mmHg) was achieved; thus evidencing that the treatment was effective in 95.6% of the patients. A significant association (Fisher Test ≤ 0.05) was identified between Wilkins score ≤ 8 and satisfactory outcome of the procedure. Conclusions: The results of percutaneous balloon mitral valvuloplasty in the medical center were successful and consistent with those achieved nationally and internationally.