Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

A Case Report on Rheumatic Heart Disease

Background: Rheumatic heart disease is caused secondary to rheumatic fever. Rheumatic fever, a systemic immune response to a beta-hemolytic streptococcal throat infection, remains a significant health issue in developing countries. Clinical Findings: This is a case report of Rheumatic heart disease in which a 19-year-old female patient was admitted to the hospital with chief complaints of cough with expectoration for 3 months (sputum of minimal quantity, white to yellowish in colour), bilateral lower limb swelling and joint pains for 2 months insidious in onset gradually progressive in nature. She did not have any comorbidities. So, based on her signs and symptoms the physician has advised her for CBC, 2D Echo, ECG, C3 & C4 test, chest X-ray, urine routine & analysis, thyroid profile, anti-nuclear antibody test (ANA) and ASLO (antistreptolysin) test. In which her hemoglobin, RBC, WBC and platelets levels were abnormal. Chest X-ray shown presence of cardiomegaly, Urine routine & Analysis shown 4-5 pus cells and 1-2 epithelial cells are seen/hpf. 2D echo shown Dilated chamber, Global LV dysfunction EF- 40%, MVP severe MR: PML (posterior mitral leaflet) calcified, Moderate Aortic regurgitation (AR), Inferior vena cava dilated. ECG shown sinus rhythm, T wave inversion on V1-V3. ASLO test was 549.5 mg/dL which confirms recent streptococcal infection. Management: The treatment was initiated with Antibiotics, Proton pump inhibitors, Antiemetics, Diuretics, Anti-hypertensive, Corticosteroids and NSAID’s etc. Outcome: Therefore Rheumatic heart disease can be prevented by preventing streptococcal infections or treating them with Antibiotics when they occur.

A study of clinical and etiological profile of mitral valve dysfunction

Background: Heart valve diseases are a leading cause of cardiovascular morbidity and mortality globally; putting a significant strain on healthcare resources. In developing countries, rheumatic heart disease (RHD) remains the most common type of heart valve disease. Mitral valve disease is the most frequent of the valvular heart diseases. Mitral valve disease is a distressing and painful condition, and requires immediate attention before they result in death. Methods: This was a prospective observational study done from September 2019 to February 2021, at the Department of General Medicine, Goa Medical College and Hospital, Bambolim, Goa: A tertiary care hospital in Goa. Results: Out of the 50 patients enrolled in the study 44% patients had MS ,18% had MR and 38%had MR+MS. Mean age of the study population was 41 to 50 years of which 54% patients were females. All isolated Mitral Stenosis patients were rheumatic origin. Of the 9 MR patients, predominant form of MR was ischemic (66.66%), followed by rheumatic (22.22%) and MVP (11.11%). 19 patients had MR+MS, predominant form was rheumatic (84.21%). It was also observed that 42% each of total patients had pulmonary hypertension and congestive cardiac failure, 40% had pulmonary edema, while 30% had atrial fibrillations complications. Conclusions: Our study revealed that the most common valve dysfunction observed is mitral stenosis, with a female preponderance and its most common etiology being rheumatic. Further it was also observed that the most common complication is pulmonary hypertension and congestive cardiac failure.

Anaesthetic Management Of A Patient With Rheumatic Valvular Heart Disease Posted For Fixation Of Acetabulum Fracture

Patients with rheumatic heart disease (RHD) undergoing non-cardiac surgeries present a challenge for anesthesiologists. This case report discusses the anesthetic management of a 56-year-old female with severe mitral stenosis, posted for acetabulum fracture ?xation. The patient's history revealed RHD with severe mitral stenosis, mild mitral regurgitation, and severe pulmonary hypertension. Considering the risks associated with neuraxial anesthesia in mitral stenosis, general anesthesia (GA) with a Pericapsular Nerve Group (PENG) block was chosen. The patient was carefully premedicated, induced with appropriate drugs, and monitored intraoperatively. The PENG block, performed under ultrasound guidance, aimed to reduce hip pain without causing motor blockade. The patient remained hemodynamically stable throughout the surgery, and postoperatively, the combination of GA with PENG block provided effective pain control, reducing the need for opioids. This approach contributed to an early recovery, emphasizing the importance of tailored anesthesia strategies for valvular heart disease patients undergoing non-cardiac surgeries.

Gerência do cuidado de enfermagem à criança com cardiopatia reumática no contexto hospitalar / Management of nursing care for children with rheumatic heart disease in the hospital context

It is known that rheumatic heart disease in childhood causes repeated and long hospitalizations, social and family withdrawal, surgical and drug treatment with benzathine penicillin and other medications on an ongoing basis, causing pain and causing some possible trauma due to the constant nature of interventions. Children with rheumatic heart disease will depend on many types of care, including those provided by nurses, within the scope of care management. Care management is not only related to direct care, but also involves indirect care. The objective of this study was to understand the meanings that nurses attribute to the management of nursing care for children with rheumatic heart disease in the hospital context; build a theory on the management of nursing care for children with rheumatic heart disease in the hospital context. Therefore, the study is characterized as qualitative. Nine nurses and ten nursing technicians participated in the research. Symbolic Interactionism was used as a theoretical framework and Data-Based Theory was used as a method. The data collection technique used was the semistructured interview. Data were collected only after the research was approved by the Research Ethics Committee of the institutions, proponent and co-participant. As results, five categories emerged, namely: Understanding the dimensions of the practice of managing nursing care for children with rheumatic heart disease; Symbolic aspects of the hospitalization of children with rheumatic heart disease; Presenting the conditions involved in nursing care management; Implementing symbolic action and interaction strategies in care relationships; Evaluating the management of nursing care for children and their families.

Se sabe que la cardiopatía reumática en la infancia provoca hospitalizaciones repetidas y prolongadas, aislamiento social y familiar, tratamientos quirúrgicos y farmacológicos con penicilina benzatínica y otros medicamentos de forma continua, provocando dolor y provocando algunos posibles traumatismos por el carácter constante de las intervenciones. Los niños con cardiopatía reumática dependerán de muchos tipos de atención, incluida la proporcionada por enfermeras, dentro del ámbito de la gestión de la atención. La gestión del cuidado no sólo está relacionada con la atención directa, sino que también involucra la atención indirecta. El objetivo de este estudio fue comprender los significados que los enfermeros atribuyen a la gestión del cuidado de enfermería al niño con cardiopatía reumática en el contexto hospitalario; construir una teoría sobre la gestión del cuidado de enfermería al niño con cardiopatía reumática en el contexto hospitalario. Por tanto, el estudio se caracteriza como cualitativo. Participaron de la investigación nueve enfermeros y diez técnicos de enfermería. Se utilizó el Interaccionismo Simbólico como marco teórico y la Teoría Basada en Datos como método. La técnica de recolección de datos utilizada fue la entrevista semiestructurada. Los datos fueron recolectados sólo después de que la investigación fuera aprobada por el Comité de Ética en Investigación de las instituciones, proponente y coparticipante. Como resultados surgieron cinco categorías, a saber: Comprender las dimensiones de la práctica de gestión del cuidado de enfermería al niño con cardiopatía reumática; Aspectos simbólicos de la hospitalización de niños con cardiopatía reumática; Presentar las condiciones involucradas en la gestión del cuidado de enfermería; Implementar estrategias de acción e interacción simbólica en las relaciones de cuidado; Evaluar la gestión de los cuidados de enfermería a los niños y sus familias.

Sabe-se que a cardiopatia reumática na infância causa internações repetidas e longas, afastamento social e familiar, tratamento cirúrgico e medicamentoso com penicilina benzatina e outros medicamentos de forma contínua, acarretando dor e trazendo alguns possíveis traumas devido à constância de intervenções. A criança com cardiopatia reumática dependerá de muitos cuidados, dentre os quais, estão os desenvolvidos pelo enfermeiro, no âmbito da gerência do cuidado. A gerência do cuidado não se relaciona apenas com os cuidados diretos, como também envolve os cuidados indiretos. Objetivou-se, neste estudo, compreender os significados que os enfermeiros atribuem à gerência do cuidado de enfermagem à criança com cardiopatia reumática no contexto hospitalar; construir uma teoria sobre a gerência do cuidado de enfermagem à criança com cardiopatia reumática no contexto hospitalar. Para tanto, o estudo se caracteriza como qualitativo. Participaram da pesquisa nove enfermeiros e dez técnicos de enfermagem. O Interacionismo Simbólico foi utilizado como referencial teórico e a Teoria Fundamentada em Dados foi utilizada como método. A técnica de coleta de dados utilizada foi a entrevista semiestruturada. Os dados foram coletados apenas após a aprovação da pesquisa pelo Comitê de Ética em Pesquisa das instituições, proponente e coparticipante. Como resultados, emergiram cinco categorias, quais sejam: Compreendendo as dimensões da prática da gerência do cuidado de enfermagem à criança com cardiopatia reumática; Aspectos simbólicos da hospitalização da criança com cardiopatia reumática; Apresentando as condições intervenientes à gerência do cuidado de enfermagem; Implementando estratégias simbólicas de ação e interação nas relações de cuidado; Avaliando o gerenciamento do cuidado de enfermagem à criança e sua família.

Nursing care management for hospitalized children with rheumatic heart disease: grounded theory study / Gestión del cuidado de enfermería en niños hospitalizados con cardiopatía reumática: estudio de la teoría fundamentada / Gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática: estudo de teoria fundamentada

ABSTRACT Objective: to develop a theoretical model on the nursing care management for hospitalized children with rheumatic heart disease. Method: a qualitative study developed in light of the theoretical and methodological frameworks, respectively, Symbolic Interactionism and Data Grounded Theory. Nineteen nursing professionals participated in the study, divided into two sample groups. Data were collected through semi-structured interviews, and were analyzed follow the coding stages: open, axial, and integration. Results: the theoretical model identifies the central category/phenomenon: nursing care management for hospitalized children with rheumatic heart disease and their families. It reveals both direct and indirect care provided to the child and family, as well as action/interaction strategies within interprofessional relationships, relationships with the child and family, and their consequences in symbolic care interactions. Conclusion: the theoretical model aids in understanding nursing care management practices for hospitalized children with rheumatic heart disease, serving as an action guide for nursing professionals to enhance the quality of life for the child and family within ethical and technical professional boundaries.

RESUMEN Objetivo: desarrollar un modelo teórico sobre la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio cualitativo desarrollado a la luz de los referentes teóricos y metodológicos, respectivamente, el Interaccionismo Simbólico y la Teoría Basada en Datos. Participaron de la investigación 19 profesionales de enfermería, organizados en dos grupos muestreo. Los datos fueron recolectados a través de entrevistas semiestructuradas y analizados siguiendo las etapas de codificación: abierta, axial e integración. Resultados: el modelo teórico presenta como categoría/fenómeno central la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática y su familia. Se revelan los cuidados directos e indirectos desarrollados con los niños y sus familias, así como estrategias de acción/interacción en el ámbito de las relaciones interprofesionales, las relaciones con el niño y la familia, y sus consecuencias en las interacciones simbólicas de cuidado. Conclusión: el modelo teórico permite comprender la práctica de gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática, y sirve como guía de acción para que los profesionales de enfermería, dentro de los límites éticos y técnicos de su práctica profesional, contribuyan a la promoción de calidad de vida del niño y su familia.

RESUMO Objetivo: elaborar um modelo teórico sobre a gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo qualitativo desenvolvido à luz dos referenciais teórico e metodológico, respectivamente, Interacionismo Simbólico e Teoria Fundamentada em Dados. Participaram da pesquisa 19 profissionais de enfermagem, organizados em dois grupos amostrais. Os dados foram coletados por meio da entrevista semiestruturada e foram analisados seguindo as etapas de codificação: aberta, axial e integração. Resultados: o modelo teórico apresenta como categoria/fenômeno central: gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática e sua família. São revelados os cuidados diretos e indiretos desenvolvidos junto à criança e seus familiares, bem como as estratégias de ação/interação no âmbito das relações interprofissionais, relações com a criança e com a família, e suas consequências nas interações simbólicas de cuidado. Conclusão: o modelo teórico possibilita compreender a prática da gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática, conformando-se como guia de ação para que profissionais de enfermagem, nos limites éticos e técnicos de seu exercício profissional, contribuam para a promoção da qualidade de vida da criança e sua família.

Risk Factors for Acute Rheumatic Disease: Exploring Factors at Individual and Collective Levels

ABSTRACT Acute rheumatic fever (ARF) is a complex disease with several clinical manifestations. Its most significant long-term complication is valvular heart damage, commonly referred to as chronic rheumatic heart disease. The risk of ARF varies globally, with over 80% of cases occurring in low- and middle-income countries, highlighting the role of socioeconomic factors. A comprehensive understanding of the risk factors associated with ARF and its clinical, genetic, and sociodemographic mediators can help clinicians identify high-risk individuals, develop effective management strategies, enhance target screening and active case-finding initiatives, and ultimately improve patient outcomes. This review aimed to provide an overview of ARF and its global burden, focusing on the established and potential risk factors associated with its development.

A successful pregnancy outcome after mitral valve replacement: a case report

Valvular heart disease can be acquired or congenital. Although the incidence of rheumatic heart disease is on the decline, the number of patients with congenital heart disease who survive into adulthood has grown substantially over the past 30 years. Therefore, a large number of patients with valvular heart disease will be of childbearing age. Here we presented a case of second gravida who was diagnosed with rheumatic heart disease and had undergone mitral valve prosthesis and tricuspid valve repair delivered a healthy live male baby weighing 2.250 kg.

Spectrum of valvular lesions in newly diagnosed rheumatic heart disease

Background: Rheumatic heart disease (RHD) is the most common acquired heart disease among young adults and an important health problem in developing countries. There is much scarcity of information about echocardiographic evaluation of valvular involvement of RHD in Bangladesh. Objective of this study was to analyze the clinical spectrum and pattern of cardiac valvular lesions in newly diagnosed RHD patients. Methods: This cross-sectional study was conducted from April 2019 to May 2021 in National Center for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD), Dhaka, Bangladesh. Newly diagnosed 160 RHD patients irrespective of age and sex were enrolled. Medical history was obtained, physical examination was carried out, several investigations were done and standard color Doppler echocardiography was performed. Diagnosis of RHD was made following 2012 World Heart Federation criteria. Results: More than 60% of newly diagnosed patients of RHD were female; mean age of patients was 24.29±9.17 years and 77.5% of patients were between 15-34 years of age. Detected valvular lesions were mostly isolated (65%) and mitral valve involvement was 88.7%. Isolated mitral regurgitation was detected among 56.3% patients and was higher in female. Combination of mitral regurgitation and mitral stenosis were reported in 12.5% cases whereas mitral regurgitation with aortic regurgitation was present in 10.6% cases. Overall, 14 (6.4%) of the newly diagnosed patients were detected with severe forms of cardiac valvular lesion. Conclusions: RHD were common in young adults. Mitral valve was predominantly involved, particularly presenting as isolated mitral regurgitation.

The maternal and perinatal outcomes in heart disease in pregnancy in a tertiary care hospital

Background: The incidence of cardiac diseases in pregnancy ranges from 1 to 3%. Pregnancy in women with heart disease is associated with considerable mortality and morbidity. Thorough prenatal care and team approach involving obstetricians, cardiologists, anaesthesiologists and neonatologists can improve the maternal and fetal outcome in these women. Rheumatic heart disease is still the leading cause of maternal heart disease during pregnancy in developing countries.Methods: Between February 2022 and August 2022, a retrospective research at the RL Jalappa Hospital in Kolar was carried out. Out of 764 deliveries made at the facility throughout the study period, 30 singleton pregnancies complicated with heart disease admitted department of obstetrics and gynaecology at different periods of gestation. The maternal and perinatal outcome was thus noted.Results: Out of 764 deliveries, 30 women were found to have been complicated with heart disease. Overall incidence was 3.9%. Rheumatic heart disease was the most common heart disease seen among them. The most common congenital heart disease present was atrial septal defect (ASD). The most common cause for LSCS was fetal distress. 93.3% of the babies delivered were shifted to NICU, with the most common cause being, preterm and low birth weight. No maternal mortality seen, though 1 neonatal mortality present due to extreme low birth weight.Conclusions: A multidisciplinary team approach including obstetrician, cardiologist, pediatrician and anesthesiologist is needed in the cases of pregnancy with heart disease to determine the mode of delivery, timing of delivery, change in anticoagulant drugs in pregnancy, type of anesthesia, care of neonate, and follow-up of mother for better maternal and fetal outcomes.

Case of rheumatic heart disease and severe mitral stenosis, managed by balloon mitral valvuloplasty in pregnancy

Mitral stenosis (MS) is a progressive situation caused by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. It is one of the most common valvular heart lesions found during pregnancy. The chances of significant maternal and fetal morbidity and mortality are more in the case of severe MS. Balloon mitral valvuloplasty (BMV) is a life-saving procedure in pregnancy instead of surgical correction. We are presenting the case of a 24-week pregnant woman with severe MS. She developed pulmonary edema and had undergone successful BMV which allowed her to tolerate her pregnancy decently. It leads to a decrease in the left atrial pressure as well as pulmonary arterial pressure. The patient underwent normal delivery uneventfully. Antibiotics were used with proper consultation and the patient was treated conservatively with excellent maternal and fetal outcomes. BMV is turns out to be a life-saving therapy for severe MS complicated by pulmonary edema.

A study of maternal outcome in heart disease in pregnancy in a tertiary care centre

Background: Cardiovascular disease in women is associated with 4% complications during pregnancy and is the most frequent leading cause of maternal mortality reaching up to 15%. It stands third among the most common causes of maternal mortality after obstetric haemorrhage and preeclampsia respectively.The objective of this study is to study the maternal outcome of heart disease in pregnancy.Methods: An Observational study was conducted over a period of 8 months over 50 antenatal patients with heart disease from January 2020 to August 2020 in the department of obstetrics and gynaecology, grant government medical college and JJ group of hospitals, Mumbai with appropriate inclusion and exclusion criteria. Prevalence of congenital and acquired heart disease complicating pregnancy, complications, age wise and parity wise distribution were mainly studied.Results: The incidence of heart disease was 1.8% amongst the 2,750 total deliveries conducted. In this study 46 (92%) were registered and 4 (8%) were unregistered antenatal cases. 45 (90%) belonged to upper lower class and lower class as per Kupuswamy scale with poor nutrition and antenatal care. 34 (68%) of patients had rheumatic heart disease and 11 (22%) patients had congenital heart disease. Mitral stenosis was found to be the dominant valvular lesion in rheumatic heart disease in 12 (24%) cases. Over 25 (50%) of the patients had normal vaginal delivery and 9 (18%) had instrumental vaginal deliveries, 7 (14%) with vacuum and 2 (4%) with forceps. Congestive cardiac failure was found to be the major complication found in 4 (3.9%) cases. About 8 (16%) patients required intensive care unit admission. Maternal maternity is about 4% (2 patients) in the present study.Conclusions: Maternal mortality in heart disease patients can be brought down significantly by effective preconceptional counselling, and improvements in medical, surgical, antenatal, intranatal, and postnatal care and effective motivation for contraception.

Cardiovascular accident unveiling rheumatic heart disease

Infection with group A Streptococci causes an autoimmune reaction known as acute rheumatic fever (ARF) which leads to chronic cardiac condition called rheumatic heart disease (RHD). Rheumatic involvement of the cardiac valves is one of the sequelae of ARF. The valvular lesions begin as verrucae along the borders of heart valves and tend to resolve leaving a scar once the inflammation subsides. Cardio embolism is seen as the main pathophysiological mechanism of ischemic stroke in RHD.

Clinical characteristics of infantile Takayasu arteritis complicated with cardiac involvements / 中华风湿病学杂志

Objective:To analyze the clinical characteristics of infantile Takayasu Arteritis (TAK) complicated with cardiac involvements.Methods:The clinical data and cardiac lesions of infantile TAK were collected retrospectively, and the clinical characteristics of the disease were analyzed and summarized. Mainly using decriptive statistical methods.Results:In these 20 cases, 16 cases (80%) had cardiac involvements, only 2 cases had related symptoms. The common lesions were coronary artery lesion (CAL), valvular disease, and elevated myocardial enzymes, while the rare lesions were arrhythmia, pericardial effusion, hypertensive heart disease, and heart failure. One case had acute heart failure, which was systolic heart failure and was accompanied by hypertensive heart disease. All 14 patients with CAL were found by conventional coronary ultrasound screening. A total of 39 CAL were found, all of which were coronary artery dilation, and the left main coronary artery was involved. Five patients had heart valve disease, all of them were valve insufficiency. The involved valves were mitral and tricuspid valves, and one of them was severe insufficiency. Arrhythmias were found in 2 cases, of which P1 was found to have paroxysmal atrial tachycardia with high atrioventricular block at 3 months. All 20 children survived and were in stable condition after being treat with biological agents and/or glucocorticoids. A case of hypertensive heart disease complicated with heart failure was followed up for 4 years, and the cardiac function and blood pressure returned to normal. Fourteen children with CAL lesions were given oral aspirin disease, the CALs disappeared in 10 cases and retracted in 4 cases. During the follow-up of 5 children with heart valves, insufficiency disappeared in 4 cases and improved in 1. No child underwent valve replacement during the follow-up. One of the children with arrhythmia was treated with antiarrhythmic drugs. After treatment, the arrhythmia disappeared. Now they have been followed up for 5 years without recurrence.Conclusion:Infantile TAK has a high incidence of heart involvement, with extensive lesions but insidious clinical symptoms. CALs are common, and heart failure is rare. It should be evaluated and treated as early as possible.

The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America / El papel del tamizaje ecocardiográfico en la reducción de la carga de la cardiopatía reumática en América Latina / O papel da triagem ecocardiográfica na redução da carga de doença cardíaca reumática na América Latina

ABSTRACT The objectives of this article are to reflect on the rationale behind the use of echocardiographic screening for rheumatic heart disease and to provide key recommendations about steps needed to implement and improve echocardiographic screening programs in Latin America. Rheumatic heart disease remains a public health problem affecting mainly low-income and lower-middle-income countries and populations. Latin America is an area with economic inequalities, and the epidemiology of rheumatic heart disease remains largely unknown. Echocardiographic screening is useful for updating the epidemiology and providing early diagnosis of the disease. We discuss different approaches used in successful echocardiographic screening programs worldwide and in Latin America. We then identify the key elements needed to establish successful echocardiographic screening programs in Latin America, including increased awareness and involvement from multiple sectors (e.g. the community, health care professionals, scientific organizations and public health entities), identification of areas in need, development of a plan and structure that include different screening approaches, and how to ensure appropriate follow up for those who screen positive.

RESUMEN Los objetivos de este artículo son reflexionar sobre los fundamentos que justifican el uso del tamizaje ecocardiográfico para detectar la cardiopatía reumática y ofrecer algunas recomendaciones importantes sobre los pasos que habría que dar para poner en marcha programas de tamizaje ecocardiográfico y mejorar los existentes en América Latina. La cardiopatía reumática sigue siendo un problema de salud pública que afecta principalmente a países y grupos poblacionales de ingresos bajos y medianos bajos. América Latina es una región de grandes desigualdades económicas y las características epidemiológicas de la cardiopatía reumática siguen siendo desconocidas en gran medida. El tamizaje ecocardiográfico resulta útil para actualizar los datos epidemiológicos y posibilitar un diagnóstico temprano de la enfermedad. En este artículo se analizan los diferentes enfoques empleados en algunos programas de tamizaje ecocardiográfico eficaces de distintas partes del mundo, incluida América Latina. A continuación se determinan los elementos clave necesarios para establecer programas eficaces de tamizaje ecocardiográfico en América Latina, incluida una mayor concientización y participación de diversos sectores (p. ej., la comunidad, los profesionales de salud, las organizaciones científicas y las entidades de salud pública), la identificación de las zonas más necesitadas, la elaboración de un plan y una estructura que incluyan diferentes abordajes del tamizaje, y el modo de garantizar un seguimiento adecuado de aquellas personas con un resultado positivo en el tamizaje.

RESUMO Os objetivos deste artigo são oferecer observações sobre a fundamentação do uso da triagem ecocardiográfica para doença cardíaca reumática e fornecer recomendações importantes sobre as etapas necessárias para implementar e melhorar os programas de triagem ecocardiográfica na América Latina. A doença cardíaca reumática continua sendo um problema de saúde pública que afeta principalmente países e populações de renda baixa e média-baixa. A América Latina é uma área com desigualdades econômicas, e a epidemiologia da doença cardíaca reumática continua amplamente desconhecida. A triagem ecocardiográfica serve para atualizar a epidemiologia e proporcionar o diagnóstico precoce da doença. Examinamos as diferentes abordagens usadas em programas de triagem ecocardiográfica bem-sucedidos em todo o mundo e na América Latina. Em seguida, identificamos os principais elementos necessários para estabelecer programas de triagem ecocardiográfica com sucesso na América Latina. Tais programas incluiriam maior conscientização e envolvimento de vários setores (por exemplo, a comunidade, profissionais de saúde, organizações científicas e entidades de saúde pública), identificação de áreas carentes, desenvolvimento de um plano e estrutura abrangendo diferentes abordagens de triagem e formas de garantir o seguimento adequado de pessoas com resultado positivo na triagem.

The occult rheumatic scourge: A clinicopathological analysis of missed rheumatic heart disease

Aims: To study the clinical and pathological manifestations of missed cases of rheumatic heart disease (RHD) and postulate possible reasons behind a missed diagnosis. Materials and Methods: Retrospective 20-year (2000–2019) autopsy data of chronic RHD were reviewed and patients, in whom the valvular deformities had been incidental autopsy findings, were selected. The clinical details of these patients were correlated with the morphology of the affected valves. On this pathological analysis, the patients were assigned to a category of subtle or significant valvular deformity. By clinically correlating, the latter group was subdivided into clinically misdiagnosed, clinically undiagnosed, and sudden cardiac death. Statistical Analysis: Nil. Results: Among the 475 cases of chronic RHD identified at autopsy in the study period, the disease was diagnosed incidentally in 69 patients (14.5%). Significant valvular deformity was noted in 61 cases while the other 8 cases had subtle valvular deformity. The most common cause of death was cardiac failure in 39 out of 69 patients (56%). Eleven (16%) patients had experienced sudden cardiac death. Among the undiagnosed cases, 5 (7%) of them had a diagnosis of non-rheumatic cardiac disease, while the other 14 (20.5%) patients had overwhelming non-cardiac diseases. Conclusions: Our study indicates that mortality and morbidity due to RHD are underdetermined. The patients remain undiagnosed due to either insignificant valvular involvement, clinically silent in the presence of significant valvular deformity, presence of other overwhelming diseases or misdiagnosis partly due to the resemblance with the other pathologies.

Rare case of hereditary spherocytosis with rheumatic mitral stenosis

A rare case of hereditary spherocytosis (HS) and rheumatic mitral stenosis coexisting in a patient having severe stenosis, atrial fibrillation, and symptoms of the left ventricular dysfunction, along with hemolytic anemia attributed to HS. We present the case of a 58-year-old lady who presented to the emergency department with complaints of increasing shortness of breath for the past week. She was examined to have atrial fibrillation with a fast ventricular rate. On investigations, she was found to have severe rheumatic mitral stenosis with evidence of hemolytic anemia. Further, evaluation of the cause of her anemia revealed HS.This case highlights the importance of the evaluation of anemia in patients with valvular heart diseases. If a treatable cause is found, anemia can be treated to reduce the cardiac burden

Gender differences in genotypic distribution of endothelin-1 gene and endothelin receptor A gene in pulmonary hypertension associated with rheumatic mitral valve disease

Introduction: The female gender is a risk factor for idiopathic pulmonary arterial hypertension. However, it is unknown whether females with rheumatic mitral valve disease are more predisposed to develop pulmonary hypertension compared to males. Aim: We aimed to investigate whether there was a difference in genotypic distribution of endothelin-1 (ET-1) and endothelin receptor A (ETA) genes between female and male patients of pulmonary hypertension associated with rheumatic mitral valve disease (PH-MVD). Methods: We compared prevalence of ET-1 gene (Lys198Asn) and ETA gene (His323His) polymorphisms according to gender in 123 PH-MVD subjects and 123 healthy controls. Results: The presence of mutant Asn/Asn and either mutant Asn/Asn or heterozygous Lys/Asn genotypes of Lys198Asn polymorphism when compared to Lys/Lys in females showed significant association with higher risk (odds ratio [OR] 4.5; p ¼0.007 and OR 2.39; p ¼0.02, respectively). The presence of heterozygous C/T and either mutant T/T or heterozygous C/T genotypes of His323His polymorphism when compared to wild C/C genotype in females showed a significant association with higher risk (OR 1.96; p ¼0.047 and OR 2.26; p ¼0.01, respectively). No significant difference was seen in genotypic frequencies in males between PH-MVD subjects and controls. Logistic regression analysis showed that mutant genotype Asn/Asn (p ¼0.007) and heterozygous genotype Lys/Asn of Lys198Asn polymorphism (p ¼0.018) were independent predictors of development of PH in females.

Early and long-term outcomes after left-side heart valve replacement and tricuspid valve replacement in rheumatic patients / 中华胸心血管外科杂志

Objective:To evaluate and compare the early and long-term outcomes of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement, and analyze the difference of early mortality and long-term survival rate between mild pulmonary artery systolic pressure (PASP) and moderate to severe PASP patients.Methods:From January 2009 to December 2018, 79 cases of patients were reviewed and summarized. The mean age before operation was (45.7±7.8) years old. These patients were divided into mild PASP group(<50 mmHg, 38 cases) (1 mmHg=0.133 kPa) and moderate-severe PASP group (>50 mmHg, 41 cases) . Kaplan- Meier method was used to estimate the overall long-term survival rate and the incidence of complications, and to compare the long-term survival rate of patients with mild and moderate -severe PASP elevation. Results:The mortality rate of early postoperative patients was 8.9% (7/79). The causes of death included: low cardiac output syndrome in 3 cases, multiple organ failure caused by pulmonary infection in 2 cases, acute renal insufficiency in 1 case, sudden cardiac arrest in 1 case. Although the mortality rate of early moderate-severe PASP group (12.2% vs. 5.3%) was higher than that of mild PASP group, there was no significant difference ( P>0.05). The mean follow-up time was (51.8±31.7) months (3-115 months). Kaplan- Meier method was used to estimate the 10-year survival rate, the rate of avoiding thrombosis, the rate of avoiding serious bleeding event and the rate of avoiding reoperation, which were (67.2±10.6)%, (85.7±6.2)%, (83.4± 6.9)% and (93.7 ± 3.7)%, respectively. Although the long-term survival rate of mild PASP (78.0±10.6) % was higher than that of moderate-severe PASP (62.8 ± 13.4) %, there was no significant difference ( P>0.05). Conclusion:The early mortality rate of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement is still relatively high. The recurrent heart failure is the major causes of long-term death.