pattern of valvular heart disease in Iraqi patients attending a major cardiac center

ABSTRACT

Two hundred and twenty consescutive cases of valvular heart disease were studied. They constituted 20.8% of cardiac admissions and 5.4% of total admissions in the five medical units and cardio-thoracic surgical unit at the Medical City Teaching Hospital in Baghdad. About 1/3 of the patients were less than 20 years old. The overall sex ratio was about equal [112 males and 108 females] but under the age of 20 the M/F ratio was 21. The most frequent valve affected was the mitral valve [52%], followed by the aortic valve and combind aortic and mitral valve leasions [19% for each category]. Pulmonary stenosis constituted 5% of cases while mitral valve prolapse and non rheumatic tricuspid regurgitation constituted 2% each. The peak incidence of mitral stenosis was in the fourth and fifth decades, aortic stenosis in the 1st and 6th decades, while mitral regurgitation, aortic regurgitation and combind mitral and aortic valve lesions had a peak incidence in the 2nd decade. Fourty - two precent of patients were in grades III and IV according to the New York Heart Association functional classification. History of rheumatic fever was obtained in 46% of patients with a mean age of onset of 11.7 +/- 3yrs. and amean latent interval of 9 +/- 3.3 years between initial attack of rheumatic fever and appearance of cardiac symptoms. Only 30% of patients with rheumatic heart disease were taking adequate prophylaxis for rheumatic fever. Infective endocarditis was present in 31 patient [14%]. Systemic embolism in 8 patients [3.6%] and atrial fibrillation in 64 patients [29%]