EC Microbiology

Review Article Volume 17 Issue 2 - 2021

Complications and Management of Rheumatic Mitral Valve Disease

Mohammed Saleh Hussein1,2*, Muad Ali Al Fayea3, Shorooq Salem Aljizani4, Nadeer Saeed Alqahtani5, Hala Wadea Zahed6, Atheer Mohammed Bazaid5, Mohammed Husam Al-Tamimi7, Sultanah Khalid Alshahwan6, Yara Eyob Mickael6, Ghada Waheed AlMojadidi8, Ruba Abdullah Alsanoosy9 and Ruzan Mohammed Saleh10

1Department of Internal Medicine, Dr. Samir Abbas Hospital, Jeddah, Saudi Arabia

2Assistant Professor of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

3General Physician, Prince Faisal Bin Khalid Cardiac Center, Jeddah, Saudi Arabia

4Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

5Collage of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia

6Collage of Medicine, Ibn Sina National Collage for Medical Studies, Jeddah, Saudi Arabia

7Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia

8Department of Internal Medicine, Hera General Hospital, Mecca, Saudi Arabia

9Department of Emergency Medicine, King Faisal Hospital, Mecca, Saudi Arabia

10Department of Internal Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia

*Corresponding Author: Mohammed Saleh Hussein, Department of Internal Medicine, Dr. Samir Abbas Hospital, Jeddah, Saudi Arabia and Assistant Professor of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Received: December 22, 2020; Published: January 19, 2021



ackground: Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Mitral regurgitation (MR) is caused by the retrograde flow of blood from the left ventricle (LV) to the left atrium (LA) through the mitral valve (MV), which allows the systolic murmur to be heard best at the top of the heart with radiation to the left axilla.

Aim: This study overviews the pathophysiology, diagnosis, complications and management of rheumatic mitral valve diseases.

Conclusion: Rheumatic Mitral Valve Disease might happen in young age, it is mostly asymptomatic and only symptoms appear when they become. Management of the condition depends on the severity of the symptoms; surgical intervention could be used in severe cases while medications such as anticoagulants can work in mild conditions. Finally, more efforts should be paid to the low-income countries to help decrease the incidence of these diseases.

Keywords: Mitral Valve Stenosis; Mitral Valve Regurgitation; Rheumatic Valve Disease

  1. Lawrence JG., et al. “Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010”. Circulation 128 (2013): 492-501.v
  2. He VY., et al. “Long-Term OutcomesFrom Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach”. Circulation 134 (2016): 222-232.
  3. Stollerman GH. “Rheumatogenic streptococci and autoimmunity”. Clinical Immunology and Immunopathology 61 (1991): 113-142.
  4. Raizada V., et al. “Tissue distribution of lymphocytes in rheumatic heart valves as defined by monoclonal anti-T cells antibodies”. The American Journal of Medicine 74 (1983): 90-96.v
  5. Kemeny E., et al. “Identification of mononuclear cells and T cell subsets in rheumatic valvulitis”. Clinical Immunology and Immunopathology 52 (1989): 225-237.
  6. Roberts S., et al. “Pathogenic mechanisms in rheumatic carditis: focus on valvular endothelium”. The Journal of Infectious Diseases 183 (2001): 507-511.
  7. Okello E., et al. “Socioeconomic and environmental risk factors among rheumatic heart disease patients in Uganda”. PLoS One 7 (2012): e43917.v
  8. Watkins DA., et al. “Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel”. Journal of the American College of Cardiolog 72 (2018): 1397-1416.
  9. Cannon J., et al. “Rheumatic Heart Disease Severity, Progression and Outcomes: A Multi-State Model”. Journal of the American Heart Association (2017).
  10. Parnaby MG and Carapetis JR. “Rheumatic fever in indigenous Australian children”. Journal of Paediatrics and Child Health 46 (2010): 527-533.v
  11. Carapetis JR, andCurrie BJ. “Rheumatic fever in a high incidence population: the importance of monoarthritis and low-grade fever”. Archives of Disease in Childhood 85 (2001): 223-227.
  12. Riaz BK., et al. “Risk factors of rheumatic heart disease in Bangladesh: a case-control study”. Journal of Health, Population and Nutrition 31 (2013): 70-77.v
  13. Shiffman RN. “Guideline maintenance and revision. 50 years of the Jones criteria for diagnosis of rheumatic fever”. Archives of Pediatrics and Adolescent Medicine 149 (1995): 727-732.
  14. Gray C and Thomson N. “Review of acute rheumatic fever and rheumatic heart disease among Indigenous Australians”. Australian Indigenous HealthInfo Net 14 (2013): 1-15.
  15. Watkins DA., et al. “Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015”. The New England Journal of Medicine 377 (2017): 713-722.
  16. Otto CM and Bonow RO. “Valvular heart disease”. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald’s Heart Disease: A Text book of Cardiovascular Medicine”. 8th edition. Philadelphia, PA: WB Saunders (2007): 1625-1712.
  17. Seckeler MD and Hoke TR. “The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease”. Clinical Epidemiology3 (2011): 67-84.
  18. Imran TF and Awtry EH. “Severe Mitral Stenosis”. The New England Journal of Medicine3 (2018): e6.
  19. Banovic M and DaCosta M. “Degenerative Mitral Stenosis: From Pathophysiology to Challenging Interventional Treatment”. Current Problems in Cardiology1 (2019): 10-35.
  20. Maeder MT., et al. “Pulmonary Hypertension in Aortic and Mitral Valve Disease”. Frontiers in Cardiovascular Medicine 5 (2018): 40.
  21. Maganti K., et al. “Valvular heart disease: diagnosis and management”. In Mayo Clinic Proceedings5 (2010): 483-500.v
  22. Zoghbi WA., et al. “Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography”. Journal Info. American Society of Echocardiography 16 (2003): 777.
  23. Roes SD., et al. “Flow assessment through four heart valves simultaneously using 3-dimensional 3-directional velocity-encoded magnetic resonance imaging with retrospective valve tracking in healthy volunteers and patients with valvular regurgitation”. Investigative Radiology (2009).
  24. Watkins DA., et al. “Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel”. Journal of the American College of Cardiology12 (2018): 1397-1416.
  25. Chandrashekhar Y., et al. “Mitral stenosis”. The Lancet 374.9697 (2009): 1271-1283.
  26. Bonow RO., et al. “Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. Circulation 118 (2008): e523-661.
  27. Harikrishnan S and Kartha CC. “Pulmonary hypertension in rheumatic heart disease”. Pulmon Vasc Res 1 (2009): 13-19.
  28. Bahl V., et al. “Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures”. Catheterization and Cardiovascular Diagnosis 36 (1995): 211-215.v
  29. Maeder MT., et al. “Pulmonary Hypertension in Aortic and Mitral Valve Disease”. Frontiers in Cardiovascular Medicine 5 (2018): 40.
  30. Szczygielska I., et al. “Rheumatic fever - new diagnostic criteria”. Reumatologia 56.1 (2018): 37-41.
  31. Mohanty S., et al. “Gender specific considerations in atrial fibrillation treatment: a review”. Expert Opinion on Pharmacotherapy4 (2018): 365-374.v
  32. Data show decrease in the incidence of stroke when using anticoagulants. The treatment regimen should begin with low-molecular weight heparin and Coumadin at the time of anti-arrhythmia initiation.
  33. Bonow RO., et al. “Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. Circulation 118 (2008): e523-661.
  34. Capomolla S., et al. “Beta blockade in chronic heart failure: diastolic function and mitral regurgitation improvement by carvedilol”. American Heart Journal 139 (2000): 596-60835.v
  35. Linde C., et al. “Long term benefits of biventricular pacing in congestive heart failure: results from the multisite stimulation in Cardiomyopathy (MUSTIC) study”. Journal of the American College of Cardiology 40 (2002): 111-118.
  36. De Bonis M., et al. “Treatment and management of mitral regurgitation”. Nature Reviews Cardiology3 (2011): 133-146.
  37. Breithardt OA., et al. “Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure”. Journal of the American College of Cardiology 41 (2003): 765-770.
  38. Jones T. “Diagnosis of rheumatic fever”. Journal of the American Medical Association 126 (1944): 481-484.
  39. Wolf P., et al. “Atrial fibrillation as an independent risk factor for stroke: The Framingham Study”. Stroke 22 (1991): 983-988.
  40. Burckhardt D., et al. “Treatment of mitral stenosis”. European Heart Journal 12 (1991): 95-98

Mohammed Saleh Hussein., et al. “Complications and Management of Rheumatic Mitral Valve Disease”. EC Microbiology  17.2 (2021): 133-140.