Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience

Abstract

Background: Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo).

Methods: Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort.

Results: In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease.

Conclusion: RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases.

Keywords: Echocardiography; Incidence; Rheumatic heart disease; Valvular heart disease.

Fig. 1

Algorithm showing the inclusion and exclusion criteria of cases for the present study (AR = Aortic Regurgitation, MR = Mitral Regurgitation, TR = Tricuspid Regurgitation).

Fig. 2

Overview of patterns of valvular heart disease (AR = Aortic Regurgitation, AS = Aortic Stenosis, MR = Mitral Regurgitation, MS = Mitral Stenosis, PS = Pulmonary Stenosis, TR = Tricuspid Regurgitation, TS = Tricuspid Stenosis).

Fig. 3

Age and Sex-wise distribution of Rheumatic Mitral Stenosis cases.

Fig. 4

Distribution of cases across the three severities of MS (MS = Mitral Stenosis).

Fig. 5

Distribution of cases with pulmonary hypertension (MS = Mitral Stenosis).

Fig. 6

Incidence of various etiologies of isolated mitral regurgitation (MAC = Mitral Annular Calcification, MVP/MYX = Mitral Valve Prolapse/Myxomatous mitral valve, RHD = Rheumatic Heart Disease).

Fig. 7

Age and Etiology-wise distribution of cases of isolated aortic stenosis.

Fig. 8

Etiology and Sex-specific distribution of cases of isolated aortic regurgitation.

Fig. 9

Patterns of anatomic/hemodynamic combinations of valve lesions (Abbreviations are as used in Fig. 2).

Fig. 10

Distribution of Tricuspid Regurgitation cases (TR = Tricuspid Regurgitation, TV = Tricuspid Valve).