Rheumatic heart disease: current status of diagnosis and therapy

Abstract

Rheumatic heart disease (RHD) is the only preventable cardiovascular disease which causes significant morbidity and mortality particularly in low- and middle-income countries. Early clinical diagnosis is key, the updated Jones criteria increases the likelihood of diagnosis in endemic settings, including the echo diagnosis of sub-clinical carditis, polyarthralgia and monoarthritis as well as amended thresholds of minor criteria. The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation while severe disease is managed with medical, interventional and surgical treatment. In this report we detail some of the more recent epidemiological findings and focus on the diagnostic and interventional elements of the specific valve lesions. Finally, we discuss some of the recent efforts to improve medical and surgical management for this disease. As we are already more than a year from the historic 2018 World Heart Organization Resolution against Rheumatic Fever and Rheumatic Heart Disease, we advocate strongly for renewed efforts to prioritize this disease across the endemic regions of the world.

Keywords: Echocardiography; Jones criteria; World Health Organization Resolution; rheumatic heart disease (RHD); surgery.

Figure 1

WHF criteria: (A,B) mitral valve and (C,D) aortic valve. WHF, World Heart Federation.

Figure 2

Restriction of posterior leaflet and failure of coaptation.

Figure 3

Eccentric mitral regurgitation jet.

Figure 4

Beaded aortic valve doming in systole.