Andersons pediatric cardiology 1455
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ChronicRheumaticHeartDisease
BoRemenyi
Abstract
Rheumaticheartdisease(RHD)isthemostimportantlong-term
consequenceofacuterheumaticthatnowlargelyaffectstheworld’spoorest
populations.Morethan30millionpeopleworldwidehaveRHDandmore
than300,000deathsand10milliondisability-adjustedlife-yearsoccurper
yearasaresult.Althoughdiseaserateshavedeclinedglobally,RHDis
increasinglyconcentratedamongthepoorestandmarginalized.Heartvalve
involvementinRHDcanbedetectedandgradedclinically.However,
accuratediagnosisrequiresechocardiography.Standardizedcriteria
developedbytheWorldHeartFederationallowsforunambiguousdiagnosis
ofRHDandareespeciallyusefulintheabsenceofahistoryofRHD.Much
ofthedamagefromRHDislimitedtomitral,aortic,andtricuspidvalves,
andseveredamagerequiresexpertcardiovascularcareintheformof
correctivesurgery.Interventionaltherapywithpercutaneousmitralballoon
valvotomyislargelylimitedtoselectedpatientswithpuremitralstenosis.
Thischapterseekstoprovideacontemporaryandcomprehensiveupdateon
rheumaticheartdisease.
Keywords
Rheumaticheartdisease;mitralvalve;aorticvalve;percutaneousmitral
balloonvalvuloplasty;mitralstenosis;mitralregurgitation;aortic
regurgitation;atrialfibrillation;mitralvalverepair;pregnancy
Chronicrheumaticheartdisease(RHD)isthepersistenceofvalvardysfunction
followinganepisodeofacuterheumaticfever(ARF)orARFrecurrence.Once
theinflammatorymarkersnormalize,anypersistentvalvedysfunctionshouldbe
termedchronicRHD.
