An appraisal of rheumatic valvular disease in Western Samoa

Rheumatic valvular heart disease appears to be common in Western Samoa, although the exact incidence is unknown. The outcome in 170 known cases since 1974 is reviewed. Thirty-six patients underwent cardiac surgery overseas, with one operative and four late deaths and a further 32 patients died while on medical treatment. Advanced disease was present in the majority of the surviving medical patients. Mitral stenosis was the most common problem. Thromboembolism appeared to be uncommon despite the absence of anticoagulant therapy. Bacterial endocarditis was also seldom recognised, but was probably under-diagnosed. At present penicillin prophylaxis is often taken haphazardly and an unknown number of cases receive no treatment at all. A prophylactic programme centred on the screening of schoolchildren is suggested.

[Heart valve prostheses in children with reference to 95 cases]

Over a 10 year period, 95 children aged 15 years and less underwent replacement of one or several of their heart valves, usually by a Starr-Edwards ball prosthesis. The predominant pathology was rheumatic heart disease and the most commonly affected valve was the mitral. Severe symptomatology, heart failure, cardiomegaly and high wedged-capillary and pulmonary arterial pressures were practically constant findings. Operative mortality was low (3.2%) and the long-term mortality was 10 patients. With an average follow-up of 40 months, results were excellent in the great majority of patients, with complete regression of symptoms, cardiomegaly and high capillary and pulmonary arterial pressures. Anticoagulant therapy was not systematic and only half the series were so treated. Thromboembolic complications were rare, 5.5% patients, but only affected those without anticoagulant therapy. The problems of evolving rheumatic disease and, above all, of tricuspid incompetence, the persistence of which after surgery on the mitral valve seems to be a sign of advanced myocardial damage, are discussed.

[Diagnosis of primary chronic rheumatic carditis in adults]

The authors maintain that in some cases one can note the so-called primar chronic rheumatic carditis, or apparently primary rheumatic carditis. Streptococcal infections can be held responsible for the eventuality of a sub-clinical evolution of rheumatism, and there which develops as a clinical form of latent rheumatism, and there is the possibility of ulterior development of valvular cardiopathy without a clear history of acute rheumatic fever in the antecedents. One of the groups subjects with maximal exposure to repeated streptococcic infection is represented by the teaching personnel working permanently in school or pre-school children collectivities or with teen-agers, which are both carriers and disseminators of the rheumatogenic streptococcal infection. Of a total of 50 cases of apparently primary chronic valvular cardiopathies that have been followed by the ASCAR personnel, 48 had tonsillary infections in their antecedents, 8 had arthralgia and 4 cases were detected by chance. In school collectivities at high risk prophylaxis with penicillin should be mandatory, both for the students and for the teaching personnel.

[Differential diagnosis of myocarditis from a number of cardiovascular system diseases]

The work is based on the analysis of 206 patients with myocarditis of whom 168 had infectious allergic myocarditis and 38 had idiopathic myocarditis. A wide variety of clinical laboratory and instrumental methods of examination was used and intravital puncture biopsy of the myocardium was conducted. The article discusses the criteria of differential diagnosis which make it possible to distinguish the form of myocarditis from a large group of cardiovascular diseases following a similar course, i.e. primary rheumatic carditis, ischemic heart disease, valvular diseases, pericarditis and others.

Pericardial disease in rheumatoid arthritis

Six patients with rheumatoid constrictive pericarditis, five seen in a two and one half year period, are described. All patients were male, all had rheumatoid factor, and all had active arthritis. Diagnosis was suspected from careful physical examination and confirmed in five patients by cardiac catheterization. Pericardiectomy was successful in all five patients on whom it was performed. Rheumatoid constrictive pericarditis should be suspected in any patient with rheumatoid arthritis and unexplained signs of right heart failure.