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Hibino M, Halkos ME, Murphy DA, Dhingra NK, Verma R, Hibino H, Aune D, Yanagawa B, Bhatt DL, Verma S. Age period cohort analysis of rheumatic heart disease in high-income countries. Clin Res Cardiol 2023; 112:1568-1576. [PMID: 36820872 DOI: 10.1007/s00392-023-02168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Rheumatic heart disease is considered well-controlled in high-income countries; however, its actual trends in mortality remain unclarified. We analyzed trends in mortality from rheumatic heart disease in association with age, period, and birth cohort. METHODS We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020. We used age-cohort-period modeling to estimate cohort and period effects. Net drift (overall annual percentage change), local drift (annual percentage change in each age group) and heterogeneity were calculated. RESULTS In the most recent year, crude mortality rates and age-standardized mortality rates ranged from 1.10 in the USA to 6.17 in Germany, and 0.32 (95% CI 0.31-0.34) in Japan and 1.70 (95% CI 1.65-1.75) in Germany, respectively. During the observation period, while Germany had a constant trend in overall annual percentage change, all the other countries had significant decreasing trends (p < 0.0001, respectively). Annual percent change was not homogeneous across each group in all 8 countries (pheterogeneity < 0.0001), with 2 peaks in the younger and older age categories. In Germany, Italy, Australia, and Canada, we found increasing mortality rates among older patients. Improving period and cohort risks for rheumatic heart disease mortality were generally observed, excluding Germany where the period effect was worsening and the cohort effect was constant. CONCLUSIONS Mortality trends from rheumatic heart disease were decreasing in the study high-income countries except for Germany where higher mortality and two peaks in annual percentage change in younger and older age groups warrant further investigation.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA.
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA
| | - Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA
| | - Nitish K Dhingra
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Raj Verma
- Royal College of Surgeon in Ireland, Dublin, Ireland
| | - Hiromi Hibino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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MacDonald B, Tarca A, Causer L, Maslin K, Bruce D, Schreiber-Wood R, Kumar M, Ramsay J, Andrews D, Budgeon C, Katzenellenbogen J, Bowen AC, Carapetis J, Friedberg MK, Yim D. Left ventricular remodelling in rheumatic heart disease - trends over time and implications for follow-up in childhood. BMC Cardiovasc Disord 2023; 23:462. [PMID: 37715115 PMCID: PMC10503178 DOI: 10.1186/s12872-023-03497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common form of acquired heart disease worldwide. In RHD, volume loading from mitral regurgitation leads to left ventricular (LV) dilatation, increased wall stress, and ultimately LV dysfunction. Improved understanding of LV dynamics may contribute to refined timing of intervention. We aimed to characterize and compare left ventricular remodelling between rheumatic heart disease (RHD) severity groups by way of serial echocardiographic assessment of volumes and function in children. METHODS Children with RHD referred to Perth Children's Hospital (formally Princess Margaret Hospital) (1987-2020) were reviewed. Patients with longitudinal pre-operative echocardiograms at diagnosis, approximately 12 months and at most recent follow-up, were included and stratified into RHD severity groups. Left ventricular (LV) echocardiographic parameters were assessed. Adjusted linear mixed effect models were used to compare interval changes. RESULTS 146 patients (median age 10 years, IQR 6-14 years) with available longitudinal echocardiograms were analysed. Eighty-five (58.2%) patients had mild, 33 (22.6%) moderate and 28 (19.2%) severe RHD at diagnosis. Mean duration of follow-up was 4.6 years from the initial diagnosis. Severe RHD patients had significantly increased end-systolic volumes (ESV) and end-diastolic volumes (EDV) compared to mild/moderate groups at diagnosis (severe versus mild EDV mean difference 27.05 ml/m2, p < 0.001, severe versus moderate EDV mean difference 14.95 ml/m2, p = 0.006). Mild and moderate groups experienced no significant progression of changes in volume measures. In severe RHD, LV dilatation worsened over time. All groups had preserved cardiac function. CONCLUSIONS In mild and moderate RHD, the lack of progression of valvular regurgitation and ventricular dimensions suggest a stable longer-term course. Significant LV remodelling occurred at baseline in severe RHD with progression of LV dilatation over time. LV function was preserved across all groups. Our findings may guide clinicians in deciding the frequency and timing of follow-up and may be of clinical utility during further reiterations of the Australia and New Zealand RHD Guidelines.
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Affiliation(s)
- Bradley MacDonald
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia.
- School of Population and Global Health, University of Western Australia, Perth, Australia.
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia.
| | - Adrian Tarca
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Louise Causer
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Katie Maslin
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Di Bruce
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Rachel Schreiber-Wood
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Mohit Kumar
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - James Ramsay
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - David Andrews
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
| | - Charley Budgeon
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Judith Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Perth, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Asha C Bowen
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Jonathan Carapetis
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid's Institute, University of Western Australia, Perth, Western, Australia
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Deane Yim
- Children's Cardiac Centre, Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, WA, 6008, Australia
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3
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Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease. Int J Cardiovasc Imaging 2022; 38:2667-2676. [DOI: 10.1007/s10554-022-02678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
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Montera MW, Marcondes-Braga FG, Simões MV, Moura LAZ, Fernandes F, Mangine S, Oliveira Júnior ACD, Souza ALADAGD, Ianni BM, Rochitte CE, Mesquita CT, de Azevedo Filho CF, Freitas DCDA, Melo DTPD, Bocchi EA, Horowitz ESK, Mesquita ET, Oliveira GH, Villacorta H, Rossi Neto JM, Barbosa JMB, Figueiredo Neto JAD, Luiz LF, Hajjar LA, Beck-da-Silva L, Campos LADA, Danzmann LC, Bittencourt MI, Garcia MI, Avila MS, Clausell NO, Oliveira NAD, Silvestre OM, Souza OFD, Mourilhe-Rocha R, Kalil Filho R, Al-Kindi SG, Rassi S, Alves SMM, Ferreira SMA, Rizk SI, Mattos TAC, Barzilai V, Martins WDA, Schultheiss HP. Brazilian Society of Cardiology Guideline on Myocarditis - 2022. Arq Bras Cardiol 2022; 119:143-211. [PMID: 35830116 PMCID: PMC9352123 DOI: 10.36660/abc.20220412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Sandrigo Mangine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Bárbara Maria Ianni
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil.,Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.,Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Imbroise Bittencourt
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - Marcelo Iorio Garcia
- Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Monica Samuel Avila
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University,Cleveland, Ohio - EUA
| | | | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil.,Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | - Silvia Moreira Ayub Ferreira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Stéphanie Itala Rizk
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Sírio Libanês, São Paulo, SP - Brasil
| | | | - Vitor Barzilai
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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Singh N, Haydock DA, Goh SSC. Medium-term outcomes from mitral valve surgery for rheumatic heart disease in young adults in Aotearoa New Zealand: a cohort study. ANZ J Surg 2022; 92:1060-1065. [PMID: 35403789 DOI: 10.1111/ans.17685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains an important cause of morbidity and mortality in New Zealand. Factors associated with the choice of surgical treatment for advanced RHD in young adults are poorly understood. We sought to review our local experience with the surgical management of young adults with rheumatic mitral valvular disease. METHODS From 2003 to 2016, all patients aged 15-24 years undergoing mitral valve surgery for rheumatic disease at Auckland City Hospital, New Zealand were retrospectively reviewed. RESULTS During the 13-year study period, 73 young adults underwent mitral surgery; 85% were Maori or Pacific Islanders. Mitral repair was performed in 32 patients and replacement in 41 patients. Isolated mitral valve surgery was performed in 36%, double valve procedures in 47%, and triple valve procedures in 17% of patients. The 30-day mortality rate and stroke rate were 1.4% and 2.7% respectively. The medium-term mortality rate was 11.9% across a mean follow-up of 6 years (6.9% in the repair group, 15.8% in the replacement group, p = 0.25). There were increased bleeding complications (p = 0.04) in patients with mechanical mitral valve replacement. For patients on warfarin, across medium-term follow-up, the INR was in the therapeutic range only 23% of the time. CONCLUSION Most young adults in New Zealand with severe RHD requiring surgery are of indigenous Maori or Pacific Island ethnicity. There is a trend towards improved survival with mitral repair. There is a significant tendency towards increased bleeding complications in patients on warfarin for mechanical mitral replacement. Warfarin compliance is poor.
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Affiliation(s)
- Navneet Singh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - David A Haydock
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Siew S C Goh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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6
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Rheumatic heart disease in The Gambia: clinical and valvular aspects at presentation and evolution under penicillin prophylaxis. BMC Cardiovasc Disord 2021; 21:503. [PMID: 34663206 PMCID: PMC8525010 DOI: 10.1186/s12872-021-02308-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains the leading cause of cardiac-related deaths and disability in children and young adults worldwide. In The Gambia, the RHD burden is thought to be high although no data are available and no control programme is yet implemented. We conducted a pilot study to generate baseline data on the clinical and valvular characteristics of RHD patients at first presentation, adherence to penicillin prophylaxis and the evolution of lesions over time. METHODS All patients registered with acute rheumatic fever (ARF) or RHD at two Gambian referral hospitals were invited for a clinical review that included echocardiography. In addition, patients were interviewed about potential risk factors, disease history, and treatment adherence. All clinical and echocardiography information at first presentation and during follow-up was retrieved from medical records. RESULTS Among 255 registered RHD patients, 35 had died, 127 were examined, and 111 confirmed RHD patients were enrolled, 64% of them females. The case fatality rate in 2017 was estimated at 19.6%. At first presentation, median age was 13 years (IQR [9; 18]), 57% patients had late stage heart failure, and 84.1% a pathological heart murmur. Although 53.2% of them reported history of recurrent sore throat, only 32.2% of them had sought medical treatment. A history suggestive of ARF was reported by 48.7% patients out of whom only 15.8% were adequately treated. Two third of the patients (65.5%) to whom it was prescribed were fully adherent to penicillin prophylaxis. Progressive worsening and repeated hospitalisation was experienced by 46.8% of the patients. 17 patients had cardiac surgery, but they represented only 18.1% of the 94 patients estimated eligible for cardiac surgery. CONCLUSION This study highlights for the first time in The Gambia the devastating consequences of RHD on the health of adolescents and young adults. Our findings suggest a high burden of disease that remains largely undetected and without appropriate secondary prophylaxis. There is a need for the urgent implementation of an effective national RHD control programto decrease the unacceptably high mortality rate, improve case detection and management, and increase community awareness of this disease.
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Tamirat S, Mazine A, Stevens LM, Agwar F, Dejene K, Bedru M, Dessie A, Lebon JS, Bouchard D. Contemporary outcomes of aortic and mitral valve surgery for rheumatic heart disease in sub-Saharan Africa. J Thorac Cardiovasc Surg 2020; 162:1714-1725.e2. [DOI: 10.1016/j.jtcvs.2020.02.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
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8
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Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Rao KN, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Chinnaswamy Reddy HM, Sharma R, Shivaprakash K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Vijaykumar R. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases. Ann Pediatr Cardiol 2019; 12:254-286. [PMID: 31516283 PMCID: PMC6716301 DOI: 10.4103/apc.apc_32_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - BRJ Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - KM Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - R Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | - K Samba Murthy
- Innova Children's Heart Hospital, Hyderabad, Telangana, India
| | | | - PV Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | - S Ramakrishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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10
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Koneti NR, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CHM, Sharma R, Shivaprakasha K, Subramanyan R, Suresh Kumar R, Talwar S, Tomar M, Verma S, Raju V. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention. Indian Heart J 2019; 71:207-223. [PMID: 31543193 PMCID: PMC6796629 DOI: 10.1016/j.ihj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/19/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. OBJECTIVES The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India.
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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11
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Chengode S, Shabadi RV, Rao RN, Alkemyani N, Alsabti H. Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach. Ann Card Anaesth 2018; 21:185-188. [PMID: 29652282 PMCID: PMC5914221 DOI: 10.4103/aca.aca_157_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.
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Affiliation(s)
- Suresh Chengode
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rahul Vijaykumar Shabadi
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ram Narayan Rao
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Alkemyani
- Department of Anaesthesia, Division of Cardiac Anaesthesia, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal Alsabti
- Department of Surgery, Division of Cardiac Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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12
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Rusingiza EK, El-Khatib Z, Hedt-Gauthier B, Ngoga G, Dusabeyezu S, Tapela N, Mutumbira C, Mutabazi F, Harelimana E, Mucumbitsi J, Kwan GF, Bukhman G. Outcomes for patients with rheumatic heart disease after cardiac surgery followed at rural district hospitals in Rwanda. Heart 2018; 104:1707-1713. [PMID: 29678896 PMCID: PMC6173815 DOI: 10.1136/heartjnl-2017-312644] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery. METHODS We collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007-2015. RESULTS The majority of patients were adults (46/54; 85%), and 74% were females. The median age at the time of surgery was 22 years in adults and 11 years in children. Advanced symptoms-New York Heart Association class III or IV-were present in 83% before surgery and only 4% afterwards. The mitral valve was the most common valve requiring surgery. Valvular surgery consisted mostly of a single valve (56%) and double valve (41%). Patients were followed for a median of 3 years (range 0.2-7.9) during which 7.4% of them died; all deaths were patients who had undergone bioprosthetic valve replacement. For patients with mechanical valves, anticoagulation was checked at 96% of visits. There were no known bleeding or thrombotic events requiring hospitalisation. CONCLUSION Outcomes of postoperative patients with RHD tracked in rural Rwanda health facilities were generally good. With appropriate training and supervision, it is feasible to safely decentralise follow-up of patients with RHD to nurse-led specialised NCD clinics after cardiac surgery.
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Affiliation(s)
- Emmanuel K Rusingiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Ministry of Health, Kigali, Rwanda
| | - Ziad El-Khatib
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gedeon Ngoga
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Symaque Dusabeyezu
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
| | - Neo Tapela
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
| | - Gene Bukhman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
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13
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Mejia OAV, Antunes MJ, Goncharov M, Dallan LRP, Veronese E, Lapenna GA, Lisboa LAF, Dallan LAO, Brandão CMA, Zubelli J, Tarasoutchi F, Pomerantzeff PMA, Jatene FB. Predictive performance of six mortality risk scores and the development of a novel model in a prospective cohort of patients undergoing valve surgery secondary to rheumatic fever. PLoS One 2018; 13:e0199277. [PMID: 29979692 PMCID: PMC6034795 DOI: 10.1371/journal.pone.0199277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mortality prediction after cardiac procedures is an essential tool in clinical decision making. Although rheumatic cardiac disease remains a major cause of heart surgery in the world no previous study validated risk scores in a sample exclusively with this condition. OBJECTIVES Develop a novel predictive model focused on mortality prediction among patients undergoing cardiac surgery secondary to rheumatic valve conditions. METHODS We conducted prospective consecutive all-comers patients with rheumatic heart disease (RHD) referred for surgical treatment of valve disease between May 2010 and July of 2015. Risk scores for hospital mortality were calculated using the 2000 Bernstein-Parsonnet, EuroSCORE II, InsCor, AmblerSCORE, GuaragnaSCORE, and the New York SCORE. In addition, we developed the rheumatic heart valve surgery score (RheSCORE). RESULTS A total of 2,919 RHD patients underwent heart valve surgery. After evaluating 13 different models, the top performing areas under the curve were achieved using Random Forest (0.982) and Neural Network (0.952). Most influential predictors across all models included left atrium size, high creatinine values, a tricuspid procedure, reoperation and pulmonary hypertension. Areas under the curve for previously developed scores were all below the performance for the RheSCORE model: 2000 Bernstein-Parsonnet (0.876), EuroSCORE II (0.857), InsCor (0.835), Ambler (0.831), Guaragna (0.816) and the New York score (0.834). A web application is presented where researchers and providers can calculate predicted mortality based on the RheSCORE. CONCLUSIONS The RheSCORE model outperformed pre-existing scores in a sample of patients with rheumatic cardiac disease.
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Affiliation(s)
- Omar A. V. Mejia
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
- * E-mail:
| | - Manuel J. Antunes
- Center of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Maxim Goncharov
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Luís R. P. Dallan
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Elinthon Veronese
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Gisele A. Lapenna
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Luiz A. F. Lisboa
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Luís A. O. Dallan
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Carlos M. A. Brandão
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Jorge Zubelli
- National Institute for Pure and Applied Mathematics, Rio de Janeiro, RJ, Brazil
| | - Flávio Tarasoutchi
- Department of the Clinical Unit of Heart Valve Diseases, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Pablo M. A. Pomerantzeff
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
| | - Fabio B. Jatene
- Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, São Paulo, Brazil
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14
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, G S, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. CSI position statement on management of heart failure in India. Indian Heart J 2018; 70 Suppl 1:S1-S72. [PMID: 30122238 PMCID: PMC6097178 DOI: 10.1016/j.ihj.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, LokmanyaTilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharshtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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15
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Walsh WF, Kangaharan N. Cardiac care for Indigenous Australians: practical considerations from a clinical perspective. Med J Aust 2017; 207:40-45. [DOI: 10.5694/mja17.00250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022]
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16
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Makrexeni ZM, Pepeta L. Clinical presentation and outcomes of patients with acute rheumatic fever and rheumatic heart disease seen at a tertiary hospital setting in Port Elizabeth, South Africa. Cardiovasc J Afr 2017; 28:248-250. [PMID: 28430286 PMCID: PMC5642025 DOI: 10.5830/cvja-2017-019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 04/04/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) has waned in Western countries, however that is not the situation in developing nations. Methods: Records were reviewed of patients from the Eastern Cape municipal districts who presented to the Paediatric Cardiology Unit with ARF and RHD from January 2008 to August 2015. Results: Total of 56 patients with ARF/RHD was reviewed. The majority of patients (n = 52) presented for the first time with RHD. Four patients presented with ARF and two had recurrent ARF. Six patients presented with a combination of RHD and congenital heart disease. Twenty-three patients were operated on for chronic rheumatic valve disease, with good outcomes. Conclusion: The true burden of ARF/RHD is unknown in the Eastern Cape. Prospective studies are needed to accurately determine the prevalence of RHD in this province.
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Affiliation(s)
| | - Lungile Pepeta
- Faculty of Health Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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17
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Palafox B, Mocumbi AO, Kumar RK, Ali SKM, Kennedy E, Haileamlak A, Watkins D, Petricca K, Wyber R, Timeon P, Mwangi J. The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of RHD. Glob Heart 2017; 12:47-62. [PMID: 28336386 DOI: 10.1016/j.gheart.2016.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022] Open
Abstract
Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts.
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Affiliation(s)
- Benjamin Palafox
- ECOHOST -The Centre for Health and Social Change, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde and Universidade Eduardo Mondlane, Maputo, Moçambique
| | - R Krishna Kumar
- Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Sulafa K M Ali
- University of Khartoum and Sudan Heart Center, Khartoum, Sudan
| | - Elizabeth Kennedy
- Fiji RHD Prevention and Control Project, Ministry of Health and Medical Services and Cure Kids New Zealand, Suva, Fiji
| | | | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kadia Petricca
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosemary Wyber
- Telethon Kids Institute, Perth, Western Australia, Australia
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18
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Nandra TK, Wilson NJ, Artrip J, Pagis B. Rheumatic fever with severe carditis: still prevalent in the South West Pacific. BMJ Case Rep 2017; 2017:bcr-2016-218954. [PMID: 28283470 DOI: 10.1136/bcr-2016-218954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.
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Affiliation(s)
| | | | - John Artrip
- Auckland City Hospital, Auckland, New Zealand
| | - Bruno Pagis
- Centre Hospitalier de la Polynesie Francaise, Papeete, French Polynesia
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19
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Abstract
Primarily affecting the young, rheumatic heart disease (RHD) is a neglected chronic disease commonly causing premature morbidity and mortality among the global poor. Standard clinical prevention and treatment is based on studies from the early antimicrobial era, as research investment halted soon after the virtual eradication of the disease from developed countries. The emergence of new global data on disease burden, new technologies, and a global health equity platform have revitalized interest and investment in RHD. This review surveys past and current evidence for standard RHD diagnosis and treatment, highlighting gaps in knowledge.
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Affiliation(s)
- Shanti Nulu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06519, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA; Section of Cardiovascular Medicine, Boston University Medical Center, Boston University School of Medicine, 88 East Newton Street, D8, Boston, MA 02118, USA.
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20
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Yangni-Angate KH, Meneas C, Diby F, Diomande M, Adoubi A, Tanauh Y. Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire. Cardiovasc Diagn Ther 2016; 6:S44-S63. [PMID: 27904843 DOI: 10.21037/cdt.2016.10.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.
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Affiliation(s)
- Koffi Herve Yangni-Angate
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Christophe Meneas
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Florent Diby
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Manga Diomande
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire
| | - Anicet Adoubi
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Yves Tanauh
- Department of Thoracic Surgery, Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
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21
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Aboriginal and Torres Strait Islander Cardiovascular Health 2016: Is the Gap Closing? Heart Lung Circ 2016; 25:765-7. [DOI: 10.1016/j.hlc.2016.05.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Abstract
Acute rheumatic fever and rheumatic heart disease remain major global health problems. Although strategies for primary and secondary prevention are well established, their worldwide implementation is suboptimum. In patients with advanced valvular heart disease, mechanical approaches (both percutaneous and surgical) are well described and can, for selected patients, greatly improve outcomes; however, access to centres with experienced staff is very restricted in regions that have the highest prevalence of disease. Development of diagnostic strategies that can be locally and regionally provided and improve access to expert centres for more advanced disease are urgent and, as yet, unmet clinical needs. We outline current management strategies for valvular rheumatic heart disease on the basis of either strong evidence or expert consensus, and highlight areas needing future research and development.
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Affiliation(s)
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Sidney C Smith
- Heart and Vascular Center, University of North Carolina, Chapel Hill, NC, USA
| | - Magdi Yacoub
- Cardiothoracic Surgery, Imperial College London, London, UK
| | - David R Holmes
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA.
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23
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Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Sable C, Steer A, Wilson N, Wyber R, Zühlke L. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2:15084. [PMID: 27188830 PMCID: PMC5810582 DOI: 10.1038/nrdp.2015.84] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.
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Affiliation(s)
- Jonathan R Carapetis
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Andrea Beaton
- Children's National Health System, Washington, District of Columbia, USA
| | - Madeleine W Cunningham
- Department of Microbiology and Immunology, Biomedical Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute for Science and Technology, São Paulo, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Craig Sable
- Children's National Health System, Washington, District of Columbia, USA
| | - Andrew Steer
- Department of Paediatrics, the University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Rosemary Wyber
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Liesl Zühlke
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Paediatric Cardiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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24
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Watson G, Jallow B, Le Doare K, Pushparajah K, Anderson ST. Acute rheumatic fever and rheumatic heart disease in resource-limited settings. Arch Dis Child 2015; 100:370-5. [PMID: 25784737 DOI: 10.1136/archdischild-2014-307938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Poststreptococcal complications, such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), are common in resource-limited settings, with RHD recognised as the most common cause of paediatric heart disease worldwide. Managing these conditions in resource-limited settings can be challenging. We review the investigation and treatment options for ARF and RHD and, most importantly, prevention methods in an African setting.
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Affiliation(s)
| | - Bintou Jallow
- Gambia Unit, Medical Research Council, Fajara, The Gambia
| | - Kirsty Le Doare
- Gambia Unit, Medical Research Council, Fajara, The Gambia Wellcome Centre for Global Health Research, Imperial College, London, UK
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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25
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Controlling acute rheumatic fever and rheumatic heart disease in developing countries: are we getting closer? Curr Opin Pediatr 2015; 27:116-23. [PMID: 25490689 DOI: 10.1097/mop.0000000000000164] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe new developments (2013-2014) in acute rheumatic fever (ARF) and rheumatic heart disease (RHD) relevant to developing countries. RECENT FINDINGS Improved opportunities for the primary prevention of ARF now exist, because of point-of-care antigen tests for Streptococcus pyogenes, and clinical decision rules which inform management of pharyngitis without requiring culture results. There is optimism that a vaccine, providing protection against many ARF-causing S. pyogenes strains, may be available in coming years. Collaborative approaches to RHD control, including World Heart Federation initiatives and the development of registers, offer promise for better control of this disease. New data on RHD-associated costs provide persuasive arguments for better government-level investment in primary and secondary prevention. There is expanding knowledge of potential biomarkers and immunological profiles which characterize ARF/RHD, and genetic mutations conferring ARF/RHD risk, but as yet no new diagnostic testing strategy is ready for clinical application. SUMMARY Reduction in the disease burden and national costs of ARF and RHD are major priorities. New initiatives in the primary and secondary prevention of ARF/RHD, novel developments in pathogenesis and biomarker research and steady progress in vaccine development, are all causes for optimism for improving control of ARF/RHD, which affect the poorest of the poor.
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