How dangerous is rheumatic heart disease?

Rheumatic heart disease affected 40.5 million people in 2019, causing approximately 1.1 million cases of heart failure and 320,000 deaths annually.

Ms. Nguyen Thi Kim Phuc (66 years old, Hanoi ) suffered from chronic rheumatic heart disease for many years, leading to mitral valve stenosis and heart failure, threatening her life. She underwent surgery to replace the valve with a biological valve, prolonging her life.

Associate Professor Ước during a surgery on a patient with rheumatic heart disease.

Previously, Ms. Phuc had undergone partial thyroidectomy in 2015, which led to post-operative hypothyroidism, paroxysmal atrial fibrillation, and irregular medication treatment.

In June 2023, a patient with multiple ischemic stroke and residual right-sided hemiparesis was admitted to the hospital's emergency room. Doctors noted severe mitral stenosis, mild to moderate mitral regurgitation, mild aortic regurgitation, paroxysmal atrial fibrillation, hypertension, and hypothyroidism. The patient was then transferred to the Cardiology department for internal medicine treatment.

In April 2024, Ms. Phuc had a follow-up examination. At this time, her mitral valve was severely narrowed, and she had stage 2 heart failure. The Cardiology Department held a multidisciplinary consultation and unanimously agreed on the solution of open-heart surgery to replace the mitral valve.

The patient is elderly, has multiple underlying conditions, and after an episode of atrial fibrillation, their heart rate has returned to a regular sinus rhythm. Therefore, the doctor used the latest generation of biological valves to replace the mitral valve. This artificial valve has better hemodynamic performance and greater durability compared to previous types of biological valves.

Associate Professor Dr. Nguyen Huu Uoc, Head of the Department of Cardiovascular and Thoracic Surgery at Tam Anh General Hospital in Hanoi, said that because patient Phuc had rheumatic heart disease since childhood, the disease progressed severely, leading to severe mitral valve stenosis.

Currently, the patient is elderly, and this permanent heart valve damage needs to be addressed early to avoid worsening conditions. Coupled with severe heart failure, the risk of death is high, and even with surgical intervention, the success rate is low.

The team accessed the patient's heart through an incision in the chest, stopped the heart, and used a cardiopulmonary bypass (CEC) system to replace the heart's function during the surgery.

The diseased heart valve is removed and replaced with a new biological valve, ensuring accuracy, safety, and optimal function. After the valve replacement is complete, the surgical team restarts the heart before stopping CEC.

Associate Professor Ước stated that the patient was small in stature, 1.53 meters tall and weighing 52 kg. The heart valves were mostly narrowed, resulting in minimal dilation of the heart chambers, making the surgery difficult for the surgeon.

There are about 5-6 approaches to mitral valve surgery, but they are all small. Surgeons must choose an approach through the atria – although more complex, it allows for the clearest visualization of the pathological valve. When selecting the size of the artificial heart valve, the patient is only fit into a size 25 valve – the smallest mitral artificial valve currently available on the market worldwide .

Despite some disadvantages during the surgery, the biological mitral valve replacement was very successful, preventing the progression of heart failure and ensuring a high and long-term survival rate for the patient.

Postoperative ultrasound examination showed that the heart valve was functioning very well and efficiently despite its small size, consistent with the advantages of the new generation of biocompatible valves.

According to Associate Professor Ước, choosing a biological mitral valve replacement helps Ms. Phúc reduce the risk of blood clot formation. Patients only need to take anticoagulant medication for about 1-2 months after surgery, and do not need to take anticoagulants for life like with mechanical valves. In the long term, they can live a normal life.

Mrs. Phuc recovered quickly, without complications, and is now free from shortness of breath, in good spirits. The medication to prevent arrhythmias has also yielded positive results, with a regular heartbeat.

Rheumatic heart disease occurs after infection with group A beta-hemolytic streptococcus, manifesting as damage to the heart, joints, and blood vessels. Although clinical manifestations affect multiple organs, heart damage is the most dangerous and can be fatal.

Rheumatic heart disease affected 40.5 million people in 2019, causing approximately 1.1 million cases of heart failure and 320,000 deaths annually.

Approximately 3% of children aged 5-15 who develop strep throat due to group A beta-hemolytic streptococcus will also develop rheumatic fever, which is the most common age group affected.

Areas with poor living conditions, cramped and unsanitary housing, economic hardship, and cold, humid climates are all factors that make children more susceptible to sore throats.

Therefore, rheumatic fever is common in developing countries, including Vietnam.

According to Associate Professor Ước, rheumatic fever was very common about 20-30 years ago. Currently, the number of new cases of rheumatic fever in Vietnam has tended to decrease due to improved medical conditions and quality of life for the people. However, complications from pre-existing rheumatic fever cases remain a medical burden that needs attention.

The progression of rheumatic heart disease over time is the primary cause of valvular heart problems, particularly with the mitral valve.

Damage to the mitral and aortic valves can cause valve regurgitation or stenosis, and if left untreated, can lead to life-threatening complications.

Mitral stenosis can easily lead to pulmonary hypertension, heart failure, cardiomegaly, atrial fibrillation, and blood clots. Mitral regurgitation leads to progressive heart failure, arrhythmias, and endocarditis.

For patients with severe mitral stenosis, valve retraction, calcification, or left atrial thrombus, surgical repair or replacement of the valve will be performed.

Mitral valve replacement surgery is a classic major surgery that requires a robust hospital system to be successfully implemented.

Open-heart surgery requires a strong team including surgeons, anesthesiologists, and pacemakers, along with a modern system of equipment for clinical examination, testing, and close interdisciplinary collaboration in consultations and treatment.

Associate Professor Ước stated that rheumatic fever is a very dangerous disease but is entirely preventable by adopting a healthy lifestyle and maintaining a balanced daily routine.

Maintain a clean living environment and personal hygiene; keep your neck, chest, nose, and throat warm in winter; and have a balanced diet to boost your immune system.

When experiencing problems such as sore throat, tonsillitis, and sinusitis, it's essential to see a doctor for thorough treatment. To date, there is no vaccine against Group A beta-hemolytic streptococcus, so early detection and timely treatment at the first sign of infection will make treatment easier and more effective.

Children, especially those aged 5-15, who exhibit symptoms such as sore throat accompanied by aches and pains, swollen joints, chest tightness, palpitations, shortness of breath, chest pain, and motor neurological abnormalities, should be taken to medical facilities with cardiology specialists for accurate health checks by doctors.

Source: https://baodautu.vn/benh-thap-tim-nguy-hiem-the-nao-d223812.html