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) had long-term rheumatic heart disease leading to mitral valve stenosis and heart failure, which threatened her life. She had surgery to replace a biological valve to prolong her life.

Associate Professor Uoc during a surgery for a patient with rheumatic heart disease.

Previously, Ms. Phuc had a partial thyroidectomy in 2015, leading to post-operative hypothyroidism, atrial fibrillation, and irregular medication.

In June 2023, a patient with multiple cerebral infarctions, with sequelae of right-sided weakness, was treated at the hospital. The doctor noted that the patient had mitral stenosis, mild to moderate mitral regurgitation, mild aortic regurgitation, paroxysmal atrial fibrillation, hypertension, and hypothyroidism. He was transferred to the Cardiology Department for internal medicine treatment.

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

The patient was elderly, had many underlying diseases, and now after a period of atrial fibrillation, the rhythm returned to regular sinus rhythm, so the doctor used the latest generation of biological valves to replace the mitral valve. This artificial valve has better hemodynamic performance and durability than previous types of biological valves.

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

Currently the patient is old, this permanent heart valve damage needs to be treated early to avoid the condition getting worse, plus severe heart failure, high risk of death, 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 the extracorporeal circulation system - CEC to replace the heart's activity during surgery.

The diseased heart valve is removed and replaced with a new biological valve, ensuring accuracy, safety and good working condition. After completing the heart valve replacement, the surgical team restarts the heart before stopping the CEC.

Associate Professor Uoc said the patient was small, 1m53 tall and weighed 52kg, with a narrow heart valve so the heart chambers did not expand much, making it difficult for the surgeon to operate.

There are about 5-6 ways to enter the mitral valve but they are all small, the surgeon must choose the way to enter through the two atria - although more complicated but allows the clearest view of the pathological valve. When choosing the size of the artificial heart valve, the patient can only fit valve number 25 - the smallest type of artificial mitral valve on the common market today in the world.

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

Postoperative ultrasound examination showed that the heart valve functioned very well, with high performance despite its small size, consistent with the advantages of the new generation of biological valves.

According to Associate Professor Uoc, choosing to replace the biological mitral valve helps Mrs. Phuc reduce the risk of blood clots. Patients maintain anticoagulant medication for about 1-2 months after surgery, do not need to take anticoagulants for life like mechanical valves, and in the long term can live like a normal person.

Mrs. Phuc recovered quickly, without complications, now has no more difficulty breathing, is in good spirits, the use of anti-arrhythmic drugs also gave good results, and her heart rate is regular.

Rheumatic heart disease occurs after a patient is infected with group A beta-hemolytic streptococcus, manifested by damage to the heart, joints and blood vessels. Although clinical manifestations occur in many organs, damage to the heart is the most dangerous, possibly causing death.

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

About 3% of children aged 5-15 years with pharyngitis caused by group A beta-hemolytic streptococcus infection will have rheumatic heart disease, which is also a common age group with the disease.

Areas with low living conditions, cramped housing, poor sanitation, economic difficulties, cold and humid climates... are factors that make children susceptible to sore throats.

That is why rheumatic heart disease is common in developing countries, including Vietnam.

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

Progression of rheumatic heart disease over time is the main cause of heart valve problems, especially the mitral valve.

Damage to the mitral valve and aortic valve can cause heart valve regurgitation or stenosis, which can be life-threatening if not treated promptly.

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

In cases where the patient has severe mitral valve stenosis, retraction, valve calcification or left atrium thrombosis, surgery will be performed to repair or replace the valve.

Mitral valve replacement surgery is a major classic surgery that requires a strong hospital machinery to be able to perform well.

Open heart surgery requires a solid team including surgeons, anesthesiologists, resuscitators, and machine operators, along with a system of modern equipment to perform clinical examinations, tests, and close coordination between specialties in consultation and treatment.

Associate Professor Uoc said rheumatic heart disease is a very dangerous disease but can be completely prevented by practicing a healthy lifestyle and regular activities.

Keep your living environment and body clean; keep your neck, chest, nose and throat warm in winter; have a nutritious diet to improve your resistance.

When you have problems with sore throat, tonsillitis and sinusitis, you need 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 when there are signs of infection will make treatment easier and more effective.

Children, especially those aged 5-15, have signs of sore throat accompanied by pain, swelling of the joints, chest tightness, palpitations and difficulty breathing, pain in the heart area accompanied by motor nerve abnormalities... parents need to take their children to medical facilities with a cardiology department so that doctors can check their health status most accurately.

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