Andersons pediatric cardiology 1455

55 Chronic Rheumatic Heart Disease Bo Remenyi Abstract Rheumatic heart disease (RHD) is the most important long-term consequence of acute rheumatic that now largely affects the world’s poorest populations More than 30 million people worldwide have RHD and more than 300,000 deaths and 10 million disability-adjusted life-years occur per year as a result Although disease rates have declined globally, RHD is increasingly concentrated among the poorest and marginalized Heart valve involvement in RHD can be detected and graded clinically However, accurate diagnosis requires echocardiography Standardized criteria developed by the World Heart Federation allows for unambiguous diagnosis of RHD and are especially useful in the absence of a history of RHD Much of the damage from RHD is limited to mitral, aortic, and tricuspid valves, and severe damage requires expert cardiovascular care in the form of corrective surgery Interventional therapy with percutaneous mitral balloon valvotomy is largely limited to selected patients with pure mitral stenosis This chapter seeks to provide a contemporary and comprehensive update on rheumatic heart disease Keywords Rheumatic heart disease; mitral valve; aortic valve; percutaneous mitral balloon valvuloplasty; mitral stenosis; mitral regurgitation; aortic regurgitation; atrial fibrillation; mitral valve repair; pregnancy Chronic rheumatic heart disease (RHD) is the persistence of valvar dysfunction following an episode of acute rheumatic fever (ARF) or ARF recurrence Once the inflammatory markers normalize, any persistent valve dysfunction should be termed chronic RHD