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AB0892 The Features of Chronic Rheumatic Heart Disease in Saint-Petersburg
  1. A.M. Shulman,
  2. A.M. Shulman,
  3. E.N. Ushakova,
  4. T.G. Shemerovskaya,
  5. O.V. Inamova
  1. City Rheumathology Centre, Saint-Petersbug, Russian Federation

Abstract

Background Chronic rheumatic heart disease (CRHD) is a pathology characterized by valve anomaly formed after acute rheumatic fever. The adequate management of CRHD is important for prognosis, necessity of surgical intervention, and life quality of patients.

Objectives The purpose of the study was to analyze the patterns of CRHD in adults with different valve anomalies together with the role of tonsillectomy and secondary prevention.

Methods 150 patients (16 males, 134 females) were examined. The age was 19–80. The anamnesis (the age of disease manifestation, number of rheumatic fevers, the age of heart failure manifestation, the period from the disease manifestation to the first symptoms of heart failure, the age of permanent atrial fibrillation manifestation, the period from disease manifestation to permanent atrial fibrillation, cardiac operation, tonsillectomy, bicillin secondary prevention, chorea), examination, ECG, echocardiography was assessed.

Results The period from disease manifestation to the first symptoms of heart failure and the first symptoms outbreak period of heart failure were more in the group of non operated patients (P<0.01). There were no differences in functional class (NYHA) between operated and non operated patients (P=0.06). The operated patients had higher level of pulmonary hypertension (P<0.001). Chorea was observed more often in the group of non operated patients. In the non operated group the age of permanent atrial fibrillation manifestation and the period from disease manifestation to permanent atrial fibrillation was observed more than in operated group (P<0.01). The permanent atrial fibrillation was seen more often in operated group (P<0.001). Operated patients had more damaged valves (P<0.001). There were no differences in age of disease manifestation in operated and non operated groups.

There were no differences between the group which had 1–2 rheumatic fevers and the group that had 3–5 rheumatic fevers in the period from disease manifestation to the first symptoms of heart failure, the age of permanent atrial fibrillation manifestation and the period from disease manifestation to permanent atrial fibrillation and in functional class (NYHA).

The patients with the history of chorea had a smaller number of damaged valves and the longer period from disease manifestation to the first symptoms of heart failure outbreak.

There were also no differences in the group which had secondary prevention in comparison with other patients in the period from disease manifestation to the first symptoms of heart failure outbreak, in functional class (NYHA), the age of permanent atrial fibrillation manifestation and the period from disease manifestation to permanent atrial fibrillation, number of damaged valves.

There were also no differences in patients with tonsillectomy and without it on the same signs.

The age of first symptoms of heart failure was more in the group without secondary prevention.

Conclusions The operation was performed in patients with more severe variant of CRHD. The operated patients have acceptable quality of life in comparison with the other patients. The quantity of rheumatic fevers does not affect the rate of progression and severity of the disease in future. Tonsillectomy and secondary prevention do not affect the rate of progression and severity of CRHD, which requires to be analyzed more.

Disclosure of Interest None declared

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