MyMedR

Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma

Haron H, Yusof MR, Maskon O, Ooi J, Rahman MR

Heart Surg Forum, 2012 Feb;15(1):E59-60.

PMID: 22360910 DOI: 10.1532/HSF98.20111000

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.

Matched MeSH terms: Rheumatic Heart Disease/diagnosis

Fulltext Transient complete heart block during acute rheumatic fever: a case report

Ong PK, Ramanathan M

Med J Malaysia, 1987 Sep;42(3):215-6.

PMID: 3506649

We report a case of transient complete heart block with Stokes-Adams attack due to acute rheumatic fever. The patient was a 12-year old boy whose illness satisfied the criteria of acute rheumatic fever. A temporary transvenous cardiac pacer was necessary to tide him over the complete heart block. The rarity of this complication of acute rheumatic fever is highlighted.

Matched MeSH terms: Rheumatic Heart Disease/complications*; Rheumatic Heart Disease/physiopathology

Fulltext Traditional Jones criteria: limitation in the diagnosis of rheumatic fever in patients with mitral valve repair

Putri Yubbu, Johan Aref Jamaluddin, Lydia Chang Mun Yin, Geetha Kandavello, Mazeni Alwi, Hasri Samion, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):316-319.

MyJurnal

The present study aims to determine the limitations of traditional Jones criteria during the first episode of acute rheu- matic fever (ARF) at the initial referral hospital, in a cohort of patients below 18 years old who had undergone mitral valve repair in National Heart Institute (IJN) from 2011 to 2016. Carditis followed by fever and joint involvement were the most frequent manifestations at first diagnosis. Of the 50 patients, only seven (14%) fulfilled the traditional Jones criteria for the diagnosis of the first episode of ARF. When compulsory evidence of a previous group A Beta he- molytic streptococcus (GABHS) was disregarded, this figure rose to 54%. Therefore, strict adherence to Jones criteria with absolute documentation of GABHS will lead to underdiagnoses of ARF. The application of echocardiographic diagnostic criteria of rheumatic heart disease (RHD) needs to be emphasized to allow early diagnosis and adminis- tration of secondary prophylaxis to prevent progression to severe valvular disease.

Matched MeSH terms: Rheumatic Heart Disease

The significance of atrial fibrillation in rheumatic mitral stenosis: an echocardiographic study

Singham KT, Ariffin M

Med J Malaysia, 1979 Dec;34(2):136-9.

PMID: 548714

Matched MeSH terms: Rheumatic Heart Disease/diagnosis*

Fulltext Socio demographic profiles of rheumatic heart disease (RHD) patients in Sabah

Narwani Hussin, Wong, Mabelle, Liew, Houng Bang, Liau, Siow Yen

Int J Public Health Res, 2016;6(2):736-740.

MyJurnal

Introduction: Rheumatic Heart Disease (RHD) has been thought as a disease of poor socioeconomic status. It is more prevalent in underdeveloped and developing countries than in developed countries. It is also common among the population with multiple social issues such as overcrowded dwellings, undernutrition, poor sanitation and suboptimal medical care. This study was done to review the socio demographic profiles of RHD patients in Hospital Queen Elizabeth (HQE) II, Kota Kinabalu, Sabah.
Methods: A secondary data review of all patients registered under the RHD registry in HQE II for one- year starting from July 2013 to June 2014.
Results: 204 RHD patients were included. Nearly three quarter (74.0%) were female. The mean age was 40.43 (14.75) years old. 61.1% has completed secondary
education. 42.7% were housewives. The mean monthly income was RM 1363.83 (1297.05) which was categorized under the vulnerable income group. When they were categorized under the poverty level and the vulnerable income group, 42.6% and 76.5% of them fell under those categories respectively. The nearest health facilities to their houses were district hospitals (33.3%) with the mean distance of 9.17 km and health clinics (30.8%) with the mean distance of 4.27 km. Only 11.5% of them lived near the specialist hospitals with the mean distance of 21.32 km.
Conclusions: Results from this review suggested that majority of RHD patients were in the low socioeconomic group with less access to health care facilities with specialist care. They are the most vulnerable groups and need to be prioritized in the specialized care program. .

Matched MeSH terms: Rheumatic Heart Disease*

Rheumatic tricuspid stenosis: an echocardiographic study

Singham KT, Ariffin M

Med J Aust, 1979 Oct 20;2(8):428-9.

PMID: 318487

Matched MeSH terms: Rheumatic Heart Disease/epidemiology*

Fulltext Rheumatic heart disease: how big is the problem?

Ibrahim A, Rahman AR

Med J Malaysia, 1995 Jun;50(2):121-4.

PMID: 7565179

Matched MeSH terms: Rheumatic Heart Disease/epidemiology*; Rheumatic Heart Disease/prevention & control

Fulltext Rheumatic heart disease in referred cases: Experience at a cardiology centre

Jamal F, Abdullah N, Zambahari R

Family Practitioner, 1988;11(1):46-47.

Matched MeSH terms: Rheumatic Heart Disease

Fulltext Rheumatic heart disease in Malaysia

Jamal F, Mohd Salleh H, Tan SP

World Health Forum, 1994;15(1):56-7.

PMID: 8141979

Matched MeSH terms: Rheumatic Heart Disease/etiology; Rheumatic Heart Disease/epidemiology*

Rheumatic heart disease complicating pregnancy - an approach to management

Ong HC

Family Practitioner, 1981;4:41-44.

Matched MeSH terms: Rheumatic Heart Disease

Rheumatic fever is a major cause of acquired heart disease in children and young adults throughout the developing world

Chadha S, Inechen B

Singapore Med J, 1997 Mar;38(3):138.

PMID: 9269387

Matched MeSH terms: Rheumatic Heart Disease/etiology*; Rheumatic Heart Disease/epidemiology

Rheumatic fever

Chadha S, Inechen B

J Public Health Med, 1997 Sep;19(3):363-4.

PMID: 9347467

Matched MeSH terms: Rheumatic Heart Disease/etiology; Rheumatic Heart Disease/prevention & control*

Fulltext Quality of benzathine penicillin G: A multinational cross-sectional study

Hand RM, Senarathna SMDKG, Page-Sharp M, Gray K, Sika-Paotonu D, Sheel M, et al.

Pharmacol Res Perspect, 2020 12;8(6):e00668.

PMID: 33090729 DOI: 10.1002/prp2.668

Benzathine penicillin G (BPG) is used as first-line treatment for most forms of syphilis and as secondary prophylaxis against rheumatic heart disease (RHD). Perceptions that poor quality of BPG is linked to reported adverse effects and therapeutic failure may impact syphilis and RHD control programs. Clinical networks and web-based advertising were used to obtain vials of BPG from a wide range of countries. The quality of BPG was assessed using a high performance liquid chromatography assay capable of detecting relevant impurities and degradation products. Tests for water content, presence of heavy metals and physical characteristics of BPG, including particle size analysis and optical microscopy, also were conducted. Thirty-five batches of BPG were sourced from 16 countries across 4 WHO regions. All batches passed the US Pharmacopeia requirements for BPG injection (content), with no evidence of breakdown products or other detected contaminants. Water content and heavy metal analysis (n = 11) indicated adherence to regulatory standards and Good Manufacturing Practice. Particle size analysis (n = 20) found two batches with aggregated particles (>400 µm) that were dispersed following sonication. Current batches of BPG were of satisfactory pharmaceutical quality but aggregated particles were found in a modest proportion of samples. Future studies should focus on the physical characteristics of BPG which may contribute to variations in plasma penicillin concentrations an observed needle blockages in clinical practice. Pharmacopeial monographs could be revised to include standards on particle size and crystal morphology of BPG.

Matched MeSH terms: Rheumatic Heart Disease/drug therapy

Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis

Ramasamy D, Zambahari R, Fu M, Yeh KH, Hung JS

Cathet Cardiovasc Diagn, 1993 Sep;30(1):40-4.

PMID: 8402863

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.

Matched MeSH terms: Rheumatic Heart Disease/complications; Rheumatic Heart Disease/therapy

Pediatric cardiology in Asia

Vongprateep C

Cor Vasa, 1981;23(1):4-7.

PMID: 7238054

The problems of pediatric cardiology in Asia can be summarized as follows. In the countries like India, Indonesia, Malaysia, Pakistan and some other countries especially with government support like Thailand, the priority is primary health care. Except in Japan, cardiac care for children is not well supported financially. Training in pediatric cardiology is not readily available. Consequently small numbers of pediatric cardiologists, pediatric cardiac surgeons and active centres are available even in Japan. It is importannt to reduce the incidence of rheumatic fever and rheumatic heart disease by prevention of streptococcal infections and to increase the standard of living and environment. Transportation and referral system diagnosis, and treatment and follow-up is a special problem in neonatal care in relation to heart disease. Concentration of physicians, medical schools and cardiac centers in urban areas, old customs and poor understanding of people about the treatability and preventability of heart diseases in children complicate the improvement in the management of children with heart diseases.

Matched MeSH terms: Rheumatic Heart Disease/epidemiology*

Fulltext Pattern of heart disease and pregnancy seen in a Malaysian hospital

Ong HC, Puraviappan AP, Sinnathuray TA, Chong CH, Sen DK

Singapore Med J, 1978 Jun;19(2):93-7.

PMID: 751193

Pregnancy was associated with cardiac disease in 0.94% of pregnancies. 0.66% with rheumatic lesions and 0.25'\'0 with congenital lesions. The Malays had a higher incidence than the Chinese and Indians. Most of the cardiac pregnancies were in patients between 20-30 years of age and gravida 1 to 4. Nevertheless. still about 30% of cardiac pregnancies were in patients 30 years and over in age and 20% in patient gravida 5 and above. Rheumatic lesions predominated. involving mainly the mitral valve. of which the major lesion was mitral stenosis. PDA. ASD and VSD were the major congenital lesions. Major antepartum matemal complications included arrhythmias. heart failure, anemia and pre-eclampsia. Of the arrhythmias. atrial fibrillation and sinus tachycardia occurred most commonly. A high incidence of prophylactic forceps and vacuum deliveries
was evident. There was one matemal death. The majority of infants were bom alive and well.

Matched MeSH terms: Rheumatic Heart Disease/epidemiology*

Microscopical atrial amyloidosis in chronic heart disease

Looi LM

Histopathology, 1981 Nov;5(6):615-22.

PMID: 7319480

Nineteen out of 121 consecutive cardiac biopsies from 107 patients were found to contain amyloid deposits on routine Congo red screening. Seventeen were left atrial appendages removed during mitral valvotomy for chronic rheumatic mitral valve disease while the remaining two were right atrial appendages excised during surgical repair of atrial septal defects. The distribution of amyloid deposits within the atria and their tinctorial characteristics are described. The high prevalence of atrial amyloidosis observed could not be attributed to generalized or senile amyloidosis. The possibility that this is a distinctive localized form of amyloidosis secondary to chronic heart disease is discussed.

Matched MeSH terms: Rheumatic Heart Disease/complications

Isolated atrial amyloidosis: a clinicopathologic study indicating increased prevalence in chronic heart disease

Looi LM

Hum Pathol, 1993 Jun;24(6):602-7.

PMID: 8505038

Congo red screening of 211 consecutive cardiac biopsy specimens obtained during cardiac surgery from 167 patients revealed 26 (16%) instances of isolated atrial amyloidosis (IAA). The ages of IAA-positive patients ranged from 25 to 52 years (mean age, 39 years). Twenty-three (88%) IAA-positive biopsy specimens were from patients with chronic rheumatic heart disease (CRHD) while three (12%) were from patients with an atrial septal defect (ASD). The prevalence of IAA in the CRHD patients was 23%, appreciably higher than that in the ASD patients (15%) and in other patients with atrial biopsies. The prevalence of IAA in both CRHD and ASD patients was significantly higher (P < .001) than in controls. Controls consisted of 247 healthy adults who were autopsied after traumatic deaths, with an age range of 18 to 89 years (mean age, 38 years). Only seven (3%) control subjects were IAA positive; all were over 40 years of age. Isolated atrial amyloidosis deposits were permanganate resistant and immunohistochemically positive for human amyloid P (AP) protein and negative for human amyloid-associated (AA) protein and immunoglobulin light chains. They were observed as fine congophilic and birefringent deposits in intramyocardial vessel walls, along the myocardial sarcolemma, and in the subendocardium. There was associated myocyte hypertrophy but no atrophy. Electron microscopy demonstrated typical nonbranching amyloid fibrils. It is postulated that stretching of the atria in chronic heart disease results in a raised prevalence of IAA. Recent reports that IAA contains atrial natriuretic peptide, a polypeptide hormone product of atrial myocytes, supports this view.

Matched MeSH terms: Rheumatic Heart Disease/complications*

Is rheumatic aetiology a predictor of poor outcome in the current era of mitral valve repair? Contemporary long-term results of mitral valve repair in rheumatic heart disease

Yakub MA, Dillon J, Krishna Moorthy PS, Pau KK, Nordin MN

Eur J Cardiothorac Surg, 2013 Oct;44(4):673-81.

PMID: 23447474 DOI: 10.1093/ejcts/ezt093

Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs.

Matched MeSH terms: Rheumatic Heart Disease/surgery*

Is it worth repairing rheumatic mitral valve disease in children? Long-term outcomes of an aggressive approach to rheumatic mitral valve repair compared to replacement in young patients

Krishna Moorthy PS, Sivalingam S, Dillon J, Kong PK, Yakub MA

Interact Cardiovasc Thorac Surg, 2019 02 01;28(2):191-198.

PMID: 30085022 DOI: 10.1093/icvts/ivy234

OBJECTIVES: Contemporary experience in mitral valve (MV) repair for children with rheumatic heart disease (RHD) is limited, despite the potential advantages of repair over replacement. We reviewed our long-term outcomes of rheumatic MV repair and compared them with the outcomes of MV replacement in children with RHD.

METHODS: This study is a review of 419 children (≤18 years) with RHD who underwent primary isolated MV surgery between 1992 and 2015, which comprised MV repair (336 patients; 80.2%) and MV replacement (83 patients; 19.8%). The replacement group included mechanical MV replacements (MMVRs) (n = 69 patients; 16.5%) and bioprosthetic MV replacements (n = 14 patients; 3.3%). The mean age with standard deviation at the time of operation was 12.5 ± 3.5 (2-18) years. Mitral regurgitation (MR) was predominant in 390 (93.1%) patients, and 341 (81.4%) patients showed ≥3+ MR. The modified Carpentier reconstructive techniques were used for MV repair.

RESULTS: Overall early mortality was 1.7% (7 patients). The mean follow-up was 5.6 years (range 0-22.3 years; 94.7% complete). Survival of patients who underwent repair was 93.9% both at 10 and 20 years, which was superior than that of replacement (P

Matched MeSH terms: Rheumatic Heart Disease/diagnosis; Rheumatic Heart Disease/surgery*

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