Epidemiology of valvular heart diseases in Africa

Rheumatic heart disease (RHD) resulting from rheumatic fever (RF) is the main form of valve disease in Africa. Other forms of valve diseases such as myxomatous mitral valve disease, age-related valve disease, sub-valvular aneurysms or valve disease related to endomyocardial fibrosis are less common than RHD. In developed countries, RF and RHD are rare and no longer pose a public health problem, but the combination of poverty, lack of awareness, lack of infrastructure and resources, and social instability contribute to the persistence of RF and RHD in Africa. The presence of other major infectious diseases also shifts attention away from RF and RHD. Contemporary population-based epidemiologic data utilising echocardiography to detect valve disease suggests the prevalence of valve diseases in Africa is likely much higher than previously thought, meaning the estimated mortality, morbidity and socio-economic burden they cause could also be much higher than currently appreciated. Increased efforts are needed to define the scope of the problem of valve diseases in Africa to draw attention to these illnesses and step up public health efforts to control and eradicate them as has already been achieved in other parts of the world. This article highlights the public health problem of valve diseases in Africa, the efforts underway to combat them and the attendant challenges

When to use stress echocardiography in the evaluation of patients with valvular heart disease

Stress testing and stress echocardiography are firmly established diagnostic tests in the evaluation of patients with suspected or known coronary artery disease, but less established in the evaluation of patients with valvular heart disease. However, there is emerging data supporting the incremental benefit of stress testing and stress echocardiography in patients with known valvular heart disease. Particular applications include hemodynamic assessment of valve function and pulmonary response during exercise induced or chemically-induced stress to correlate with the patient’s exertional symptoms. In addition, stress testing affords the opportunity for functional assessment of ventricular systolic function for prognostication and planning for surgery

Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation

ObjectivesTo study the determinants of functional tricuspid regurgitation (TR) progression after surgical correction of mitral regurgitation, including the influence of mitral valve (MV) repair (MVr) versus replacement (MVR) for degenerative mitral regurgitation.MethodsFrom January 1995 to January 2006, 747 adults with MV prolapse underwent isolated MVr (n = 683) or MVR (n = 64; mechanical in 32). The mean age was 60.8 years, and 491 were men (66.0%). Moderate preoperative functional TR was present in 115 (15.4%). The MVR group had a greater likelihood of New York Heart Association class III or IV (75.0% vs 34.4%, P < .001), atrial fibrillation (20.3% vs 8.3%, P = .002), a lower left ventricular ejection fraction (61.0% vs 65.2%, P < .003), and a higher pulmonary artery pressure (50.1 vs 41.2 mm Hg, P = .001). The patients were monitored for a mean of 6.9 years (MVr) or 7.7 years (MVR; P = .075).ResultsDuring late follow-up, no difference was found between the groups in the development of moderately severe or severe TR: 1 to 5 years (3.0% vs 3.3%, P = .91) and >5 years (6.1% vs 6.5%; P = .93). The univariate predictors of severe TR after 5 years were older age (hazard ratio [HR], 1.1; P = .011), female gender (HR, 6.86; P = .005), higher pulmonary artery pressure (HR, 1.05; P = .022), and larger left atrial size (HR, 2.11; P = .035). Two patients (0.26%) who had undergone initial MVr required reoperation for late functional TR. Another 2 patients had had the tricuspid valve addressed concurrent with reoperation for MVr failure. No tricuspid reoperations were required in the MVR group.ConclusionsThe risk of TR progression was low after MVr or MVR for MV prolapse. Timely MV surgery before the development of left atrial dilatation or pulmonary hypertension could further decrease the risk of TR progression during follow-up

Efficacy and safety of percutaneous mitral balloon valvotomy in patients with mitral stenosis: A systematic review and meta-analysis

Aims: Percutaneous mitral balloon valvotomy PMBV is an acceptable alternative to Mitral valve surgery for patients with mitral stenosis. The purpose of this study was to explore the immediate results of PMBV with respect to echocardiographic changes, outcomes, and complications, using a meta-analysis approach. Methods: MEDLINE, and EMBASE databases were searched (01/2012 to 10/2018) for original research articles regarding the efficacy and safety of PMBV. Two reviewers independently screened references for inclusion and abstracted data including article details and echocardiographic parameters before and 24–72 h after PMBV, follow-up duration, and acute complications. Disagreements were resolved by third adjudicator. Quality of all included studies was evaluated using the Newcastle-Ottawa Scale NOS. Results: 44/990 references met the inclusion criteria representing 6537 patients. Our findings suggest that PMBV leads to a significant increase in MVA (MD = 0.81 cm2; 0.76–0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52–3.26, p = 0.007), LVEDV EDV (MD = 5.81 ml; 2.65–8.97, p = 0.0003) and decrease in MPG (MD = 7.96 mmHg; 8.73 to 7.20, p < 0.00001), LAP (MD = 10.09 mmHg; 11.06 to 9.12, p < 0.00001), and SPAP (MD = 15.55 mmHg; 17.92 to 13.18, p < 0.00001). On short term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post- PMBV stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7% respectively. On long term basis, the pooled overall incidence estimates of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7% respectively Conclusion: PMBV represents a successful approach for patients with mitral stenosis as evidenced by improvement in echocardiographic parameters and low rate of complications.The authors received no financial support for the research, authorship and publication of this article

Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa

Valvular heart diseases in Africa affect mainly children and young adults and are a result of rheumatic fever. Rheumatic fever is a preventable disease, but in Africa the combination of a lack of resources, lack of infrastructure, political, social and economic instability, poverty, overcrowding, malnutrition and lack of political will contributes to the persistence of a high burden of rheumatic fever, rheumatic valvular heart diseases and infective endocarditis. Combating and eradicating rheumatic fever and rheumatic heart diseases requires economic development and implementation of best practices of primary and secondary prevention measures. The barriers to achieving this goal in Africa are numerous, but not insurmountable