IJCM  Vol.8 No.3 , March 2017
Echocardiographic and Clinical Evaluation of Rheumatic Mitral Stenosis in Younger and Elderly Patients
Abstract: Background: Rheumatic heart disease (RHD) is common form of heart disease among population, especially in developing countries like India. Mitral stenosis (MS) is majorly caused by rheumatic heart disease with mitral commissural adhesion, fibrosis and calcification of the chordae tendineae. The aim of present study was clinical and echocardiographic evaluation for mitral stenosis in RHD patients with different age group. Methods: This was a retrospective, nonrandomized, and single-centre study in which 203 consecutive patients presented rheumatic mitral stenosis. All the patients were divided into different age group viz. <40 years, 40 to 65 years and >65 years. Cardiovascular examination and echocardiography were done in each patient. Mitral valve area (MVA), mitral valve gradient (MVG) and left atrial (LA) diameter were assessed by echocardiography. Mitral valve score was recorded to analyse the degenerative changes in mitral valve structure. Results: A total of 203 patients (133 females) were enrolled and divided into three age groups. Patients with age above 65 years were considered as elderly and those patients with age below 40 years were considered as younger. Echocardiographic assessment showed mean 4.7 and 4.9 cm LA diameter, 0.92 and 0.86 cm2 MVA and 11.2 and 9.7 mm Hg MVG in younger and elderly patients respectively. Total mitral valve score has shown significant (p < 0.001) difference between younger and elder patients. Moreover, calcification and subvalvular thickening score with >2 had shown significant difference (p < 0.001) between younger and elderly patients. Conclusion: Present study provides unique contemporary data on characteristics and management of patients with rheumatic mitral stenosis. Majority of elderly patients are unsuitable for percutaneous commissurotomy due to degenerative changes in mitral valve structure.
Cite this paper: C. D., R. and Kanattu, P. (2017) Echocardiographic and Clinical Evaluation of Rheumatic Mitral Stenosis in Younger and Elderly Patients. International Journal of Clinical Medicine, 8, 128-135. doi: 10.4236/ijcm.2017.83012.

[1]   Chandrashekhar, Y., Westaby, S. and Narula, J. (2009) Mitral Stenosis. The Lancet, 374, 1271-1283.

[2]   Padmavati, S. (2001) Rheumatic Fever and Rheumatic Heart Disease in India at the Turn of the Century. Indian Heart Journal, 53, 35-37.

[3]   Waller, B.F., Howard, J. and Fess, S. (1994) Pathology of Mitral Valve Stenosis and Pure Mitral Regurgitation—Part I. Clinical Cardiology, 17, 330-336.

[4]   Messika-Zeitoun, D., Fung Yiu, S., Cormier, B., Iung, B., Scott, C., Vahanian, A., Tajik, A.J. and Enriquez-Sarano, M. (2003) Sequential Assessment of Mitral Valve Area during Diastole Using Colour M-Mode Flow Convergence Analysis: New Insights into Mitral Stenosis Physiology. European Heart Journal, 24, 1244-1253.

[5]   Kang, W.S., Choi, J.W., Kang, J.E., Chung, J.W. and Kim, S.H. (2013) Determination of Mitral Valve Area with Echocardiography, Using Intra-Operative 3-Dimensional versus Intra- & Post-Operative Pressure Half-Time Technique in Mitral Valve Repair Surgery. Journal of Cardiothoracic Surgery, 8, 98.

[6]   Wilkins, G.T., Weyman, A.E., Abascal, V.M., Block, P.C. and Palacios, I.F. (1988) Percutaneous Balloon Dilatation of the Mitral Valve: An Analysis of Echocardiographic Variables Related to Outcome and the Mechanism of Dilatation. British Heart Journal, 60, 299-308.

[7]   Segal, B.L. (2003) Valvular Heart Disease, Part 2. Mitral Valve Disease in Older Adults. Geriatrics, 58, 26-31.

[8]   Skagen, K., Hansen, J.F. and Olesen, K.H. (1978) Closed Mitral Valvulotomy after the Age of Fifty. Scandinavian Journal of Thoracic and Cardiovascular Surgery, 12, 85-89.

[9]   Tuzcu, E.M., Block, P.C., Griffin, B.P., Newell, J.B. and Palacios, I.F. (1992) Immediate and Long-Term Outcome of Percutaneous Mitral Valvotomy in Patients 65 Years and Older. Circulation, 85, 963-971.

[10]   Wood, P. (1954) An Appreciation of Mitral Stenosis. I. Clinical Features. British Medical Journal, 1, 1051-1063.

[11]   Diker, E., Aydogdu, S., Ozdemir, M., Kural, T., Polat, K., Cehreli, S., Erdogan, A. and Goksel, S. (1996) Prevalence and Predictors of Atrial Fibrillation in Rheumatic Valvular Heart Disease. American Journal of Cardiology, 77, 96-98.

[12]   Eid Fawzy, M., Shoukri, M., Al Sergani, H., Fadel, B., Eldali, A., Al Amri, M. and Canver, C.C. (2006) Favorable Effect of Balloon Mitral Valvuloplasty on the Incidence of Atrial Fibrillation in Patients with Severe Mitral Stenosis. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions, 68, 536-541.

[13]   Tandon, H.D. and Kasturi, J. (1975) Pulmonary Vascular Changes Associated with Isolated Mitral Stenosis in India. British Heart Journal, 37, 26-36.

[14]   Sinha, N., Kapoor, A., Kumar, A.S., Shahi, M., Radhakrishnan, S., Shrivastava, S. and Goel, P.K. (1997) Immediate and Follow Up Results of Inoue Balloon Mitral Valvotomy in Juvenile Rheumatic Mitral Stenosis. The Journal of Heart Valve Disease, 6, 599-603.

[15]   Fawzy, M.E., Stefadouros, M.A., Hegazy, H., Shaer, F.E., Chaudhary, M.A. and Fadley, F.A. (2005) Long Term Clinical and Echocardiographic Results of Mitral Balloon Valvotomy in Children and Adolescents. Heart, 91, 743-748.

[16]   Shaw, T.R., Sutaria, N. and Prendergast, B. (2003) Clinical and Haemodynamic Profiles of Young, Middle Aged and Elderly Patients with Mitral Stenosis Undergoing Mitral Balloon Valvotomy. Heart, 89, 1430-1436.