Rheumatic Mitral Valve Stenosis: A Surgical Case
On this chapter, we report a case of a 61-year-old woman presenting important mitral valve stenosis causing symptoms like fatigue and shortness of breath at rest (NYHA class IV). She reported a history of rheumatic fever in her childhood. The electrocardiogram (ECG) exposed a first-degree atrioventricular block, and auscultation revealed an opening snap associated with a diastolic murmur at the mitral point. Further investigation with echocardiography with Doppler brought to light a severe mitral stenosis (valve area = 0.88 cm2), leading to a severe increase of the left atrium. After studying the case with the heart team, mitral valve replacement was the procedure of choice. Her valve did not have a favorable morphology for percutaneous mitral balloon valvuloplasty (PMBV), and she was not a high-risk surgical candidate. Unfortunately, she was also not a candidate for minimally invasive cardiac surgery (MICS) due to a small anteroposterior chest diameter, which could possibly increase the procedure’s difficulty. The types of prosthetic valves were discussed with the patient and the choice was for a biological valve. The surgery was well conducted, and she was sent home after 1 week and 2 days. After describing precisely the surgery, we also discuss some matters regarding rheumatic fever and its importance (especially in Brazil), mitral valve stenosis, the Wilkins score, prosthetic valve types, mitral valve replacement, and its correlation with this case.
- 1.Kouchoukos N, Kirklin J. Kirklin/Barratt-Boyes cardiac surgery. 1st ed. Philadelphia: Elsevier/Saunders; 2013. p. 473–540.Google Scholar
- 2.Who.int. WHO | Rheumatic fever and rheumatic heart disease. [online]. 2017. Available at: http://www.who.int/cardiovascular_diseases/publications/trs923/en/. Accessed 1 Oct 2016.
- 3.Mota CCC, et al. Rheumatic fever prevention program: long-term evolution and outcomes. Front Pediatr N.p. 2015. Web. 1 Oct 2016.Google Scholar
- 5.Barbosa PJB, Müller RE, Latado AL, Achutti AC, Ramos AIO, Weksler C, et al. Diretrizes Brasileiras para Diagnóstico, Tratamento e Prevenção da Febre Reumática da Sociedade Brasileira de Cardiologia, da Sociedade Brasileira de Pediatria e da Sociedade Brasileira de Reumatologia. Arquivos brasileiros de cardiologia., São Paulo. 2009;93(3, supl. 4):3–18.Google Scholar
- 6.Rajamannan NM, Antonini-Canterin F, Moura L, Zamorano JL, Rosenhek RA, Best PJ, Lloyd MA, Rocha-Goncalves F, Chandra S, Alfieri O, Lancellotti P, Tornos P, Baliga RR, Wang A, Bashore T, Ramakrishnan S, Spargias K, Shuvy M, Beeri R, Lotan C, Suwaidi JA, Bahl V, Pierard LA, Maurer G, Nicolosi GL, Rahimtoola SH, Chopra K, Pandian NG. Medical therapy for rheumatic heart disease: is it time to be proactive rather than reactive? Indian Heart J. 2009;61(1):14–23.PubMedPubMedCentralGoogle Scholar
- 7.Liguori GR, Barros LN, Tenório DF, Jatene FB, Almeida RMS. Manual Acadêmico de Cirurgia Cardiovascular, São Paulo; 2014. p. 199–211.Google Scholar