Improvements in transcatheter valves may impact surgical valve choice for those in whom repair is not possible. In patient populations for which chronic anticoagulation can be problematic, newly designed mechanical valves may allow for lower levels of anticoagulation. Furthermore, newer oral anticoagulants are being developed that may make the management of anticoagulation for mechanical valves safer and easier.

RA: How often do you see patients with RHD? Do any interesting cases come to mind that you can share?

Dr Boyd: With a relatively large immigrant population from the developing world located in the Bay Area [of California], I typically see several patients each month with RHD. One that stands out in my mind is a mother of 3 who was no longer able to work outside the home due to progressive heart failure from longstanding untreated rheumatic valve disease. (Related echocardiograms below)


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Previously, she helped support her family with 2 jobs. Prior to surgery, she was so short of breath with the most minimal exertion she could no longer work. Caring for her home and her children was becoming an impossible task. Her aortic and mitral valves were severely affected by RHD, and a third valve, the tricuspid, had suffered as a result.

We performed aortic and mitral valve replacements and repaired her tricuspid valve. She spent a week in the hospital after surgery and was back to work in less than 2 months. She told me she couldn’t remember the last time she felt so good.

Clinical Images

The thickened edges of the aortic leaflets prevent proper opening and closing of the aortic valve, seen on short axis.   Photo courtesy of Jack Boyd, MD.

Characteristic severe thickening of the mitral valve is seen in this 4 chamber view of the heart. Photo courtesy of Jack Boyd, MD.

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References

  1. Excler J, Kim JH. Accelerating the development of a group A Streptococcus vaccine: an urgent public health need. Clin Exp Vaccine Res. 2016; 5(2):101-107. doi:10.7774/cevr.2016.5.2.101
  2. Beaudoin A, Edison L, Introcaso CE, et al; on behalf of the US Centers for Disease Control and Prevention. Acute rheumatic fever and rheumatic heart disease among children—American Samoa, 2011–2012. MMWR Morb Mortal Wkly Rep. 2015 May 29;64(20):555-558.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6420a5.htm. Accessed November 15, 2016.
  3. Woldu B, Bloomfield GS. Rheumatic heart disease in the twenty-first century. Curr Cardiol Rep. 2016;18:96. doi: 10.1007/s11886-016-0773-2.

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