Victor S
Heart Institute, Chennai.
J Indian Med Assoc. 1999 Jul;97(7):265-70.
Rheumatic heart disease (RHD) is a major health care problem in India and will continue to be so for few more decades. As there is no vaccine against RHD, it is difficult to control the disease. Besides RHD, most children have other preventable ailments as well. Hence the schools, specially for the poor, must act as primary and preventive health care centres. Prevention of RHD starts with school prophylaxis. Primary, secondary and tertiary prophylaxis play their roles afterwords. After the heart valves have been damaged, tertiary prevention might minimise further damage. For mitral stenosis, closed mitral valvotomy (CMV), open mitral valvotomy (OMV) and interventional mitral valvotomy (IMV) are the different options but none is curative. Valve replacement poses many problems and therefore valvotomy is deferred as far as possible. Mild or moderate mitral regurgitation (MR) is best treated medically. For more advanced disease repair or replacement is the option. For aortic stenosis (AS), valvotomy may be preferred to replacement wherever feasible and for aortic regurgitation (AR) repair is not yet well established. In combined mitral and aortic valve disease it is important to assess both the valves carefully and try to repair one or both the valves and to avoid double valve replacement as far as possible. Once the heart valve is damaged any treatment is palliative, hence all efforts should be directed towards prevention of RHD. Indian Medical Association can play a major role in this endeavour and help children in India to grow up free from RHD.
风湿性心脏病（RHD）是印度一个重大的医疗保健问题，并且在未来几十年内仍将如此。由于没有针对RHD的疫苗，很难控制这种疾病。除了RHD，大多数儿童还患有其他可预防的疾病。因此，特别是为贫困儿童设立的学校，必须充当初级和预防性医疗保健中心。RHD的预防始于学校预防。初级、二级和三级预防随后发挥作用。在心脏瓣膜受损后，三级预防可能会将进一步的损害降至最低。对于二尖瓣狭窄，闭式二尖瓣切开术（CMV）、开放式二尖瓣切开术（OMV）和介入性二尖瓣切开术（IMV）是不同的选择，但都无法治愈。瓣膜置换存在许多问题，因此尽可能推迟二尖瓣切开术。轻度或中度二尖瓣反流（MR）最好通过药物治疗。对于更严重的疾病，修复或置换是选择。对于主动脉狭窄（AS），在可行的情况下，瓣膜切开术可能比置换术更可取，而对于主动脉反流（AR），修复方法尚未得到充分确立。在二尖瓣和主动脉瓣联合疾病中，仔细评估两个瓣膜并尝试修复其中一个或两个瓣膜，并尽可能避免双瓣膜置换非常重要。一旦心脏瓣膜受损，任何治疗都是姑息性的，因此所有努力都应致力于预防RHD。印度医学协会可以在这项努力中发挥重要作用，并帮助印度儿童健康成长，免受RHD的困扰。
