The changing spectrum of rheumatic mitral regurgitation in Soweto, South Africa.

OBJECTIVES

To determine the clinical and echocardiographic characteristics of contemporary patients with rheumatic mitral regurgitation (MR) at Chris Hani Baragwanath Academic Hospital.

METHODS

This prospective, cross-sectional study included 84 patients with isolated moderate or severe rheumatic MR who underwent clinical and echocardiographic assessment.

RESULTS

Mean age of the patients was 44 ± 15.3 years (84% females). Acute rheumatic fever was rare. Hypertension and HIV were present in 52 and 26%, respectively. Echocardiography showed leaflet thickening and calcification, restricted motion and subvalvular disease in 41, 25 and 34%, respectively. Carpentier IIIa leaflet dysfunction occurred in 80% of patients and leaflet prolapse was seen in only 20%. These findings contrast with the previous literature, where patients were younger, they had rheumatic carditis and there were no co-morbidities. Leaflets were pliable, isolated leaflet prolapse was common and commissural fusion was absent.

CONCLUSION

Contemporary patients with rheumatic MR were older, fewer had rheumatic fever and there were more co-morbidities. Echocardiographic features had evolved to greater leaflet thickening, calcification and reduced motion with minimal prolapse. These findings may have important implications for surgical management of this disease.