Lilyasari Oktavia, Prakoso Radityo, Kurniawati Yovi, Roebiono Poppy S, Rahajoe Anna Ulfah, Sakidjan Indriwanto, Harimurti Ganesja M
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia.
Front Surg. 2020 Aug 12;7:47. doi: 10.3389/fsurg.2020.00047. eCollection 2020.
Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children ( < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children ( = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.
风湿性心脏病（RHD）仍是发展中国家影响儿童和年轻人的一个主要公共卫生问题。本研究旨在评估儿童和年轻人中风湿性心脏病的临床特征、治疗及复发情况。这是一项在印度尼西亚哈帕恩基塔国家心血管中心开展的基于医院的回顾性研究；我们从2012年至2018年期间被诊断为风湿性心脏病的患者中检索相关数据。279例患者被诊断为风湿性心脏病，其中108例为儿童（平均年龄12.02±3.36岁），171例为年轻人（平均年龄24.9±3.84岁）。风湿性心脏病在年轻女性中比男性更常见（比例为1.5:1）。儿童因风湿性心脏病并发症如充血性心力衰竭住院的病例占11.11%，而年轻人中肺动脉高压的病例占19.95%。风湿性心脏病复发发生在17.2%（48/279）的病例中，在儿童中显著更高（<0.001）。总体而言，二尖瓣（单独或合并病变）是儿童（39.13%）和年轻人（44.81%）中受影响最严重的器官。单纯二尖瓣反流在儿童中更常见（13/21，61.9%），而单纯二尖瓣狭窄在年轻人中更常见（19/47，40.42%）。所有人群中风湿性三尖瓣疾病的发生率都很高（193/279，69.17%），且有肺动脉反流受累的报告（46/279，16.48%）。两组中多瓣膜病变比单瓣膜病变更常见，儿童中以二尖瓣和三尖瓣反流合并为主（32/43，74.41%），年轻人中以二尖瓣病变合并三尖瓣反流为主（22/72，30.56%）。我们观察到儿童中四瓣膜病变的发生率有显著差异（=0.039）。瓣膜修复在儿童中更常见（49.07%），瓣膜置换在年轻人中更常见（32.16%），住院死亡率较低。二级预防的依从性是一个重大挑战。慢性风湿性心脏病常伴有疾病并发症或风湿热（RF）复发。风湿热/风湿性心脏病治疗不充分会导致广泛的瓣膜损害及随之而来的残疾。积极进行早期诊断、及时治疗风湿热/风湿性心脏病以及采取有效的预防措施至关重要。
