Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Cardiology, University of KwaZulu-Natal, Durban, South Africa.
Cardiovasc J Afr. 2021;32(2):62-69. doi: 10.5830/CVJA-2020-029. Epub 2021 Mar 16.
Recent evidence suggests that there is a change in the profile of rheumatic mitral regurgitation (MR) in South Africa to a pattern of chronic fibrotic valvular disease.
This study describes the clinical profile of patients with rheumatic MR in the province of KwaZulu-Natal (KZN).
A retrospective chart review was performed on patients seven years and older with moderate to severe rheumatic MR referred to Inkosi Albert Luthuli Central Hospital from 2006 to 2015.
There were 320 patients meeting the study criteria (mean age 22.2 ± 15.8 years, male:female 1:2). Severe dyspnoea was present in 45.9% of patients, heart failure in 117 (36.6%) and atrial fibrillation in 13.8%. Three patients were diagnosed with active carditis at initial presentation and a further 31 had evidence of carditis during follow up. Of the 216 patients who underwent surgery, over one-third (37%) had prolapse of the anterior mitral leaflet, which was due to chordal elongation ( = 63, 29.2%) and/or ruptured chordae ( = 41, 19%). There were 32 deaths (10%) and of these, 27 (8.4%) patients died prior to surgery.
Rheumatic MR in KZN predominantly affects the young, with concomitant carditis resulting in high morbidity and mortality rates.
最近的证据表明，南非风湿性二尖瓣反流（MR）的发病模式已经发生变化，表现为慢性纤维性瓣膜病。
本研究描述了夸祖鲁-纳塔尔省（KZN）风湿性 MR 患者的临床特征。
对 2006 年至 2015 年期间因中重度风湿性 MR 而被转诊到因科西·阿尔伯特·卢图利中央医院的 7 岁及以上患者进行了回顾性病历审查。
符合研究标准的患者共有 320 例（平均年龄 22.2 ± 15.8 岁，男女比例为 1:2）。45.9%的患者存在严重呼吸困难，117 例（36.6%）存在心力衰竭，13.8%存在心房颤动。3 例患者在初次就诊时被诊断为活动性心内膜炎，另有 31 例在随访期间存在心内膜炎证据。在 216 例接受手术的患者中，超过三分之一（37%）的患者存在前二尖瓣叶脱垂，这是由于腱索伸长（=63，29.2%）和/或腱索断裂（=41，19%）引起的。共有 32 例患者（10%）死亡，其中 27 例（8.4%）患者在手术前死亡。
KZN 的风湿性 MR 主要影响年轻人，同时存在的心肌炎导致高发病率和死亡率。
