Singh Manila, Abraham Abey, Soni Swati Chhabra, Singh Saket
Department of Anesthesiology and Critical Care Surgery, Ochsner Medical Center, New Orleans, LA, USA.
Department of Anesthesiology and Intensive Care and Resuscitation, Cleveland Clinic, Ohio, USA.
J Anaesthesiol Clin Pharmacol. 2025 Jul-Sep;41(3):384-395. doi: 10.4103/joacp.joacp_124_24. Epub 2025 Jun 19.
Rheumatic heart diseases (RHDs) impose a substantial global burden, primarily affecting individuals under 25 years of age in low- and medium-income countries (LMICs) and poor and marginalized groups in high-income countries.[123] The underlying cause is a group A beta-hemolytic streptococcus, which triggers an immune-mediated attack on the heart and joints. Although acute rheumatic fever (ARF) is treatable, its occurrence and complications remain high in impoverished areas.[4] Variations in social structure contribute to differences in the incidence and progression of the disease, even in affluent regions.[5] Administering anesthesia to this patient population presents significant challenges, particularly when early management has been inadequate due to limited medical care and follow-up. Literature shows evidence for anesthetic management of different types of RHDs, mostly focusing on mitral and aortic valvulopathies.[67] This review synthesizes literature from databases such as MEDLINE and PubMed searches from the year 2000 to date, focusing on anesthesia management strategies and the challenges posed by ARF and RHD. Specific topics covered include the diagnosis and management of ARF, acute complications, perioperative care for patients with RHD, and unique considerations for different valvular pathologiesWith this review, we aim to discuss the available evidence, current World Health Organization (WHO) and societal guidelines in the context of perioperative medical and anesthetic management, hemodynamic challenges, and postoperative courses. An emphasis on basic point-of-care ultrasound (POCUS) training is made in this review as the current era of diagnostics and therapeutics is increasingly reliant on echocardiography.
风湿性心脏病（RHD）给全球带来了沉重负担，主要影响低收入和中等收入国家（LMIC）25岁以下的人群以及高收入国家的贫困和边缘化群体。[123]其根本原因是A组β溶血性链球菌，它会引发对心脏和关节的免疫介导攻击。尽管急性风湿热（ARF）是可治疗的，但在贫困地区其发病率和并发症仍然很高。[4]社会结构的差异导致了该病发病率和进展的不同，即使在富裕地区也是如此。[5]对这一患者群体实施麻醉面临重大挑战，尤其是当由于医疗护理和随访有限而导致早期管理不足时。文献显示了针对不同类型RHD进行麻醉管理的证据，主要集中在二尖瓣和主动脉瓣病变方面。[67]本综述综合了2000年至今MEDLINE和PubMed等数据库中的文献，重点关注麻醉管理策略以及ARF和RHD带来的挑战。涵盖的具体主题包括ARF的诊断和管理、急性并发症、RHD患者的围手术期护理以及不同瓣膜病变的特殊注意事项。通过本综述，我们旨在讨论现有证据、世界卫生组织（WHO）和社会在围手术期医疗和麻醉管理、血流动力学挑战以及术后病程方面的现行指南。本综述强调了基础床旁超声（POCUS）培训，因为当前的诊断和治疗时代越来越依赖超声心动图。
