Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-24T06:15:20.522Z Has data issue: false hasContentIssue false
  • English
  • Français

Co-existence of congenital and rheumatic heart disease in 404 post-mortem cases—comparison with findings in 2,352 cases with isolated rheumatic disease

Published online by Cambridge University Press:  19 August 2008

Carlos Zabal ,
Fause Attie ,
Alfonso Buendía ,
Juan Calderón ,
Paris Troyo  and
Daniel Guzzo
Carlos Zabal
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
Fause Attie*
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
Alfonso Buendía
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
Juan Calderón
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
Paris Troyo
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
Daniel Guzzo
Affiliation:
Instituto Nacional de Cardiología “Ignacio Chávez”, México
*
Dr. Fause Attie, Instituto Nacional de Cardiología “Ignacio Chávez”, Juan Badiano I, Tlalpan, 14080 México, D.F., México. Tel. 52-5-573-0480; Fax. 52-5-573-0994
Get access Rights & Permissions [Opens in a new window]

Summary

We reviewed 2,756 necropsy studies of patients who died because of rheumatic heart disease. The anatomic material was divided into two groups. The first group was made up of 404 cases (14.6%) having the association of rheumatic and congenital heartdisease. The second group comprised 2,352 cases with isolated rheumatic heart disease. The analysis of the site and types of congenital malformations in the first group showed 160 cases (39.6%) with aortic, 112 (27.7%) with pulmonary, 15(3.7%) with tricuspid and six (1.5%) with mitral lesions. Twenty patients (4.9%) had an atrial septal defect whilenine (2.2%) had patency of the arterial duct and four (1 %) a ventricular septal defect. The incidence of rheumatic aortic valvar disease in cases also having congenital lesions of the aortic valve (83.7%) was higher than in patients with isolated rheumatic involvement of the aortic valve (67.7%) (p<0.001). The difference in the incidence of rheumatic lesions found in patients with congenital pulmonary lesions (9.8%) and in the patients with isolated rheumatic disease (3.3%) was also significant (p<0.001). No differences were observed in rheumatic lesions to the mitral and tricuspid valves in those with or without associated congenital lesions. In patientswith an atrial septal defect, there was a higher incidence of combined mitral and tricuspid lesions (35% vs. 18%, p<0.02). Patients with patency of the arterial duct andco-existing rheumatic heart disease had a greater incidence of isolated rheumatic aortic disease (11% vs. 0.7%), and also of combined aortic and mitral lesions (33% vs. 17%), but the differences were not significant. The incidence of involvement of all four valves was 5.4% in those with associated congenital lesions and 3% in those in which rheumatic involvement was isolated (p<0.O2). We conclude that rheumatic heart disease has a tendency to involve preferentially cardiac valves that are the sites of congenital malformations.

Keywords

Rheumatic heart diseasecongenital heart defects
Type
World Forum for Pediatric Cardiology Symposium on Rheumatic Fever
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 261 - 265
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ferrans, VJ, Roberts, WC. Pathology of rheumatic heart dis ease. In: Borman, JB, Gotsman, MS (eds). Rheumatic Valvular Disease in Children. Springer-Verlag, Berlin, 1980, pp 28–58.Google Scholar
2. Roberts, WC. Characteristics and consequences of infective endocarditis (active or healed or both) learned from morphologic studies. In: Rahimtoola, SH (ed). Infective Endocarditis. Grune & Stratton, New York, 1978, pp 55–123.Google Scholar
3. Roesler, H.Interatrial septal defect. Arch Int Med 1934; 54: 339–380.Google Scholar
4. Taussig, HB, Harvey, AM, Follis, RH Jr. The clinical and pathological findings in interauricularseptal defects. Bull Johns Hopkins Hosp 1938; 63: 61–89.Google Scholar
5. Koletsky, S.Congenital bicuspid aortic valves. Arch Int Med 1941; 67: 129–156.Google Scholar
6. Bedford, DE, Papp, C, Parkinson, J.Atrial septal defect. Br Heart J 1941; 3: 37–68.Google Scholar
7. Gelfman, R, Levine, SA.The incidence of acute and subacute bacterial endocarditis in congenital heart disease. Am J Med Soc 1942; 204: 324–333.Google Scholar
8. Tinney, WS, Barnes, AR.Interauricular septal defect. Minne sota Med 1942; 25: 637–643.Google Scholar
9. Espino-Vela, J.Rheumatic heart disease associated with atrial septal defect: clinical and pathologic study of 12 cases of Lutembacher's syndrome. Am Heart J 1959; 57: 185–202.Google Scholar
10. Rosenberg, SZ, Braun, K.Ventricular septal defect with aortic insufficiency, acute rheumatic carditis and Asian influenza. Am J Cardiol 1961; 7: 273–276.Google Scholar
11. Harley, HRS, Watkins, AG.A case of rheumatic mitral regur gitation and persistent ductus arteriosus. Br Heart J 1962; 24: 245–248.Google Scholar
12. Marshall, RJ, Warden, HE.Mitral valve disease complicated by left-to-right shunt at atrial level. Circulation 1964; 29: 432–439.Google Scholar
13. Muller, WH Jr, Littlefield, JB, Beckwith, JR.Surgical treatment of Lutembacher's syndrome. J Thorac Cardiovasc Surg 1966; 51: 66–70.Google Scholar
14. Goldfarb, B, Wang, Y.Mitral stenosis and left to right shunt at the atrial level: a broadened concept of the Lutembacher syndrome. Am J Cardiol 1966; 17: 319–326.Google Scholar
15. John, S, Munshi, SC, Bhati, BS, Gupta, RP, Sukumar, IP, Cherian, G.Coexistent mitral valve disease with left-to-right shunt at the atrial level: results ofsurgical treatment in 15 cases. J Thorac Cardiovasc Surg 1970; 60: 174–187.CrossRefGoogle Scholar
16. Dry, TJ, Connolly, DC. Inflammatory complications of congenital heart disease. In: Thomas, L (ed). Rheumatic Fever: A Symposium. University of Minnesota Press, Minneapolis, 1952, pp 52–57.Google Scholar
17. Davies, MJ.Mitral valve in secundum atrial sepral defects. Br Heart J 1981; 46: 126–128.Google Scholar
18. Disciascio, G, Taranta, A.Rheumatic fever in children. Am Heart J 1980; 99: 635–658.Google Scholar
19. Shibata, H, Matsuzaki, T, Hayashi, N, Morishima, A, Seino, T.Congenital heart disease in high school and college students. Jpn Heart J 1977; 18: 457–462.Google Scholar
20. John, S, Munsi, S, Sukumar, IP, Cherian, G.Mitral valve replacement in children and adolescents with rheumatic heart disease. Jpn Heart J 1976; 17: 570–575.Google Scholar
21. Attie, F, Kuri, J, Zanoniani, C, Rentería, V, Buendía, A, Ovseyevirz, J, López-Soriano, F, García-Cornejo, M, Martínez-Ríos, MA.Mitral valve replacement in children with rheumatic heart disease. Circulation 1981; 64: 812–817.Google Scholar
22. Attie, F, López-Soriano, F, Ovseyevitz, J, Martínez, J, Gil-Moreno, M, Buendía, A, Chávez-Domínguez, R, Richhcimer, R.Late results of mitral valve replacement with the Björk-Shiley prosthesis in children under 16 years of age. J Thorac Cardiovasc Surg 1986; 91: 754–758.Google Scholar
23. Lutembacher, R.De la stenose mitrale avec communication inrerauriculaire. Arch Mal Coeur 1916; 9: 237–260.Google Scholar