Background: Rheumatic heart disease (RHD), brought about by an autoimmune reaction after Streptococcus pyogenes infection, is a condition of global importance, mostly affecting low and middle-income countries. A minority progress to more severe disease requiring valve surgery. Surgical correction of RHD may have post-operative complications, which may be prognosticated by echocardiography. This study aims to determine echocardiographic parameters that may be associated with perioperative complications in RHD patients.
Method: This was a retrospective analytic study involving chart review at the Philippine Heart Center. Demographic data and echocardiographic findings (LVEF, LVESD, LVEDD, LA Diameter, LAVI, RVFAC, chamber enlargement, wall motion abnormality, pulmonary hypertension, type and severity of valvular heart disease, and pulmonic regurgitation) were documented. The outcome measure was a composite of multi-system perioperative complications. Using Stata version 13.0, the Fisher's exact test and the T-test for independent samples were employed to analyze the data.
Result: The mean age of the subjects was 42
±13; majority were females (66%), and had normal BMI (63%). Mean echocardiographic parameters derived were: LVEDD 5.5±4 cm, LVESD 3.5±1 cm, LVEF 60±10%, LAVI 107±103 gm/m2, and RVFAC 44±11%. The LA was the most commonly enlarged chamber (91.2%). Most had normal wall motion (83%) and had pulmonary hypertension (62%). Among the valve lesions, the following were the most common (cited in descending frequency): mitral regurgitation (144/170, 84.7%), tricuspid regurgitation (142/170, 84%), mitral stenosis (135/170, 79.4%), aortic regurgitation (122/170, 71.8%), pulmonic regurgitation (83/170, 48.8%), and aortic stenosis (65/170, 38.2%). Severe mitral stenosis was the specific type of valve lesion with the most number of cases (87/170, 51.2%). There was a 28% (48/170) perioperative complication rate and a 4% (7/170) rate of in-hospital mortality. The most common perioperative complications were: pneumonia (10.6%), atrial fibrillation (8.8%), and congestion beyond 48 hours post-op (8.8%). Among the echocardiographic parameters, the presence of pathological pulmonic regurgitation and moderate to severe tricuspid regurgitation were significantly associated with the development of perioperative complications.
Conclusion: The presence of moderate to severe tricuspid regurgitation, as well as pathological pulmonic regurgitation in echocardiography were associated with perioperative complications among RHD patients who underwent valve surgery.