Key result
A 60-year-old man with unrecognized rheumatic heart disease presented with severe mitral stenosis and heart failure, and was successfully treated with surgical mitral valve replacement.
Case Report (n=1)
This case highlights the late presentation of rheumatic mitral stenosis in a patient without a known history of acute rheumatic fever, successfully managed with surgical valve replacement due to heavy calcification precluding percutaneous commissurotomy.
May support MVR feasibility in unrecognized RHD; hypothesis-generating and should not yet change practice.
The case of a 60-year-old man illustrates a number of important features of rheumatic heart disease (RHD). The patient’s age of presentation was late (>50 yo) and he had no history of predisposing condition for RHD but served in the South Pacific when he was in the US Navy. RHD was limited to mitral stenosis in this patient and his presentation of heart failure was late. His ECG revealed ample evidence of right ventricular enlargement, and echocardiography demonstrated severe mitral stenosis, enlarged right ventricle and right atrium and marked pulmonary hypertension. Because percutaneous balloon mitral valve commissurotomy was precluded by the degree of mitral valve calcification, he underwent successful surgical valve replacement with relief of symptoms. Although RHD is rarely encountered in North America and Europe, it remains a major cause of mortality in the developing nations.
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Venugopal et al. (2021) conducted a case report in Rheumatic heart disease with severe mitral stenosis (n=1). Surgical mitral valve replacement was evaluated. A 60-year-old man with unrecognized rheumatic heart disease presented with severe mitral stenosis and heart failure, and was successfully treated with surgical mitral valve replacement.
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