Quick Fire Cases
Olukayode O. Aremu, PhD
Postdoctoral Research Fellow
University of Cape Town, South Africa
Olukayode O. Aremu, PhD
Postdoctoral Research Fellow
University of Cape Town, South Africa
.jpeg.jpg "Petronella Samuels, MSc photo")
Petronella Samuels, MSc
Head Radiographer at the Cape Universities Body Imaging Centre
University of Cape Town, South Africa
Stephen Jermy, MSc
Research Fellow
University of Cape Town, South Africa
Morné Kahts, MD
Research Medical Officer at the Cape Universities Body Imaging Centre
University of Cape Town, South Africa
Ntobeko Ntusi, MD, PhD
President and CEO
South African Medical Research Council, South Africa
Rheumatic heart disease (RHD) remains a significant cause of morbidity and mortality, particularly in low- and middle-income countries. Multivalvular involvement often complicates the clinical picture, necessitating complex surgical interventions. Cardiovascular magnetic resonance (CMR) provides accurate means of assessing valvular lesions. This case report aims to evaluate the impact of multivalvular replacement on prognostic outcomes in patients with RHD.
40-year-old female with a history of recurrent rheumatic fever, asthma, tobacco smoking, regular methamphetamine uses for 15 years and pulmonary hypertension, presented with NYHA class IV dyspnoea and orthopnoea and paroxysmal nocturnal dyspnoea over three months. Physical examination revealed a diastolic murmur indicative of mitral stenosis and a holosystolic murmur suggestive of mitral regurgitation. Comprehensive evaluation included transthoracic echocardiography (TTE), electrocardiogram (ECG), chest X-ray and CMR.
Diagnostic Techniques and Their Most Important Findings:
TTE demonstrated severe mitral stenosis with a mean gradient of 12 mmHg, along with moderate mitral regurgitation and tricuspid regurgitation. Left atrial (LA) enlargement was observed, consistent with prolonged pressure overload. ECG revealed left atrial enlargement and atrial fibrillation. The chest X-ray showed slight enlargement of the cardiac silhouette, indicating cardiomegaly. CMR showed a left sided transudative pleural effusion, akinetic and reduced ejection (EF), enlarged LA, thickened mitral valve, severe aortic and tricuspid regurgitation. Based on these findings, the diagnosis of severe multivalvular RHD was established, leading to recommendations for surgical intervention. Six-twelve months, post-surgery, CMR showed a completely resolved pleural effusion, improved EF, reduced LA and LGE mass and percentage.
Learning Points from this Case:
This case report highlights that multivalvular replacement can lead to significant improvements in prognostic outcomes and quality of life in patients with RHD. Early surgical intervention in the context of symptomatic multivalvular disease may be crucial for enhancing recovery and reducing morbidity. Further studies are warranted to establish standardized treatment protocols for optimal management of multivalvular RHD.
This case report aims to contribute to the growing body of literature emphasizing the critical role of early intervention in improving outcomes for patients with rheumatic heart disease.
