Rheumatic Valvular Heart Disease

Author: Kirsten Freeman, MD
Institution: University of Florida
Date Reviewed: 2022
Original Case: Edward Verrier, MD / University of Washington
Learning Domain: Adult Cardiac Surgery
Learning Objective: Evaluation of and surgical decision making associated with Rheumatic Heart Valve Disease
PowerPoint File: Rheumatic Valvular Heart Disease

Discussion Points

• Natural History of Rheumatic heart Disease
• Historical approaches to Mitral stenosis
• Operative approaches now 
  • Sequencing / Protection
• How to deal with Patient / prosthetic mismatch
  • Double Valve replacement?
• Is 19 mmHg aortic mechanical prosthesis too small
• Valve choices

Learning Points

• Rheumatic Heart Disease 
  • Rare in U.S.
  • Endemic around the world
  • Important historical contributions to open heart surgery
  • Closed approaches to Rheumatic Mitral Stenosis common as initial procedure
  • Repair of MS often difficult if late
• Double valve pearls
  • Small aortic mechanical prosthesis probably adequate
  • Mitral completed before aortic valve
  • Need to use low profile prostheses
  • Annular enlargement procedures can be difficult in double valve replacements