• Shakeel Ahmad
  • Umar Hayat
  • Humera Naz


Background: High morbidity and mortality due to Rheumatic heart disease (RHD) associatedwith females is mainly because of late diagnosis on one hand and socioeconomic reasons on theother hand. Poor referral to tertiary care centres leads to delayed diagnosis which results incomplications. The objectives of this cross-sectional descriptive study was to assess the frequencyof severe mitral stenosis in woman of child bearing age, having pure mitral stenosis (MS)secondary to rheumatic heart disease. Methods: Two hundred and fifty women of child bearingage with RHD were enrolled in the study using consecutive non-probability sampling technique.Out of these 250 patients, cases of pure MS were selected. Patients with associated mitralregurgitation and aortic valve disease were excluded. After admission, assessment of mitral valvestenosis was done with 2D colour Doppler echocardiography. Results: Out of 250 consecutivepatients of rheumatic carditis, 110 (44%) patients had pure mitral valve stenosis, 85 (34%) hadstenosis with mitral regurgitation and 55 (22%) patients had both mitral and aortic valve problemof varying severity. Among 110 patients with pure mitral valve stenosis, 48 (43.6%) had severemitral valve stenosis. Severe mitral valve gradient (MVG) and high pulmonary artery pressure(PAP) was observed in 66 (60%) and 49 (44.5%) of the patients respectively. Conclusion: Thishigh frequency can be linked to lack of early detection of the disease at primary level, poormanagement of throat infections and poor rheumatic fever prophylaxis at community level.Keywords: Rheumatic heart disease, mitral stenosis, mitral valve gradient, pulmonary arterypressure, primary health centre


Carrilho-Ferreira P, Pedro MM, Varela MG, Diogo AN.

Severe rheumatic mitral stenosis: a 21st century medusa.

Arch Intem Med 2011;171:1498–9.

Bisno Al, Shulman St, Dajan A. The rise and fall of

rheumatic. JAMA 1988;259:728–9.

Akhtar N, Sadiq M, Chagani H. Guidlines for prevention of

rheumatic fever and rheumatic heart disease. Pak J Cardio


Rose AG. Etiology of acquired valvular disease in adults. A

survey of 18132 autopsies and 100 consecutive valve

replacement operations. Arch Pathol Lab Med


Mitral stenosis, valvular heart disease In: Braunwald, Heart

Disease: A textbook of cardiovascular medicine. (6th edition)

Philadelphia: WB Saunders; 2001. p. 1643

Burger W, Brinkies C, Illert S, Teupe C, Kneissl GD,

Schräder R. Right ventricular failure before and after

percutaneous balloon mitral valvuloplasty. Int J Cardiol


Movahed MR, Ahmad Kashani M, Kasravi B, Saito Y.

Increase prevalence of mitral stenosis in women. J Am Soc

Echocardiogr 2006;19:911–3.

Ozer O, Davutoglu V, Sari I, Akkoyun DC, Suco M. The

spectrum of rheumatic heart disease in the south eastern

entolia endemic region. Results from 1900 patients. J Heart

Valve Dis 2009;18:68–72.

Nichol PM, Gibert BW, Kisslo JA. Two dimensional

echocardiographic assessment of mitral stenosis. Circulation


J Ayub Med Coll Abbottabad 2010;22(4)

Akhtar N, Rehman F, Anam K, Begum N, Naher S, Fatima

N, et al. Valvular heart disease in pregnancy. Maternal and

foetal outcome. Mymensingh Med J 2011;20:436–40.

Binder TM, Rosenhek R, Porenta G, Maurer G, Baumgartner

H. Improved assessment of mitral valve stenosis by lumetric

real-time three-dimensional echocardiography. J Am Coll

Cardiol 2000; 36:1355–61.

Saxena A. Strategies for the improvement of cardiac care

services in developing countries: What does the future hold,

Future Cardiol 2012;8:29–38.

Leavitt JL, Coats MH, Falk RH. Effects of exercise on

transmitral gradient and pulmonary artery pressure in patients

with mitral stenosis or prosthetic mitral valve Doppler

echocardiographic study J Am Coll Cardiol 1991;17:1520–6.

Lue HC, Wv MH, Wang JR, Wufi Wu YN. Long term

outcome of patients with rheumatic fever receiving penicillin

G prophylaxis every three weeks doses ever 4 week. J Padiat


Lock JE, Kalilula M, Shrivastavas BJ and Kearne JF.

Percutaneous catheter commissurotomy in rheumatic mitral

stenosis. N Eng J Med 1985;313:1515–8.

Selcuk MT, Selcuk H, Maden O, Temizhan A, Aksu T,

Dogan M, et al. Relationship between inflammation and

atrial fibrillation in patients with isolated rheumatic mitral

stenosis. J Heart Valve Dis 2007;16:468–74.

Movahed MR, Ahmadi-Kashani M, Kasravi B, Saito Y.

Increased prevalence of mitral stenosis in women. J Am Soc

Echocardiogr 2006;19:911–3.

Supino PG, Borer JS, Preibisz J, Bornstein A The

epidemiology of valvular heart disease: a growing public

health problem. Heart Fail Clin 2006;2::379–93.

Glancy DL Mitral stenosis: I. Anatomical, physiological, and

clinical considerations. J La State Med Soc 2003;155(2):91–

, quiz 96, 119.

Roberts-Thomson KC, Stevenson IH, Kistler PM, Haqqani

HM, Goldblatt JC, Sanders P, et al. Anatomically determined

functional conduction delay in the posterior left atrium

relationship to structural heart disease. J Am Coll Cardiol


Naveed Akhtar, Sabeen Razaque. Penicillin clinic; a model

program for prevention of Rheumatic fever & Rheumatic

heart disease in Pakistan. Pak J Cardiol 2007;18(3-4):66–72.

Messika-Zeitoun D, Serfaty JM, Laissy JP, Berhili M,

Brochet E, Iung B, et al. Assessment of the mitral valve area

in patients with mitral stenosis by multislice computed

tomography. J Am Coll Cardiol 2006;48:411–3.

Rashid SZ, Rajput IA, Samad A. Echocardiographic profile

in mitral stenosis. Pak J Cardiol 2007;18:18–24.



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