Pattern of rheumatic heart disease in Western Rajasthan- an echocardiographic study: a single centre experience

Rohit Mathur, Palsingh Yadav, Sanjeev Sanghvi, Anil Baroopal, Swati Mahajan


Background: Rheumatic heart disease (RHD) is a common form of heart valve disease associated with episodes of rheumatic fever. Despite the developments achieved in the field of cardiology, the consequences of acute rheumatic fever remain significantly high in developing countries like India.  Objectives of current study aims to evaluate the pattern of valvular involvement in patients of RHD in Western Rajasthan assessed by echocardiography.

Methods: This is an observational study conducted at the department of Cardiology, Dr. S. N. Medical College, Jodhpur, India between September 2015 and February 2019. The study includes analysis of echocardiograms of RHD patients performed during this period.

Results: Total 502 echocardiograms of RHD patients between 4 and 75 years of age with mean age of 35.6±11.6 years were evaluated, in which the most common age group was 21-40 years.  There were 191 (38.04%) males, and 311(61.95%) females. Mitral valve was most commonly involved in which mitral stenosis (MS) was seen in 345(68.72%) and mitral regurgitation (MR) was seen in 350(69.72%) patients. Aortic stenosis (AS) was seen in 61(12.15%) and aortic regurgitation (AR) was found in 224(44.62%) cases. Organic tricuspid valve (TV) disease was seen in 18(3.58%). In combined valvular involvement MS+MR was seen in 234(46.61%) cases; followed by MR+AR in 171(34.06%); MS+AR in 161(32.07%); AS+AR in 62(12.35%); MR+AS in 46(9.16%) and MS+AS in 42(8.36%) subjects.

Conclusion: The echocardiographic pattern of RHD patients of Western Rajasthan showed a predominant involvement of mitral valve, followed by aortic and tricuspid valves. Further amongst multi-valvular involvement the sequence was predominantly MS+MR followed by MR+AR, MS+AR, AS+AR, MR+AS, and MS+AS.


Echocardiography, Rheumatic heart disease, Valvular heart disease

Full Text:



Carapetis JR. Rheumatic heart disease in developing countries. N Engl J Med. 2007;357(5):439-41.

Roberts WC. Morphologic features of the normal and abnormal mitral valve. Am J Cardiol. 1983; 51(6):1005-28.

Roberts WC. The congenitally bicuspid aortic valve: a study of 85 autopsy cases. Am J Cardiol. 1970;26(1):72-83.

Roberts WC, Virmani R. Aschoff bodies at necropsy in valvular heart disease. Circulation 1977; 57(4):803-7.

Olson LJ, Subramanian R, Ackermann DM, Orszulak TA, Edwards WD. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987;62(1):22-34.

Dare AJ, Harrity PJ, Tazelaar HD, Edwards WD, Mullany CJ. Evaluation of surgically excised mitral valves: revised recommendations based on changing operative procedures in the 1990s. Hum Pathol. 1993;24(12):1286-93.

Duren DR, Becker AE, Dunning AJ. Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: a prospective study. J Am Coll Cardiol. 1988;11(1):42-7.

Hauck AJ, Freeman DP, Ackermann DM, Denielson GK, Edwards WD. Surgical pathology of the tricuspid valve: a study of 363 cases spanning 25 years. Mayo Clin Proc. 1988;63(9):851-63.

Sanyal SK, Thapar MK, Ahmed SH, Hooja V, Tewari P. The initial attack of acute rheumatic fever during childhood in North India; a prospective study of the clinical profile. Circulation. 1974;49(1):7-12.

Sanyal SK, Berry AM, Duggal S, Hooja V, Ghosh S. Squeal of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study. Circulation 1982;65(2):375-9.

Jones TD. Diagnosis of rheumatic fever. JAMA 1944;126(8):481-4.

Stollerman GH, Markowitz M, Taranta A, Wanna maker LW, Whittemore R. Report of the Ad hoc committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of Rheumatic Fever. Circulation 1965;32:664-8.

Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation. 1984;69:203A-8A.

Special writing group of the Committee on Rheumatic fever, Endocarditis and Kawasaki disease of the Council of Cardiovascular disease in the young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever: Jones criteria: 1992 update. JAMA. 1992;268: 2069-73.

WHO. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation, Geneva, 29 October–1 November 2001. Geneva, Switzerland: World Health Organization; 2004.

Bhaya M, Panwar S, Beniwal R, Panwar RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiog 2010;27(4):448-53.

Saxena A, Ramakrishnan S, Roy A, Seth S, Krishnan A, Misra P, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study. Heart. 2011;97(24):2018-22.

Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian heart J. 2014 May 1;66(3):320-6.

Kafle R, Alurkar VM , Paudel N, Jha GS. Pattern of Valvular involvement in RHD Patients in a Tertiary Care Hospital of western Nepal, Nepalese Heart J. 2016; 13(2): 29-31.

Chandrashekhar Y, Narula J. Rheumatic fever In: Alpert Joseph S. Valvular Heart Disease. Springer, London. 3rd ed. 2007;431-441.

Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X. Prevalence of rheumatic heart disease detected by echocardiographic screening. New Eng J Med. 2007 Aug 2;357(5):470-6.

Mason T, Fisher M, Kujala G. Acute rheumatic fever in West Virginia: not just a disease of children. Arch Inter Med. 1991 Jan 1;151(1):133-6.

Hanson TP, Edwards BS, Edwards JE. Pathology of surgically excised mitral valves: one hundred consecutive cases. Arch Pathol Lab Med. 1985; 109:823-8.

Olson LJ, Subramanian R, Edwards WD. Surgical pathology of pure aortic regurgitation: a study of 225 cases. Mayo Clin Proc. 1984;5(11-12)9:835-41.

Dare AJ, Veinot JP, Edwards WD, Tazelaar HD, Schaff HV. New observations on the etiology of aortic valve disease: a surgical pathologic study of 236 cases from 1990. Hum Pathol. 1993;24(12):1330-8.