New treatment available for rheumatic heart disease

RHEUMATIC HEART disease (RHD) is an important cause of acquired heart disease in children and young adults, and is particularly common in Jamaica and the Caribbean, where access to healthcare and close cardiac monitoring is not yet optimal. It is responsible for approximately 250,000 deaths worldwide yearly and affects over 15 million people.

In Jamaica, RHD is endemic and is a recognised cause of cardiac valvular disease. Currently, despite the absence of a cure for this disease, there are strides being made, especially as it pertains to the identification, monitoring and potential treatment of these affected patients nationwide.

First, what is rheumatic heart disease you may say? Well, it is a condition characterised by the damage of the heart valves from an abnormal immune response to streptococcus pyogenes infection, leading to rheumatic fever. Rheumatic fever can go on to affect the brain, skin and joints, but when it affects the heart, heart valves becomes inflamed, thickened, stiff, deformed and narrowed, resulting ultimately in the classical findings of rheumatic heart disease.

Complications of RHD include heart failure, abnormal beating of the heart (e.g., atrial fibrillation), increased lung pressures and early death. The most affected valve is the mitral heart valve. Narrowing of this heart valve results in mitral stenosis. Percutaneous mitral balloon valvuloplasty is the standard first-line therapy for cases of mitral stenosis stemming from rheumatic heart disease.

Balloon valvuloplasty is a non-surgical procedure done to open narrowed or stiffened heart valves. It is a less invasive procedure than cardiothoracic surgery, a lower risk of complications, including death, and a shorter recovery time than surgery. Usually, patients do not have to be admitted in intensive care units. Patients are usually up and about the same day and home in about three to five days, for example. In general, balloon valvuloplasty can be used to treat the stenosis of any valve but as it pertains to RHD, for mitral valve stenosis it is recommended when:

• It is severe;

• Symptomatic, regardless of severity;

• The affected are older patients or patients who are at high risk for surgery;

• There are pliable, noncalcified mitral valves.

Symptoms include shortness of breath or difficulty breathing, chest heaviness, leg swelling, palpitations or fast/irregular heart beating or strokes.

As it stands these procedures, both balloon valvuloplasty and transcatheter valve replacements (being less invasive, nonsurgical procedures), are not available in the English-speaking Caribbean, except in Jamaica where they are performed by Canadian-trained Jamaican Dr Tahira Redwood, a cardiologist trained in structural and adult congenital heart intervention. A number of these procedures have been done in both the public and private setting with a 100 per cent success rate.

The future of RHD treatment in Jamaica and the Caribbean at large looks promising and with time, surveillance, and an integrated medical specialty approach, prevention of rheumatic heart disease is more than a goal … one day it can be a reality. We welcome this new procedure and many more to Jamaica.

Dr Kelly is a member of the first Structural and Adult Congenital Intervention programme in the English-speaking Caribbean.