Valvular Complication
Treatment of Rheumatic Heart Disease with Moderate to Severe Mitral Regurgitation
Rheumatic heart disease complicated by moderate to severe mitral regurgitation represents a significant valvular burden requiring careful clinical assessment. The degree of mitral valve dysfunction directly shapes the management strategy in this setting.
Clinical Scenario
In patients with rheumatic heart disease, mitral regurgitation of moderate to severe degree indicates substantial leaflet and subvalvular damage resulting from the rheumatic process. Symptomatic management includes measures targeting fluid overload and afterload reduction, but medical therapy alone does not address the underlying structural valve disease.
Approach
When valvular dysfunction reaches a severe level — particularly with symptoms — a surgical approach to the mitral valve is indicated; the preferred technique depends on the extent of rheumatic damage.
The full structured regimen — including surgical decision thresholds, procedural preference criteria, and follow-up considerations — is available via the complete protocol.
References
DOI: 10.1161/CIR.0000000000000921
Symptomatic medical management of moderate to severe MR includes diuretic agents (loop diuretic agents and spironolactone) and afterload reduction with vasodilator therapy, most often angiotensin-converting enzyme inhibition and angiotensin II receptor blockers.
When there is severe valvular dysfunction, especially if the patient is symptomatic, surgery is indicated.
Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions.
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