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Cardiac
Diagnosis
Valvular
Rheumatic Heart Disease
Rheumatic Heart Disease
Suhny Abbara, MD, FACR, FSCCT; Naveen M. Kulkarni, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Definitions

            • Condition characterized by cardiac valve damage secondary to previous rheumatic fever
              • Rheumatic fever is complication of group A β-hemolytic streptococcal pharyngitis (strep throat) in children and adolescents
              • Rheumatic valve disease may first become apparent years or decades after initial infection
            • May include valvular stenosis, regurgitation, left ventricular and left atrial enlargement, pericarditis, and heart failure
            • Most commonly affects mitral valve, followed by aortic and tricuspid valve
              • Mitral regurgitation > mitral stenosis > aortic regurgitation > aortic stenosis

          IMAGING

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Mutnuru PC et al: Cardiac MR imaging in the evaluation of rheumatic valvular heart diseases. J Clin Diagn Res. 10(3):TC06-9, 2016
                                2. Ramtohal RL et al: 'New world' imaging for an 'old world' disease: use of cardiac magnetic resonance imaging and 3D transesophageal echocardiography in severe rheumatic mitral valve disease. J Cardiol Cases. 6(1):e4-7, 2012
                                3. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) et al: Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 33(19):2451-96, 2012
                                4. Zhang XC et al: Assessment of right ventricular function for patients with rheumatic mitral stenosis by 64-slice multi-detector row computed tomography: comparison with magnetic resonance imaging. Chin Med J (Engl). 125(8):1469-74, 2012
                                5. Hajsadeghi F et al: Porcelain heart. J Cardiovasc Comput Tomogr. 5(3):183-5, 2011
                                6. Shriki J et al: Delayed gadolinium enhancement in the atrial wall: a novel finding in 3 patients with rheumatic heart disease. Tex Heart Inst J. 38(1):56-60, 2011
                                7. Cawley PJ et al: Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation. 119(3):468-78, 2009
                                8. Carapetis JR: Rheumatic heart disease in developing countries. N Engl J Med. 357(5):439-41, 2007
                                9. American College of Cardiology/American Heart Association Task Force on Practice Guidelines et al: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons: Circulation. 114(5):e84-231, 2006
                                10. Carapetis JR et al: Acute rheumatic fever. Lancet. 366(9480):155-68, 2005
                                11. Carapetis JR et al: The global burden of group A streptococcal diseases. Lancet Infect Dis. 5(11):685-94, 2005
                                12. Djavidani B et al: Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol. 45(12):2048-53, 2005
                                13. Lin SJ et al: Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound. J Am Coll Cardiol. 44(1):133-7, 2004
                                14. No authors listed: ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol. 32(5):1486-588, 1998
                                15. Wyttenbach R et al: Integrated MR imaging approach to valvular heart disease. Cardiol Clin. 16(2):277-94, 1998
                                16. Braunwald E: Valvular heart disease. In Braunwald E: Heart Disease. 5th ed. Philadelphia: W. B. Saunders. 1007-76, 1997
                                17. Globits S et al: Assessment of valvular heart disease by magnetic resonance imaging. Am Heart J. 129(2):369-81, 1995
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Pathology

                                        TERMINOLOGY

                                        • Definitions

                                          • Condition characterized by cardiac valve damage secondary to previous rheumatic fever
                                            • Rheumatic fever is complication of group A β-hemolytic streptococcal pharyngitis (strep throat) in children and adolescents
                                            • Rheumatic valve disease may first become apparent years or decades after initial infection
                                          • May include valvular stenosis, regurgitation, left ventricular and left atrial enlargement, pericarditis, and heart failure
                                          • Most commonly affects mitral valve, followed by aortic and tricuspid valve
                                            • Mitral regurgitation > mitral stenosis > aortic regurgitation > aortic stenosis

                                        IMAGING

                                        • Radiographic Findings

                                          • CT Findings

                                            • MR Findings

                                              • Echocardiographic Findings

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Gross Pathologic & Surgical Features

                                                      • Microscopic Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Mutnuru PC et al: Cardiac MR imaging in the evaluation of rheumatic valvular heart diseases. J Clin Diagn Res. 10(3):TC06-9, 2016
                                                              2. Ramtohal RL et al: 'New world' imaging for an 'old world' disease: use of cardiac magnetic resonance imaging and 3D transesophageal echocardiography in severe rheumatic mitral valve disease. J Cardiol Cases. 6(1):e4-7, 2012
                                                              3. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) et al: Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 33(19):2451-96, 2012
                                                              4. Zhang XC et al: Assessment of right ventricular function for patients with rheumatic mitral stenosis by 64-slice multi-detector row computed tomography: comparison with magnetic resonance imaging. Chin Med J (Engl). 125(8):1469-74, 2012
                                                              5. Hajsadeghi F et al: Porcelain heart. J Cardiovasc Comput Tomogr. 5(3):183-5, 2011
                                                              6. Shriki J et al: Delayed gadolinium enhancement in the atrial wall: a novel finding in 3 patients with rheumatic heart disease. Tex Heart Inst J. 38(1):56-60, 2011
                                                              7. Cawley PJ et al: Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation. 119(3):468-78, 2009
                                                              8. Carapetis JR: Rheumatic heart disease in developing countries. N Engl J Med. 357(5):439-41, 2007
                                                              9. American College of Cardiology/American Heart Association Task Force on Practice Guidelines et al: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons: Circulation. 114(5):e84-231, 2006
                                                              10. Carapetis JR et al: Acute rheumatic fever. Lancet. 366(9480):155-68, 2005
                                                              11. Carapetis JR et al: The global burden of group A streptococcal diseases. Lancet Infect Dis. 5(11):685-94, 2005
                                                              12. Djavidani B et al: Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol. 45(12):2048-53, 2005
                                                              13. Lin SJ et al: Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound. J Am Coll Cardiol. 44(1):133-7, 2004
                                                              14. No authors listed: ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol. 32(5):1486-588, 1998
                                                              15. Wyttenbach R et al: Integrated MR imaging approach to valvular heart disease. Cardiol Clin. 16(2):277-94, 1998
                                                              16. Braunwald E: Valvular heart disease. In Braunwald E: Heart Disease. 5th ed. Philadelphia: W. B. Saunders. 1007-76, 1997
                                                              17. Globits S et al: Assessment of valvular heart disease by magnetic resonance imaging. Am Heart J. 129(2):369-81, 1995