BACKGROUND: Rheumatic heart disease is an increasingly common cause of valvular heart disease worldwide, affecting both underdeveloped and developed countries, with reported decline of cases in the latter. This cross-sectional study compared findings in echocardiography and gross morphology in native valves among rheumatic valvular disease patients in the Philippine Heart Center.
METHODS: Correlation of transthoracic echocardiographic findings taken at most three months from the time of valve replacement surgery were reviewed and the following data recorded: presence or absence of calcification, valve cusp thickening, vegetation, thrombus formation, and commissural fusion. Presence and absence of these findings were compared to their corresponding histopathologic reports and level of agreement was recorded.
RESULTS: The study group included a total of 200 cases, 88 (44%) of which were male and 112 (56%) were female, with a mean age of 41 years. Associated clinical findings include pulmonary hypertension (16%), congestive heart failure (6%), stroke (4%), major bleeding (1.50%) and infective endocarditis (1%). Perfect level of agreement was observed in findings of fibrosis, cuspal thickening, and chordal thickening, from both the mitral and aortic valve. Perfect level of agreement was observed in findings of commissural fusion from the aortic valve but with moderate level of agreement from the mitral valve. No level of agreement was observed in vegetation findings from the mitral valve. Moderate level of agreement was observed in thrombus formation from the mitral valve.
CONCLUSIONS: Transthoracic echocardiography is the most widely used non-invasive imaging modality for evaluation and diagnosis of cardiac lesions. However, discordance on certain pathologic findings are still observed. Size, location, shape of the lesions, and interobserver variability result to dissimilarities in findings. Determining imaging-pathology concordance is crucial, which most management and treatment options are based upon. Utilization of supplementary imaging techniques may be employed if with clinical suspicion. Active communication with pathologist, and referring physician is likewise essential in the management of RHD patients.