Title : Echocardiographic predictors of children with Rheumatic Heart Disease (RHD) requiring mitral valve repair
Abstract:
In paediatric rheumatic heart disease (RHD), echocardiographic markers may guide surgical timing and outcomes but predictive data are currently limited. The aim of our research was to identify echocardiographic features that predict the need for mitral valve (MV) repair in paediatric patients with RHD. We retrospectively analysed 53 children (< 18 years old) who underwent MV repair at the national heart centre between 2011–2016. Pre-operative echocardiographic variables, including leaflet thickening, chordal rupture, prolapse, degree of mitral regurgitation (MR), and left atrial/ventricular dimensions, were correlated with clinical status and surgical outcomes. Leaflet thickening was seen in 85%, chordal rupture in 60%, and prolapse in 45%. Children with chordal rupture and severe MR had more advanced heart failure, characterised by New York Heart Association (NYHA) classes (class III–IV) and shorter time to surgery. Leaflet thickening alone but with moderate MR was associated with relatively preserved functional status. Preoperative left atrial enlargement correlated significantly with chordal rupture (p < 0.05) and earlier referral. No perioperative mortality was noted across all echocardiographic phenotypes. Specific echocardiographic features especially chordal rupture, leaflet thickening, and degree of MR, are strong indicators of surgical necessity and correlate with clinical severity of heart failure in paediatric RHD. These findings support incorporating targeted echocardiographic evaluation into early referral protocols for MV repair where RHD is endemic.
