Article Title

To Estimate the Prevalence of Functional and Organic Tricuspid Regurgitation in Rheumatic Heart Disease with Mitral Stenosis

Authors

Sonam Suresh Bhandurge, Consultant and Interventional Cardiologist, Associate Professor of Cardiology, Jawaharlal Nehru Medical College KLES Dr. Prabhakar Kore Hospital & MRC
Sameer Ambar, Consultant and Interventional Cardiologist, Associate Professor of Cardiology, Jawaharlal Nehru Medical College KLES Dr. Prabhakar Kore Hospital & MRC
Sanjay C. Porwal, Professor, HOD and Senior Interventional Cardiologist, Jawaharlal Nehru Medical College

Abstract

Background: Rheumatic fever is an inflammatory condition that occurs as a delayed complication of a pharyngeal infection caused by group A beta-hemolytic streptococci. It primarily affects the heart, joints, central nervous system, skin, and subcutaneous tissues. When the heart is involved, rheumatic endocarditis develops, often targeting the valves and leading to verrucous valvulitis. Over time, this can heal with fibrous thickening, commissural fusion, and shortening of the chordae tendineae, resulting in varying degrees of valvular stenosis and regurgitation. Mitral stenosis, a common outcome of rheumatic heart disease, involves narrowing of the mitral valve, which impairs blood flow from the left atrium to the left ventricle. While the normal mitral valve area ranges from 4 to 6 cm2, abnormal diastolic pressure gradient between the left atrium and ventricle typically develop when the area falls below 2 cm2. This leads to elevated left atrial pressure, which is transmitted backward to the pulmonary circulation, causing pulmonary congestion and pulmonary hypertension. As a result, right heart strain may develop, leading to functional tricuspid regurgitation, which is frequently observed in patients with rheumatic mitral stenosis.

Objective: Primary objectives-: To assess echocardiographic prevalence of functional and organic tricuspid regurgitation in rheumatic heart disease with mitral stenosis. Secondary objectives- To assess the tricuspid regurgitation association with the severity of mitral stenosis.

Methodology: The study was conducted from May 2024 to April 2025 in KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, an attached teaching hospital of KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka.30 patients diagnosed with RHD with mitral stenosis were enrolled in this study.

Results: The study population includes 30 RHD patients with mitral stenosis. In this study, 26.7% of the patients were males, and 73.3% were females. In the present study 43.4% of the patients were aged between 36 to 50 years. The Minimum 2D mitral valve area by planimetry was 0.7 cm², and the maximum 2D MVA was 2.1 cm² and with a mean standard deviation of 1.23 cm². Tricuspid valve thickened and mobility restricted in 12 patients (40%) and tricuspid valve thickness and mobility normal in 18 patients (60%).Diastolic doming and calcification is present in 12 patients (40%) and absent in 18 patients (60%).

Conclusion: The study concluded that prevalence of functional tricuspid regurgitation is more than organic tricuspid regurgitation. In our study it revealed that prevalence of functional tricuspid regurgitation (60%) and prevalence organic tricuspid regurgitation (40%).