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New York City Conference

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Epidemiology and Clinical Profile of Severe Rheumatic Heart Disease in Malaysia
Benjamin Levin1, Maizatu Akma Solong2, Norfazlina Jaffar2, Siti Nurzaliana Mohd Safari2, MF Ramli2, MA Rosli2.
1Duke University, Durham, NC, USA, 2National Heart Institute, Kuala Lumpur, Malaysia.

OBJECTIVE: Rheumatic heart disease (RHD) is the most common cause of valvular heart disease in the developing world and a major global public health challenge; yet there is a paucity of data on severe RHD in Southeast Asia. We defined the epidemiology and clinical profile of severe RHD (defined as requiring surgical or procedural intervention) that presented to the largest academic cardiology hospital in Malaysia from 2010 through 2012.
METHODS: All patients with clinically severe RHD who underwent either PTMC or surgery from 1/2010 through 12/2012 were identified from surgical OR and cath lab procedure lists. All of the patients' medical records were reviewed.
RESULTS: A total of 552 patients were identified (480 adult, 72 pediatric). 403 adult (66% female, 34% male) and 70 pediatric (50% male, 50% female) patients underwent surgical valve repair or replacement. Of the 403 adult surgical patients, none of them had either a reported history of Group A streptococcal (strep) pharyngitis, primary or secondary antibiotic prophylaxis. 6% reported history of acute rheumatic fever (ARF). Surgery involved 1 (37%), 2 (50%) or 3 heart valves (13%). 90% of adult patients had mitral valve surgery (16% mitral valve repair), 65% aortic valve surgery, 47% tricuspid valve surgery. Of the 70 surgical pediatric patients, none of them had a reported history of group A strep pharyngitis or primary antibiotic prophylaxis. 17% had history of history of ARF and 28% history/active carditis. Surgery involved 1 (40%), 2 (23%) or 3 heart valves (7%). 91% of pediatric patients had mitral valve surgery (70% mitral valve repair), 31% aortic valve surgery, 30% tricuspid valve surgery.
CONCLUSIONS: There was a significant prevalence of severe rheumatic heart disease during the three year period of 2010-2012. Patients did not report any known history of prior group A strep pharyngitis or primary antibiotic prophylaxis and low known incidence of ARF. There was significant aortic valve involvement and a predominance of female adult surgery patients. There is a strong need for better public health education and prevention of RHD in Malaysia.


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