CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 91 The echocardiographic characteristics of the study patients are summarised in Table 2. RHD was the commonest aetiology (80%) of adult MVD in this study group. Infective endocarditis (IE) was diagnosed in four study participants. MR (39%) was closely followed by mixed mitral valve disease (MMVD) (38%) as the dominant lesions found in this study group and MS was found in 23% of patients (Fig. 1). Rheumatic MS was seen more frequently in younger females with 64% being under 50 years of age. Rheumatic MR was more prevalent in older females with 60% being more than 50 years of age. Myxomatous MVD was noted in eight patients with an average age of 52 years (Fig. 2). Eighty-two per cent of patients in this research group suffered with moderate to severe MVD. Fifty-one per cent of the study population was found to have severe MVD with severe MR being the predominant pathology (20%) (Fig. 3). Concomitant valve lesions were frequently noted with MVD. Aortic regurgitation (AR) co-existed in 17% of patients with MVD. The overall mean LVEF was 57.5 ± 11.5%. The majority had preserved LV systolic function (80%). Out of the nine patients with severe LV systolic dysfunction, five had severe MR, two had severe MMVD and two had severe MS (Fig. 4). Fortyeight per cent of MR patients had a LVEF of less than 60%. LV function according to MR severity is presented in Fig. 5. HIV and hypertension were the main co-morbidities. The mean LVEF was 55 ± 13.3% in the isolated HIV MVD group and 58 ± 11.9 % in the isolated hypertensive MVD group. No significant LVEF changes were noted in patients with these co-morbidities compared to the rest of the study group. However, there were two patients who suffered from both HIV and hypertension concurrently. The mean LVEF dropped significantly to 32 ± 11.3% albeit a very small sample size. One hundred and seven patients had RHD with a mean age of 51 ± 12.6 years and 78% were female. The majority were of African ethnicity (95%) and 55% of the RHD participants were in NYHA class II. The commonest lesion was MMVD (44%), followed by MS (29%) and MR (27%). Eighty-three per cent of the RHD patients had moderate to severe MVD. Thirty-five per cent of the patients had concomitant involvement of other valves. Hypertension (19%), RVD (14%) and cerebrovascular incidents (9%) were the main co-morbidities. HF was present in 75% of the RHD patients at initial hospitalisation. MVD was complicated with pulmonary hypertension (34%) and AF in 30% of patients. Eight patients had a reduced LVEF Fig. 1. Two-dimensional modified long-axis view depicting chronic RHD of the MV with thickening of the subvalvar apparatus and the MV leaflets (A), and severe rheumatic mitral regurgitation (B) in a 50-year-old female. A B Table 2. Echocardiographic findings of patients with MVD in absolute numbers and percentages Echocardiography Study group (n = 134) Type of valve lesion, n (%) Isolated mitral stenosis 31 (23) Isolated mitral regurgitation 52 (39) Mixed mitral valve disease 51 (38) Mitral valve disease severity, n (%) Mild 24 (18) Moderate 41 (31) Severe 69 (51) Aetiology, n (%) Rheumatic heart disease 107 (80) Mitral valve prolapse 15 (11) Myxomatous degenerative disease 8 (6) Infective endocarditis 4 (3) Concomitant valve disease, n (%) Aortic regurgitation 23 (17) Aortic stenosis 3 (2) Mixed aortic valve disease 8 (4) Tricuspid regurgitation 9 (6) LV function, mean ± SD LV ejection fraction (%) 57.5 ± 11.5 LV end-diastolic diameter (mm) 50.7 ± 7.2 LV end-systolic diameter (mm) 34.6 ± 7.3 LV systolic function according to valve lesion and LVEF, n (%) LVEF < 40% Mitral regurgitation Mitral stenosis Mixed mitral valve disease 9 (7) 5 (4) 2 (1.5) 2 (1.5) LVEF 40–50% Mitral regurgitation Mitral stenosis Mixed mitral valve disease 17 (13) 5 (4) 4 (3) 8 (6) LVEF > 50% Mitral regurgitation Mitral stenosis Mixed mitral valve disease 108 (80) 42 (31) 25 (19) 41 (30) Mitral valve disease-related complications, n (%) Pulmonary hypertension 38 (28) Arrhythmia (AF and flutter) 35 (26) LV dysfunction 26 (19) Left atrial clot 1 (0.7) TIA, transient ischaemic attach; LV, left ventricular; LVEF, left ventricular ejection fraction.
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