Background and Objectives. Valvular heart diseases are among the frequent causes of cardiac surgery. Some patients have a well-known rheumatic condition. Heart valves are fragile connective tissues which are vulnerable to any systemic autoimmune diseases. This study was designed to evaluate the frequency of rheumatological background in patients candidate for valvular heart surgery in Afshar Cardiovascular Center, Yazd, Iran. Methods. One hundred and twenty (120) patients candidate for valvular heart surgery were selected for this study. Careful history and physical examination were undertaken from rheumatological stand points. The most sensitive screening serologic tests were also assayed. Results. The result of this study showed that 53.3% were male and 46.6% were female with mean age of years old. 45.8% of the patients had history of nonmechanical joint disease, 14.2% had history of rheumatological conditions in their family, and 30% had history of constitutional symptoms. 29.8% had positive joint dysfunction findings in their physical examination while 25.8% had anemia of chronic disease. Positive Rheumatoid factor (RF), anticyclic citrullinated peptide (CCP, ACPA), C-reactive protein (CRP), antinuclear antibody (ANA), abnormal urine and elevated erythrocyte sedimentation rate (ESR) were 34, 2.5, 26.7, 4.2, 5, and 36.7%, respectively. Antineutrophil cytoplasmic antibody (ANCA) and antiphospholipid (APL) were positive in a few cases. Conclusion. The findings of this study show immunologic bases for most patients with valvular heart diseases candidate for surgery. Undifferentiated connective tissue diseases may play an important role in the pathophysiology of valvular damage. 1. Introduction Valvular heart diseases (VHD) surround a number of common cardiovascular disorders that account for 15% of all cardiac surgical procedures in the world. Patients with VHD require intervention for improvement, relief, or valve replacement. One of the most important pathogeneses of coronary artery stenosis and VHD is inflammatory response of immune system. Prevalence and incidence of cardiovascular diseases resulting from rheumatologic disorders are increasing, however, advanced treatments which are now available [1–3]. Rheumatic diseases can be assumed by taking a clinical history and conducting thorough physical examination. Laboratory and radiographic investigations can help to diagnose more accurately; however, clinical skills and expertise are an essential factor in diagnosing undifferentiated connective tissue diseases. The frequent complaints of rheumatologic
References
[1]
R. A. Nishimura, B. A. Carabello, D. P. Faxon et al., “ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American college of cardiology/American heart association task force on practice guidelines endorsed by the society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, and society of thoracic surgeons,” Journal of the American College of Cardiology, vol. 52, no. 8, pp. 676–685, 2008.
[2]
R. O. Bonow, B. A. Carabello, K. Chatterjee et al., “2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, and society of thoracic surgeons,” Circulation, vol. 118, no. 15, pp. e523–e661, 2008.
[3]
C. M. Otto and R. O. Bonow, “Valvular heart disease,” in Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, D. P. Zipes, P. Libby, R. O. Bonow, and E. Braunwald, Eds., chapter 62, pp. 1322–1326, WB Saunders, St. Louis, Mo, USA, 8th edition, 2007.
[4]
G. Kitas, M. J. Banks, and P. A. Bacon, “Cardiac involvement in rheumatoid disease,” Clinical Medicine, vol. 1, no. 1, pp. 18–21, 2001.
[5]
J. T. Giles, S. J. Bartlett, R. Andersen, R. Thompson, K. R. Fontaine, and J. M. Bathon, “Association of body fat with C-reactive protein in rheumatoid arthritis,” Arthritis and Rheumatism, vol. 58, no. 9, pp. 2632–2641, 2008.
[6]
M. B. Owlia, “Acute rheumatic fever, an acute or a chronic joint disease?” Journal of Shahid Sadoughi University of Medical Sciences, vol. 19, pp. 561–567, 2011.
[7]
M. B. Owlia, “Clinical spectrum of connective tissue disorders,” Journal, Indian Academy of Clinical Medicine, vol. 7, no. 3, pp. 217–224, 2006.
[8]
M. B. Owlia and G. Mehrpoor, “Behcet's disease: new concepts in cardiovascular involvements and future direction for treatment,” ISRN Pharmacology, vol. 2012, Article ID 760484, 13 pages, 2012.
[9]
D. Horstkotte, R. Niehues, and B. E. Strauer, “Pathomorphological aspects, aetiology and natural history of acquired mitral valve stenosis,” European Heart Journal, vol. 12, pp. 55–60, 1991.
[10]
M. Penmetcha, S. W. Rosenbush, and C. A. Harris, “Cardiac valvular disease in scleroderma and systemic lupus erythematosus/scleroderma overlap associated with antiphospholipid antibodies,” Journal of Rheumatology, vol. 23, no. 12, pp. 2171–2174, 1996.
[11]
R. D. Leff, R. N. Hellman, and C. J. Mullany, “Acute aortic insufficiency associated with Wegener granulomatosis,” Mayo Clinic Proceedings, vol. 74, no. 9, pp. 897–899, 1999.
[12]
C. W. Lee, J. Lee, W. K. Lee et al., “Aortic valve involvement in beh？et's disease. A clinical study of 9 patients,” Korean Journal of Internal Medicine, vol. 17, no. 1, pp. 51–56, 2002.
[13]
M. E. Evangelopoulos, M. Alevizaki, S. Toumanidis et al., “Mitral valve prolapse in systemic lupus erythematosus patients: clinical and immunological aspects,” Lupus, vol. 12, no. 4, pp. 308–311, 2003.
[14]
K. Maksimowicz-McKinnon and B. F. Mandell, “Understanding valvular heart disease in patients with systemic autoimmune diseases,” Cleveland Clinic Journal of Medicine, vol. 71, no. 11, pp. 881–885, 2004.
[15]
A. Doria, L. Iaccarino, P. Sarzi-Puttini, F. Atzeni, M. Turriel, and M. Petri, “Cardiac involvement in systemic lupus erythematosus,” Lupus, vol. 14, no. 9, pp. 683–686, 2005.
[16]
F. Tenedios, D. Erkan, and M. D. Lockshin, “Cardiac involvement in the antiphospholipid syndrome,” Lupus, vol. 14, no. 9, pp. 691–696, 2005.
[17]
F. Atzeni, P. Sarzi-Puttini, A. Doria, L. Boiardi, N. Pipitone, and C. Salvarani, “Beh？et's disease and cardiovascular involvement,” Lupus, vol. 14, no. 9, pp. 723–726, 2005.
[18]
G. Kamiński, K. Makowski, M. Dziuk et al., “Degenerative valvular and left ventricle structural changes in echocardiography in patients with rheumatoid arthritis,” Polski Merkuriusz Lekarski, vol. 18, no. 107, pp. 496–498, 2005.
[19]
A. E. Voskuyl, “The heart and cardiovascular manifestations in rheumatoid arthritis,” Rheumatology, vol. 45, no. 4, pp. iv4–iv7, 2006.
[20]
L. Guilherme, K. F. K？hler, and J. Kalil, “Rheumatic heart disease. Mediation by complex immune events,” Advances in Clinical Chemistry, vol. 53, pp. 31–50, 2011.
[21]
M. B. Santiago, S. M. M. Dourado, N. O. Silva et al., “Valvular heart disease in systemic lupus erythematosus and Jaccoud's arthropathy,” Rheumatology International, vol. 31, no. 1, pp. 49–52, 2011.
[22]
F. Gabrielli, E. Alcini, M. A. Di Prima, G. Mazzacurati, and C. Masala, “Cardiac valve involvement in systemic lupus erythematosus and primary antiphospholipid syndrome: lack of correlation with antiphospholipid antibodies,” International Journal of Cardiology, vol. 51, no. 2, pp. 117–126, 1995.
[23]
T. Neumann, B. Manger, M. Schmid et al., “Cardiac involvement in churg-strauss syndrome: impact of endomyocarditis,” Medicine, vol. 88, no. 4, pp. 236–243, 2009.
[24]
A. P. Beckhauser, L. Vallin, C. J. Burkievcz, S. Perreto, M. B. Silva, and T. L. Skare, “Valvular involvement in patients with rheumatoid arthritis,” Acta Reumatologica Portuguesa, vol. 34, no. 1, pp. 52–56, 2009.
