Impact of Acute Rheumatic Fever on the Type and Severity of Valvular Lesions: Experience of the Cardiology and Cardiovascular Surgery Departments of Avicenne Military Hospital of Marrakech

Abstract

Background: Acute rheumatic fever remains an important cause of acquired valvular heart disease where rheumatic heart disease persists in practice, with possible long-term consequences including severe valvular involvement, chamber remodelling, rhythm disturbances, and surgery. Objective: This study described the impact of acute rheumatic fever on the type and severity of valvular lesions among patients managed for valvular heart disease at Avicenne Military Hospital and assessed post-operative outcomes after valve surgery. Methods: This retrospective descriptive and analytical study included 106 adult patients with valvular disease documented by transthoracic echocardiography and managed in the Departments of Cardiology and Cardiovascular Surgery. Demographic, clinical, electrocardiographic, echocardiographic, and surgical data were analysed according to rheumatic or non-rheumatic aetiology. Results: The mean age was 57.4 ± 12.3 years, and 71 patients were male. Rheumatic aetiology was identified in 52 patients (49.1%). Polyvalvular disease was observed in 46 patients, atrial dilation in 84 patients, and atrial fibrillation in 40 cases among patients with arrhythmias. Severe or very severe lesions were more frequent in the rheumatic group. Surgery was performed in 58 patients, with mechanical mitral valve replacement being the most frequent procedure. Early complications included atrial fibrillation, acute cardiac failure, pericardial effusion, infection, thromboembolic events, renal failure, bleeding requiring re-exploration, and complete atrioventricular block. Four operated patients died in hospital. Conclusion: Rheumatic aetiology was the leading cause of valvular disease and was associated with clinically important severity, polyvalvular involvement, atrial remodelling, and frequent surgical management. The findings support prevention, early diagnosis, structured follow-up, and careful post-operative monitoring.