FREQUENCY OF RHEUMATIC MITRAL VALVE STENOSIS AND SEVERITY DISTRIBUTION AMONG THE AGE GROUP OF 20-45 YEARS PRESENTED TO HEALTH SETUPS OF DISTRICT SWAT: A CROSS-SECTIONAL STUDY

Abstract

Background: Rheumatic heart disease (RHD) is the most prevalent acquired cardiovascular condition in developing regions, largely affecting young populations. It typically results from an autoimmune response following untreated group A streptococcal infections. The mitral valve is most frequently compromised, with disease progression often exacerbated by limited access to antibiotics, poor sanitation, and delayed healthcare-seeking behavior in underserved communities.

Objective: To determine the frequency and severity distribution of mitral valve stenosis among patients aged 20 to 45 years diagnosed with rheumatic heart disease in District Swat, Pakistan.

Methods: A descriptive cross-sectional study was carried out over four months (November to February 2024–2025) across multiple echocardiographic centers in District Swat, Khyber Pakhtunkhwa. A total of 152 patients aged 20–45 years with echocardiographically confirmed rheumatic mitral stenosis were selected using non-probability convenience sampling. Data were collected through structured questionnaires and diagnostic imaging. Severity of mitral stenosis was classified as mild (>1.6 cm²), moderate (1.0–1.6 cm²), or severe (<1.0 cm²). Data analysis was performed using SPSS version 23.

Results: Among 152 participants, 64 (42.1%) were male and 88 (57.9%) female; 104 (68.4%) were married. Most patients (94, 61.8%) were aged 20–30 years. Mitral valve involvement was isolated in 110 cases (72.4%), while tricuspid, aortic, and pulmonic valve involvement was observed in 25 (16.4%), 12 (7.9%), and 5 (3.3%) patients respectively. Moderate mitral stenosis was the most common grade (64, 42.1%), followed by mild (56, 36.8%) and severe (32, 21.1%). Mild mitral regurgitation was found in 86 patients (56.6%). Complications were present in 35 patients (23%), including arrhythmia (13, 8.6%), heart failure (12, 7.9%), respiratory complications (9, 5.9%), and stroke (1, 0.7%).

Conclusion: Rheumatic mitral stenosis is predominantly observed in young adult females, with moderate stenosis being the most frequent form. These findings highlight the need for early diagnosis and preventive strategies targeting streptococcal infections at the community level.