# Rheumatic Valve Disease Presenting As Mitral Stenosis and Regurgitation

## TL;DR

This case report describes a patient with rheumatic heart disease causing severe mitral valve issues, emphasizing the need for early diagnosis and proper management.

## Contribution

The paper presents a clinical case highlighting the challenges and management strategies for rheumatic valve disease in a high-income country.

## Key findings

- The patient had severe mitral stenosis and regurgitation due to rheumatic heart disease.
- Diagnostic imaging revealed significant valve dysfunction and thrombi in the left atrial appendage.
- The case underscores the importance of multimodal imaging and the debate over valve repair versus replacement.

## Abstract

Rheumatic heart disease (RHD) affects many people globally, with the majority of cases in low- and middle-income countries. The disease often leads to significant valve damage, requiring surgical intervention due to complications such as regurgitation or stenosis. Although new cases have declined in high-income countries due to improved control of rheumatic fever (RF), chronic RHD remains a concern. Limited data on RHD in the US highlights the need for improved understanding and management. This case report discusses a 49-year-old male with worsening dyspnea, productive cough, and bilateral leg swelling who was diagnosed with severe mitral stenosis and regurgitation secondary to RHD. Diagnostic imaging revealed significant valve dysfunction and thrombi in the left atrial appendage, as confirmed by both echocardiography and a transesophageal echocardiogram. Despite initial management with medications and anticoagulation, the patient was transferred to a tertiary center for potential mitral valve intervention. This case highlights the importance of early identification and multimodal imaging in managing RHD, as well as the ongoing debate regarding the efficacy of mitral valve repair versus replacement.