Work

Recurrent Rheumatic Carditis Presenting With Severe Biventricular Dysfunction Despite a Normally Functioning Mechanical Mitral Valve

Year: 2025

Type: article

Abstract: BACKGROUND: Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity in endemic regions. Recurrence of acute rheumatic fever (ARF) in adults, especially after valve surgery, is rare but clinically significant. CASE SUMMARY: A 44-year-old man with rheumatic mitral stenosis underwent mechanical mitral valve replacement. He presented 5 years later with dyspnea, orthopnea, and fatigue. Echocardiography showed new severe biventricular systolic dysfunction (left ventricular ejection fraction 20%) with preserved prosthetic function. Coronary computed tomography angiography excluded obstructive disease, and pulmonary embolism was ruled out. Elevated inflammatory markers raised suspicion for recurrent rheumatic carditis. He received anti-inflammatory therapy and guideline-directed medical therapy for heart failure, with progressive recovery. DISCUSSION: Recurrent ARF should remain a diagnostic consideration in adults with prior RHD and new ventricular dysfunction, even after valve replacement. TAKE-HOME MESSAGES: Recurrent ARF may occur post-surgery and cause myocardial dysfunction. Echocardiography and multimodality imaging are essential for diagnosis and management.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106068

Authors: José Victor da Nóbrega Borges, Samira Abdel Correia Leila

Institutions: Florida International University, Baptist Health South Florida, Hospital Israelita Albert Einstein

Language: English

Topic: Streptococcal Infections and Treatments

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850