title: Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience.
abstract: BACKGROUND
  Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo).
  
  
  METHODS
  Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort.
  
  
  RESULTS
  In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease.
  
  
  CONCLUSIONS
  RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases.
authors: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors: C N
authors: CN
authors: Manjunath
authors: PG, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jaya Nagar 9th Block, Bannerghatta Road, Bangalore 560069, Karnataka, India. Electronic address: drpsrinivas@rediffmail.com.
authors: P
authors: P
authors: Srinivas
authors: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors: K S
authors: KS
authors: Ravindranath
authors: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors: C
authors: C
authors: Dhanalakshmi
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000706:statistics & numerical data*
keywords: Echocardiography; Incidence; Rheumatic heart disease; Valvular heart disease