A 28-year-old woman from rural India presents with dyspnea and palpitations. Echocardiography reveals mitral stenosis with a thickened, calcified valve. Which is the most common valve involved in chronic rheumatic heart disease?

Question

Accepted Answer

B. Mitral valve. ## Valve Involvement in Rheumatic Heart Disease

**Key Point:** The mitral valve is the single most commonly affected valve in rheumatic heart disease (RHD), accounting for approximately 65–70% of all cases.

### Frequency of Valve Involvement

| Valve | Frequency | Pattern |
|-------|-----------|----------|
| Mitral | 65–70% | Stenosis > Regurgitation |
| Aortic | 30% | Regurgitation > Stenosis |
| Tricuspid | 10% | Usually regurgitation; rarely stenosis |
| Pulmonary | <1% | Extremely rare; isolated involvement |

**High-Yield:** Mitral stenosis is the **hallmark lesion** of RHD. The mitral valve bears the highest hemodynamic stress during ventricular systole, making it most vulnerable to rheumatic damage.

### Pathophysiology of Mitral Involvement

1. **Acute phase:** Verrucous vegetations form along the line of valve closure (endocarditis).
2. **Chronic phase:** Fibrosis, calcification, and commissural fusion lead to stenosis.
3. **Hemodynamic stress:** The mitral valve closes against the highest left ventricular pressure, explaining its preferential involvement.

**Clinical Pearl:** In RHD, mitral stenosis is often **pure stenosis** (70% of cases), whereas aortic valve disease tends to present as **aortic regurgitation** (not stenosis). This anatomical difference reflects the direction of blood flow and valve closure mechanics.

**Mnemonic:** **MAT** — **M**itral (most common), **A**ortic (second), **T**ricuspid (third). Pulmonary valve is essentially never involved in isolation.

Answer

A. Aortic valve

Answer

C. Tricuspid valve

Answer

D. Pulmonary valve

A 28-year-old woman from rural India presents with dyspnea and palpitations. Echocardiography reveals mitral stenosis with a thickened, calcified valve. Which is the most common valve involved in chronic rheumatic heart disease?

Explanation

Valve Involvement in Rheumatic Heart Disease

Frequency of Valve Involvement

Pathophysiology of Mitral Involvement

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Valve	Frequency	Pattern
Mitral	65–70%	Stenosis > Regurgitation
Aortic	30%	Regurgitation > Stenosis
Tricuspid	10%	Usually regurgitation; rarely stenosis
Pulmonary	<1%	Extremely rare; isolated involvement