{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:19Z","timestamp":1787840539552,"version":"build-2784847793"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Rheumatic heart diseases (RHDs) impose a substantial global burden, primarily affecting individuals under 25 years of age in low- and medium-income countries (LMICs) and poor and marginalized groups in high-income countries.\n                    <jats:sup>[1-3]<\/jats:sup>\n                    The underlying cause is a group A beta-hemolytic streptococcus, which triggers an immune-mediated attack on the heart and joints. Although acute rheumatic fever (ARF) is treatable, its occurrence and complications remain high in impoverished areas.\n                    <jats:sup>[4]<\/jats:sup>\n                    Variations in social structure contribute to differences in the incidence and progression of the disease, even in affluent regions.\n                    <jats:sup>[5]<\/jats:sup>\n                    Administering anesthesia to this patient population presents significant challenges, particularly when early management has been inadequate due to limited medical care and follow-up. Literature shows evidence for anesthetic management of different types of RHDs, mostly focusing on mitral and aortic valvulopathies.\n                    <jats:sup>[6,7]<\/jats:sup>\n                    This review synthesizes literature from databases such as MEDLINE and PubMed searches from the year 2000 to date, focusing on anesthesia management strategies and the challenges posed by ARF and RHD. Specific topics covered include the diagnosis and management of ARF, acute complications, perioperative care for patients with RHD, and unique considerations for different valvular pathologiesWith this review, we aim to discuss the available evidence, current World Health Organization (WHO) and societal guidelines in the context of perioperative medical and anesthetic management, hemodynamic challenges, and postoperative courses. An emphasis on basic point-of-care ultrasound (POCUS) training is made in this review as the current era of diagnostics and therapeutics is increasingly reliant on echocardiography.\n                  <\/jats:p>","DOI":"10.4103\/joacp.joacp_124_24","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T11:00:58Z","timestamp":1750244458000},"page":"384-395","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative challenges and management strategies for non-cardiac surgery in patients with rheumatic heart diseases: A narrative review"],"prefix":"10.4103","volume":"41","author":[{"given":"Manila","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Surgery, Ochsner Medical Center, New Orleans, LA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abey","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care and Resuscitation, Cleveland Clinic, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati Chhabra","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saket","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, Ochsner Medical Center, New Orleans, LA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"R1-20250620","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1161\/CIRCULATIONAHA.116.008731","article-title":"Endemic cardiovascular diseases of the poorest billion","volume":"133","author":"Kwan","year":"2016","journal-title":"Circulation"},{"key":"R2-20250620","doi-asserted-by":"crossref","first-page":"336","DOI":"10.21037\/cdt.2019.11.03","article-title":"A glimpse of hope:Cardiac surgery in low-and middle-income countries (LMICs)","volume":"10","author":"Zilla","year":"2020","journal-title":"Cardiovasc Diagn Ther"},{"key":"R3-20250620","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1053\/j.jvca.2021.01.055","article-title":"Cardiac anesthesiologist and global capacity building to tackle rheumatic heart disease","volume":"35","author":"Tempe","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R4-20250620","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1471-2261-5-11","article-title":"Antibiotics for the primary prevention of acute rheumatic fever:A meta-analysis","volume":"5","author":"Robertson","year":"2005","journal-title":"BMC Cardiovasc Disord"},{"key":"R5-20250620","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, regional, and national burden of rheumatic heart disease, 1990-2015","volume":"377","author":"Watkins","year":"2017","journal-title":"N Engl J Med"},{"key":"R6-20250620","doi-asserted-by":"crossref","first-page":"721","DOI":"10.4103\/ija.IJA_378_17","article-title":"Valvular heart disease and anaesthesia","volume":"61","author":"Paul","year":"2017","journal-title":"Indian J Anaesth"},{"key":"R7-20250620","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.atc.2006.05.005","article-title":"Valvular heart diseases","volume":"24","author":"Kurup","year":"2006","journal-title":"Anesthesiol Clin"},{"key":"R8-20250620","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect Dis"},{"key":"R10-20250620","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1161\/CIR.0000000000000205","article-title":"Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography:A scientific statement from the American Heart Association","volume":"131","author":"Gewitz","year":"2015","journal-title":"Circulation"},{"issue":"5","key":"R11-20250620","doi-asserted-by":"crossref","first-page":"220","DOI":"10.5694\/mja2.50851","article-title":"The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease","volume":"214","author":"Ralph","year":"2021","journal-title":"Med J Aust"},{"key":"R12-20250620","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1093\/cid\/cix599","article-title":"Immune cross-opsonization within emm clusters following group a streptococcus skin infection:Broadening the scope of type-specific immunity","volume":"65","author":"Frost","year":"2017","journal-title":"Clin Infect Dis"},{"key":"R13-20250620","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1038\/nrcardio.2012.197","article-title":"Revisiting the pathogenesis of rheumatic fever and carditis","volume":"10","author":"Tandon","year":"2013","journal-title":"Nat Rev Cardiol"},{"key":"R14-20250620","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jacc.2022.09.050","article-title":"Rheumatic Heart Disease:JACC Focus Seminar 2\/4","volume":"81","author":"Dougherty","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"R15-20250620","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/nrcardio.2012.7","article-title":"World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline","volume":"9","author":"Rem\u00e9nyi","year":"2012","journal-title":"Nat Rev Cardiol"},{"key":"R16-20250620","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/0002-9149(89)90902-8","article-title":"Functional anatomy of severe mitral regurgitation in active rheumatic carditis","volume":"63","author":"Marcus","year":"1989","journal-title":"Am J Cardiol"},{"key":"R17-20250620","doi-asserted-by":"crossref","first-page":"3584","DOI":"10.1161\/CIRCULATIONAHA.105.539775","article-title":"Rheumatic and nonrheumatic valvular heart disease:Epidemiology, management, and prevention in Africa","volume":"112","author":"Essop","year":"2005","journal-title":"Circulation"},{"key":"R18-20250620","doi-asserted-by":"crossref","first-page":"55","DOI":"10.15420\/ahhj.2010.8.1.55","article-title":"Cardiac tamponade as a rare form of presentation of rheumatic carditis","volume":"8","author":"Rocha Ara\u00fajo","year":"2010","journal-title":"Am Heart Hosp J"},{"key":"R19-20250620","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/S2214-109X(21)00288-6","article-title":"Incidence of acute rheumatic fever in northern and western Uganda:A prospective, population-based study","volume":"9","author":"Okello","year":"2021","journal-title":"Lancet Glob Health"},{"key":"R20-20250620","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1093\/eurheartj\/ehu449","article-title":"Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease:The Global Rheumatic Heart Disease Registry (the REMEDY study)","volume":"36","author":"Z\u00fchlke","year":"2015","journal-title":"Eur Heart J"},{"issue":"(Suppl 5)","key":"R21-20250620","doi-asserted-by":"crossref","first-page":"87","DOI":"10.7326\/0003-4819-60-2-87","article-title":"Rheumatic fever in children and adolescents. A long-term epidemiologic study of subsequent prophylaxis, streptococcal infections, and clinical sequelae. VII. Cardiac changes and sequelae","volume":"60","author":"Feinstein","year":"1964","journal-title":"Ann Intern Med"},{"key":"R22-20250620","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.echo.2022.10.009","article-title":"Recommendations for the use of echocardiography in the evaluation of rheumatic heart disease:A Report from the American Society of Echocardiography","volume":"36","author":"Pandian","year":"2023","journal-title":"J Am Soc Echocardiogr"},{"key":"R23-20250620","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/AAP.0000000000000763","article-title":"Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy:American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (Fourth Edition)","volume":"43","author":"Horlocker","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R24-20250620","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1097\/EJA.0000000000001600","article-title":"Regional anaesthesia in patients on antithrombotic drugs:Joint ESAIC\/ESRA guidelines","volume":"39","author":"Kietaibl","year":"2022","journal-title":"Eur J Anaesthesiol"},{"key":"R25-20250620","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1111\/anae.12359","article-title":"Working Party;Association of Anaesthetists of Great Britain &Ireland;Obstetric Anaesthetists'Association;Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of coagulation:The Association of Anaesthetists of Great Britain &Ireland The Obstetric Anaesthetists'Association Regional Anaesthesia UK","volume":"68","year":"2013","journal-title":"Anaesthesia"},{"key":"R26-20250620","doi-asserted-by":"crossref","first-page":"383","DOI":"10.21037\/acs.2019.05.01","article-title":"Rheumatic aortic valve disease-when and who to repair?","volume":"8","author":"Afifi","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"R27-20250620","first-page":"374","article-title":"Rheumatic tricuspid valve disease:An evidence-based systematic overview","volume":"19","author":"Sultan","year":"2010","journal-title":"J Heart Valve Dis"},{"key":"R28-20250620","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ihj.2014.03.010","article-title":"Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center:A single center experience","volume":"66","author":"Manjunath","year":"2014","journal-title":"Indian Heart J"},{"key":"R29-20250620","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1159\/000484942","article-title":"Modern invasive hemodynamic assessment of pulmonary hypertension","volume":"95","author":"Pagnamenta","year":"2018","journal-title":"Respiration"},{"key":"R30-20250620","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1161\/hc3001.093437","article-title":"Prospective multicenter study of pregnancy outcomes in women with heart disease","volume":"104","author":"Siu","year":"2001","journal-title":"Circulation"},{"key":"R31-20250620","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ijgo.2008.10.031","article-title":"Maternal mortality due to cardiac disease in Sri Lanka","volume":"104","author":"Haththotuwa","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"R32-20250620","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1136\/heartjnl-2018-313810","article-title":"Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting","volume":"105","author":"Beaton","year":"2019","journal-title":"Heart"},{"key":"R33-20250620","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"Regitz-Zagrosek","year":"2018","journal-title":"Eur Heart J"},{"key":"R34-20250620","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.ihj.2018.01.018","article-title":"Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy","volume":"70","author":"Sharma","year":"2018","journal-title":"Indian Heart J"},{"issue":"5","key":"R35-20250620","first-page":"e35","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease:Executive Summary:A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"R36-20250620","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/CIRCULATIONAHA.115.015242","article-title":"Pregnancy in women with a mechanical heart valve:Data of the European Society of Cardiology registry of pregnancy and cardiac disease (ROPAC)","volume":"132","author":"Van Hagen","year":"2015","journal-title":"Circulation"},{"key":"R37-20250620","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1213\/ANE.0000000000002530","article-title":"The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants","volume":"126","author":"Leffert","year":"2018","journal-title":"Anesth Analg"},{"key":"R38-20250620","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1097\/ALN.0b013e3182084b2b","article-title":"Case scenario:Cesarean section complicated by rheumatic mitral stenosis","volume":"114","author":"Weiner","year":"2011","journal-title":"Anesthesiology"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_124_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:24:41Z","timestamp":1787837081000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_124_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_124_24","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"assertion":[{"value":"2024-03-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}