1. Can Ascending Chordal blood flow and Annular Blood Flow be a determinant of the Presentation of Rheumatic Valvular heart disease
Syed Mohiyaddin, Rebecca Phillips, Ann Susan Ninan, Ahmed Osama Saad, Azeem Sheikh, Rhodri Davies, Umair Aslam, Prof. Saeed Ashraf
Department Of Cardiothoracic Surgery, Cardiology and Respiratory Medicine

2. Can Ascending Chordal blood flow and Annular Blood Flow be a determinant of the Presentation of Rheumatic Valvular heart disease and Sex Predilection

3. OBJECTIVE
To study and understand the Hemodynamic Pathophysiology of Rheumatic Mitral Valve disease

4. METHODS
Data was collected from 2000 Mar till 2015 Dec at a single centre. An analysis was made on all the patients who underwent Mitral Valve Surgery due to Rheumatic Heart disease with or without associated other cardiac Procedures.
249 patients were identified to have Operative visual and Histopathological diagnosis of Rheumatic Valve disease as the reason for Valve surgery carried out.
Histological Patterns were studied pertaining to the vasulature of the blood supply of the Mitral Valve Apparatus

5. RESULTS Pathology Identified
Age range- 32 to 88.1 years. Median Age 60 years
Pathology Identified

9. CONCLUSIONS
After the preliminary analysis of the data as above and looking at possible other causes for valve involvement being ruled out, all pure Rheumatic valves were seggrigated. A Histopathology report was analysed on 72 pure Rheumatic patients and a detailed analysis was made at the specific area of the valve blood supply looking at the chordal and annular blood vessels which are responsible for keeping the valve dynamic. 21 comments were noted on the same. The following analysis was made.

10. The involvement by obliteration of Annular blood vessels supplying the valve resulted in a hyperemic response and annular thickening of the circumferential annular area. However the disruption of Chordal blood vessels was noted in a majority of the rheumatic valves resulting in the typical thickened rolled out appearence of the valve.
Since the natural history of the histopathological changes are hard to deliniate its quite possible that the actual involvement of the blood vessels in addition to the reaction by M-Antibodies generated against the collagen is responsible for rheumatic heart valve disease which may be the reason why people present at different age groups. Sex predilection could be secondary to the Oestrogen/ Progesterone effects on the valvular blood vessels, therefore a higher reactivity of the collagen tissue in females. A recurrent infection could be responsible for the rapid detoriation of the valves as seen in south east asian countries and shows why the population there presents early unlike the presentation of patients in the developed nations.

11. Conclusions
 ? Should a frozen section looking at the blood vessel archtecture be undertaken on what valves can be preserved by repair and what group needs to be subjected to replacement in this group of patients.