Clinical Characteristics and Management Outcomes of Severe Multi-Valvular Rheumatic Heart Disease: A Hospital-Based Analysis

Background: Multi-valvular involvement represents the most severe form of rheumatic heart disease (RHD), presenting complex clinical challenges requiring a comprehensive understanding for optimal patient management. In resource-limited settings, late presentation and inadequate secondary prophylaxis result in advanced disease with high complication burdens. Objective: To analyze the clinical presentation, diagnostic findings, treatment strategies, and outcomes, specifically in-hospital complication rates, mortality, functional improvement, and six-month follow-up outcomes in patients with severe multi-valvular RHD presenting to secondary and tertiary academic centers in Delhi, India. Methods: A retrospective observational analysis was conducted of 385 consecutive patients with severe multi-valvular RHD admitted to Lal Bahadur Shastri Hospital and Dr. Ram Manohar Lohia Hospital, New Delhi, between September 2023 and September 2025. Clinical data, echocardiographic parameters, laboratory findings, treatment protocols, and outcomes were systematically reviewed and analyzed. Results: Mean age was 31.2 ± 7.4 years; 68% were female. The majority (57%) presented with New York Heart Association Functional Classification (NYHA) Class III-IV symptoms. Atrial fibrillation was documented in 58%, severe pulmonary hypertension (>60 mmHg) in 82%, and right ventricular dysfunction in 69%. Healthcare-associated infections occurred in 23%, including MRSA bacteremia in 12%. In-hospital mortality was 3.4%; 6-month mortality was 7.2%. Admissions peaked during monsoon months (18% higher case volume). Conclusion: Severe multi-valvular rheumatic heart disease (RHD) presents complex management challenges requiring comprehensive evaluation and multidisciplinary care. Early recognition of complications and timely intervention are crucial for improving outcomes in this high-risk population.