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Rheumatic carditis treated with high doses of pulsetherapy methylprednisolone. Results in 70 children over 12 years
G V Herdy1, C A Pinto, M C Olivaes
1Hospital Universitário Antônio Pedro-UFF, Brazil.
Insights
Intravenous methylprednisolone pulse therapy effectively treats severe rheumatic carditis in children. While treatment duration varied, the protocol remains a valuable option for managing complex pediatric cardiac cases over a 12-year period.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Pharmacology
Background:
- Rheumatic carditis is a significant cause of pediatric heart disease.
- Severe cases often present with advanced heart failure (NYHA Class III-IV).
- Intravenous methylprednisolone pulse therapy is a treatment option for severe inflammatory cardiac conditions.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric patients with rheumatic carditis treated with IV methylprednisolone.
- To compare treatment responses and follow-up data over 12 years across different patient groups.
- To assess the efficacy of pulse therapy in severe pediatric rheumatic carditis.
Main Methods:
- Seventy children with active rheumatic carditis (76 episodes) were studied.
- Diagnosis confirmed by modified Jones' criteria; infections and strongyloidiasis were excluded.
- Treatment involved IV methylprednisolone bolus thrice weekly until laboratory markers normalized; patients grouped by admission time.
Main Results:
- Group 1 (40 children): 45% had their first attack; 52% required 4 series of pulse therapy.
- Group 2 (18 children): 77% had their first attack; 50% required 4 series; 66% had flail mitral valve.
- Group 3 (12 children): Significantly more patients (41%) needed 5+ series; severe mitral valve complications and mortality were noted.
Conclusions:
- Significant variations in presentation and disease progression were observed over 12 years.
- The established IV methylprednisolone pulse therapy protocol remains effective for severe pediatric rheumatic carditis.
- Long-term follow-up highlights the need for careful management of mitral valve complications in these patients.
Purpose:
To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years.
Methods:
Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After ruling out infections and strongyloidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1, 2 and 3, comprising of 40, 18 and 12 children, respectively.
Results:
Eighteen children in Group 1 (45%) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25%), 3 in 9 (23%) and 4 in 21 (52%). In Group 2, 14 cases (77%) were in their 1st attack: 2 series were used in 7 (39%), 4 in 9 (50%) and 5 in 2 (11%). The echocardiogram showed a flail mitral valve in 12 (66%) of these patients (1 death occurred after mitral valvoplasty). In Group 3, 6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41%). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3.
Conclusion:
There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.