Occurrence of valvar heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler
G M Folger1, R Hajar, A Robida
1Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Doha, Qatar.
Insights
Subclinical mitral and aortic valve regurgitation is common in children with rheumatic fever, even without signs of carditis. Colour flow Doppler imaging effectively detects this early valvar disease.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Diagnostic Imaging
Background:
- Rheumatic fever can lead to heart valve damage.
- Detecting subclinical carditis is crucial for timely intervention.
Purpose of the Study:
- To assess the frequency of mitral and aortic regurgitation in children with rheumatic fever.
- To evaluate the utility of Colour Flow Doppler imaging in detecting subclinical valvar disease.
Main Methods:
- Non-randomized study using Colour Flow Doppler imaging.
- Inclusion of children with acute rheumatic fever and quiescent disease without carditis.
- Comparison with control groups and patients with confirmed rheumatic carditis.
Main Results:
- Mitral or aortic regurgitation detected in 10 of 11 acutely ill children, all without clinical carditis.
- Mild valvar insufficiency was observed in the acute and quiescent stages.
- No regurgitation found in non-rheumatic control subjects.
Conclusions:
- Colour Flow Doppler imaging is effective in identifying subclinical mitral and aortic valvar disease in rheumatic fever.
- This imaging technique aids in diagnosing valvar disease when carditis is not clinically evident.
- It represents a valuable addition to current diagnostic criteria for rheumatic fever.
Objective:
To determine the frequency of occurrence of mitral and aortic valvar regurgitation in rheumatic children in whom there was no evidence of carditis acutely or at an earlier attack.
Design:
Colour flow Doppler imaging was used in a non-randomised study of sequentially admitted children who met the criteria for acute rheumatic fever without clinically evident carditis and patients in whom the disease was quiescent after a previous attack of rheumatic fever. Two separate control groups were used for comparison of the echocardiographic findings, and a group of patients with confirmed rheumatic carditis was included for comparison of acute phase and antistreptococcal reactants.
Setting:
A general hospital with the only paediatric inpatient department in Qatar.
Patients:
From November 1988 to October 1990, 11 children were studied during the acute rheumatic period. In seven additional children the disease was quiescent when they were studied 18 to 36 months after a documented episode of acute rheumatic fever in which there was no evidence of carditis. The control patients were all studied during the same period.
Main Outcome Measure:
Detection of mitral and aortic regurgitation in patients without clinical evidence of rheumatic carditis in the acute or quiescent stages of the disease.
Results:
Mitral or mitral and aortic regurgitation was found in 10 of the 11 children studied in the acute rheumatic period. None had a murmur or other evidence of carditis. In all the cases studied the valvar insufficiency was mild. Four of the children studied late in the quiescent period had either aortic or mitral insufficiency by colour flow Doppler evaluation; two children who had previously had valvar insufficiency no longer showed this, and one child without positive findings in the acute phase remained without insufficiency. None of the non-rheumatic control subjects showed mitral or aortic regurgitation.
Conclusions:
Colour flow Doppler imaging is a useful method of identifying subclinical mitral and aortic valvar disease at all stages of rheumatic fever when carditis cannot be otherwise detected and is a valuable addition to current diagnostic criteria.
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