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Follow-up of rheumatic carditis treated with steroids

Gesmar V H Herdy1, Rafael S Gomes, Anna E A Silva

  • 1Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil. gesmarhaddad@uol.com.br

Cardiology in the Young
|October 22, 2011
PubMed

Insights

Long-term follow-up of children with severe rheumatic carditis treated with corticosteroids shows that adherence to secondary prophylaxis is crucial. Neglecting prophylaxis led to serious sequelae and high recurrence rates, impacting long-term outcomes.

Area of Science:

  • Pediatrics
  • Cardiology
  • Rheumatology

Background:

  • Severe rheumatic carditis in children poses significant long-term health risks.
  • Corticosteroid therapy is a common treatment for rheumatic carditis.
  • Long-term outcomes and the impact of secondary prophylaxis require further investigation.

Purpose of the Study:

  • To evaluate the long-term outcomes of children hospitalized for severe rheumatic carditis treated with corticosteroids.
  • To assess the impact of secondary prophylaxis adherence on patient sequelae and recurrence.

Main Methods:

  • Retrospective analysis of 242 children with severe rheumatic carditis.
  • Follow-up of 118 patients for an average of 7.7 years.
  • Treatment included antibiotics and either intravenous methylprednisolone or oral prednisone.

Main Results:

  • Valve involvement (mitral and/or aortic) was common, with varying patterns between treatment groups.
  • Rupture of chordae tendineae occurred in 68% of first-attack patients.
  • 49% of patients experienced carditis recurrence due to neglected secondary prophylaxis, leading to re-hospitalization.
  • 33% had a favorable outcome, while 6.8% mortality was observed.

Conclusions:

  • Adherence to secondary prophylaxis is critical for preventing serious sequelae and recurrence in children with rheumatic carditis.
  • Neglect or abandonment of prophylaxis significantly increases the risk of severe complications.
  • High rates of abandonment and loss to follow-up were observed, highlighting challenges in long-term management.
Abstract

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