Diagnosis of acute rheumatic carditis by endomyocardial biopsy

Area of Science:

• Cardiology
• Pathology
• Rheumatology

Background:

• Rheumatic heart disease (RHD) is a significant cause of acquired heart disease globally.
• Diagnosing active carditis in RHD can be challenging, often relying on clinical and echocardiographic findings.
• Endomyocardial biopsy (EMB) is an invasive procedure rarely utilized for RHD diagnosis.

Observation:

• An adolescent female presented with mitral regurgitation and biventricular congestive heart failure attributed to RHD.
• During cardiac catheterization for mitral valve replacement, an endomyocardial biopsy was performed.
• The biopsy revealed an Aschoff's body in the endocardium, a pathognomonic sign of active rheumatic carditis.

Findings:

• The definitive diagnosis of acute rheumatic carditis was established via endomyocardial biopsy.
• Microscopic examination of the surgically excised mitral valve demonstrated features of acute and chronic valvulitis.
• These pathological findings were consistent with active rheumatic endocarditis.

Implications:

• Endomyocardial biopsy provides definitive histological evidence for diagnosing active carditis in rheumatic heart disease.
• This diagnostic confirmation can guide therapeutic decisions, such as the use of anti-inflammatory treatments.
• Establishing active carditis aids in understanding the disease process and potentially preventing further cardiac damage.