[The echocardiogram in the first attack of rheumatic fever in childhood]

In order to evaluate the contribution of echocardiography (echo) in the first episode of rheumatic fever, 18 children (mean age: 8.5 +/- 2.9 years) observed between 1987 and 1992 have been retrospectively studied. In 11 of them the echo has been done in the first month after the initial episode. By M-Mode echo the most constant finding was a high left atrium: aorta ratio in all cases with clinical carditis. By 2D-echo, hyperechogenicity of mitral valve leaflets and subvalvular apparatus was a common finding, three patients having mitral valve prolapse, one with dilatation of the mitral ring and the other with leaflets not able to coapt. Doppler-echo displayed in 17 patients mitral valve regurgitation, and in three aortic regurgitation. In three children the diagnosis of carditis was made by echo in the absence of murmur. During follow-up mitral valve regurgitation disappeared in four children. The authors conclude that early echo is very important in all children suspected to have rheumatic fever, specially because mitral valve regurgitation can be demonstrated by color flow mapping even in the absence of cardiac murmur.