Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-29T01:08:05.805Z Has data issue: false hasContentIssue false

Evaluation of subclinical valvar disease in patients with rheumatic fever

Published online by Cambridge University Press:  24 May 2005

Suheyla Ozkutlu
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Ankara, Turkey
Olgu Hallioglu
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Ankara, Turkey
Canan Ayabakan
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Ankara, Turkey

Abstract

Carditis is the only manifestation of acute rheumatic fever that leads to permanent disability. Hence, its diagnosis is of paramount importance. Recently, it has been reported that Doppler echocardiography has disclosed subclinical valvar regurgitation in some patients with acute rheumatic fever manifested as isolated arthritis or pure chorea. The prognosis of such patients with acute rheumatic fever and subclinical valvitis is not clear. We aimed, therefore, prospectively to investigate the potential to diagnose patients with subclinical carditis. We examined 40 patients, aged from 7 to 16 years, with Doppler evidence of mitral and aortic regurgitation, but in the absence of any pathologic murmur. The major findings satisfying the Jones criterions were arthritis in 29 patients, chorea in 10 patients, and arthritis and erythema marginatum in one patient. Of the patients, 33 had mitral regurgitation, 6 patients had combined mitral and aortic regurgitation, and one patient had aortic regurgitation. The patients were followed over a mean period of 18.1 ± 13.9 months, the valvar regurgitation disappearing in 23 (57.5%). No significant differences were observed in the resolution of the valvitis between those treated with acetylsalicylic acid, steroids, or those receiving no treatment. It is noteworthy, nonetheless, that patients treated with steroids were the fastest to recover from valvitis (p < 0.05).

Based on our study, we suggest that subclinical valvitis demonstrated by echocardiography should now be accepted as adequate evidence for the diagnosis of carditis, and become a major diagnostic criterion for acute rheumatic fever. When managing this group of patients with subclinical disease, treatment with steroids seems to have a role in promoting early resolution of the valvitis.

Type
Original Article
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Eisenberg MJ. Rheumatic heart disease in the developing world: prevalence, prevention, and control. Eur Heart J 1993; 14: 122128.Google Scholar
Folger GM, Hajar R, Robida A, Hajar HA. Occurrence of valvular heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler identification. Br Heart J 1992; 67: 434438.Google Scholar
Veasy LG, Tani LY, Hill HR. Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr 1994; 124: 916.Google Scholar
Elevli M, Celebi A, Tombul T, Gokalp AS. Cardiac involvement in Sydenham's chorea: clinical and Doppler echocardiographic findings. Acta Paediatr 1999; 88: 10741077.Google Scholar
Ozkutlu S, Ayabakan C, Saraclar M. Can subclinical valvitis detected by echocardiography be accepted as evidence of carditis in the diagnosis of acute rheumatic fever? Cardiol Young 2001; 11: 255260.Google Scholar
Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268: 20692073.
Minich LL, Tani LY, Pagotto LT, Shaddy RE, Veasy LG. Doppler echocardiography distinguishes between physiologic and pathologic “silent” mitral regurgitation in patients with rheumatic fever. Clin Cardiol 1997; 20: 924926.Google Scholar
Wilson NJ, Neutze JM. Echocardiographic diagnosis of subclinical carditis in acute rheumatic fever. Int J Cardiol 1995; 50: 16.Google Scholar
Mota CC. Doppler echocardiographic assesment of subclinical valvitis in the diagnosis of acute rheumatic fever. Cardiol Young 2001; 11: 251254.Google Scholar
Steinfeld L, Ritter S, Rappaport H, Martinez E. Silent rheumatic mitral regurgitation unmasked by Doppler studies. Circulation 1986; 74 (Suppl 11): 385.Google Scholar
Mota CC, Meira ZM, Graciano RN, Silva MC. Diagnostic aspects of streptococcal infections carditis and other acute forms. Cardiol Young 1992; 2: 222228.Google Scholar
Figueroa FE, Fernandez MS, Valdes P, et al. Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease. Heart 2001; 85: 407410.Google Scholar
Vasan RS, Shrivastava S, Vijayakumar M, Narang R, Lister BC, Narula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996; 94: 7382.Google Scholar
Yoshida K, Yoshikawa J, Shakudo M, et al. Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation 1988; 78: 840847.Google Scholar
Thomson JD, Allen J, Gibbs JL. Left sided valvular regurgitation in normal children and adolescents. Heart 2000; 83: 185187.Google Scholar
Brand A, Dollberg S, Keren A. The prevalence of valvular regurgitation in children with structurally normal hearts: a color Doppler echocardiographic study. Am Heart J 1992; 123: 177180.Google Scholar