Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-24T02:32:26.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Echocardiographic diagnosis of rheumatic fever and rheumatic valvar disease

Published online by Cambridge University Press:  19 August 2008

Caio César Jorge Medeiros ,
Alvaro Villela de Moraes ,
Rachel Snitcowsky ,
Pedro Mauro Graziosi ,
José Albuquerque de Figueiredo Neto ,
José Rodrigues Parga Filho ,
Giovanni Bellotti  and
Fulvio Pileggi
Caio César Jorge Medeiros*
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
Alvaro Villela de Moraes*
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
Rachel Snitcowsky
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
Pedro Mauro Graziosi
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
José Albuquerque de Figueiredo Neto
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
José Rodrigues Parga Filho
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
Giovanni Bellotti
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
Fulvio Pileggi
Affiliation:
Department of Pediatric Cardiology, Instituto do Coração, Hospital das Clinicas, Universidade de São Paulo, São Paulo
*
Dr. Caio César Jorge Medeiros, Avenida Dr. Eneas de Carvalho 44, CEP -05403 São Paulo-SP, Brazil. Tel. 55-1 1-282-7766; Fax. 55-11-282-2354.
Dr. Caio César Jorge Medeiros, Avenida Dr. Eneas de Carvalho 44, CEP -05403 São Paulo-SP, Brazil. Tel. 55-1 1-282-7766; Fax. 55-11-282-2354.
Get access Rights & Permissions [Opens in a new window]

Summary

We studied 56 children echocardiographically, ages four to 15 years (mean nine years) with acute rheumatic fever to determine the extent of cardiac involvement. All had a clinical diagnosis of carditis. Mitral regurgitation was always present and was associated with aortic regurgitation in 53.6% and tricuspid regurgitation in 32.1%. Mitral valvar prolapse was observed in 18 patients 5(32.1%) and could not be differentiated from myxomatous prolapse in 10 (17.8%). Cordal rupture was detected in seven patients (12.5%), three of whom required surgical treatment. Other findings concerning the mitral valve were vegetations in two patients (3.6%), commissural fusion without stenosis in 36(64.3%), and mitral stenosis in four (7.1%). Heart failure was usually secondary to valvitis rather than myocarditis, and led to surgical treatment in seven patients. The myocardial function was depressed in only two patients. In both, the ejection function returned to normal after medical treatment. Echocardiography provides important information on the involvement of the heart in acute rheumatic fever, helping to determine prognosis and the results of treatment.

Keywords

Echocardiographyrheumatic fevervalvopathycarditis
Type
World Forum for Pediatric Cardiology Symposium on Rheumatic Fever
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 236 - 239
Copyright
Copyright © Cambridge University Press 1992

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

1. Veasy, LG, Wiedmeier, SE, Orsmond, GS, Ruttenberg, HD, Boucek, MM, Roth, SJ, Tait, VF, Thompson, JA, Daly, JA, Kaplan, EL, Hill, HR. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med 1987; 316: 421–427.Google Scholar
2. Vardi, P, Markiewicz, W, Weiss, Y, Levi, J, Benderly, A. Clinical echocardiographic correlations in acute rheumatic fever. Pediatrics 1983; 71: 830–834.Google Scholar
3. Kajino, Y, Iwayani, H, Haneda, N, Saito, M, Nishio, T, Mori, C, Kijima, Y, Nakao, A. A case of acute rheumatic fever: Echocardiographic findings for mitral regurgitation in acute rheumatic carditis. Jpn Circ J 1987; 51: 1393–1396.Google Scholar
4. Lewis, BS, Geft, IL, Milo, S, Gotsman, MS. Echocardiography and valve replacement in critically ill patient with acute rheumatic carditis. Ann Thorac Surg 1979; 27: 529–535.Google Scholar
5. AL Kasab, S, AL Fagih, MR, Shahid, M, Habbab, M, Al Zaibag, M. Valve surgery in acute rheumatic heart disease. One-to four year follow-up. Chest 1988; 94: 830–833.Google Scholar
6. Marcus, RH, Sareli, P, Pocock, WA, Meyer, TE, Magalhaes, MP, Grieve, T, Antunes, MJ, Barlow, JB. Functional anatomy of severe mitral regurgitation in active rheumatic carditis. Am J Cardiol 1989; 63: 577–584.CrossRefGoogle ScholarPubMed
7. Schieken, RM, Kerber, RE. Echocardiographic abnormalities in acute rheumatic fever. Am J Cardiol 1976; 38: 458–462.CrossRefGoogle ScholarPubMed
8. American Heart Association: Jones criteria (revised) for guidance in the diagnosis of rheurnatic fever. Circulation 1965; 32: 662–673.Google Scholar
9. Markowitz, M, Gordis, L. Rheumatic Fever. Second Edition. WB Saunders, Philadelphia, 1972.Google Scholar
10. Sahn, DJ, DeMaria, A, Kisslo, J, Weyman, A. (Committee on Mmode echocardiography of the American Society of Echocardiography): Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocar diographic measurements. Circulation 1978; 58: 1072–1083.Google Scholar
11. Henry, WL, Gardin, JM, Ware, JH. Echocardiography measurements in normal subjects from infancy to old age. Circulation 1980; 62: 1054–1060.Google Scholar
12. Hatle, L, Angelsen, B. Doppler Ultrasound in Cardiology. Physical Principles and Clinical Applications. Second Edition. Lea & Febiger, Philadelphia, 1985.Google Scholar
13. Lembo, NJ, Dell'ltalia, LJ, Crawford, MH, Miller, JF, Richards, KL, O'Rourke, RA. Mitral valve prolapse in patients with prior rheumatic fever. Circulation 1988; 77: 830–836.CrossRefGoogle ScholarPubMed
14. Taranta, A, Spagnuolo, M, Feinstein, AR. Chronic rheumatic fever. Ann Intern Med 1962; 56: 367–388.Google Scholar
15. Weinhouse, E, Wanderman, KL, Loutaty, G, Gussarsky, Y, Gedalia, A, Gueron, M. Severe rheumatic valve disease in children. Evaluation by echocardiography. Pediatr Cardiol 1982; 3: 197–203.CrossRefGoogle ScholarPubMed
16. Cormier, B, Starkman, C, Enriquez-Sarano, M, Vitoux, B, Kulas, A, Dewilde, J, Grimberg, D, Acar, J. L'echocardiographie des insuffisances mitrales chirurgicales. Diagnostic lesionnel et prevision du type de chirurgie. Arch Mal Coeur 1990; 83:345–350.Google Scholar