The value of echocardiography in the diagnosis and followup of rheumatic carditis in children and adolescents: a 2 year prospective study.
OBJECTIVE
To evaluate echocardiographic/Doppler findings in patients with rheumatic fever whether or not clinical manifestations of carditis were present, and the followup of these findings 24 months after the acute phase.


METHODS
Twenty-two patients with rheumatic fever (13 boys, 9 girls, mean age 11.0 years) were evaluated at baseline (at diagnosis) and after 3 and 6 mo of disease. Eighteen patients were reevaluated 24 mo later. The assessment included physical and cardiac examination, electrocardiogram, chest radiography, and color ECHO/Doppler performed blindly by different investigators. The control group included 15 healthy children.


RESULTS
We observed clinical carditis in 8 patients (36.4%): Group 1, all with ECHO abnormalities. We observed no clinical cardiac manifestations in 14 patients (Group 2), but 5 (35.7%) had positive ECHO/Doppler abnormalities that persisted at least 6 mo in followup assessments. Mitral and aortic were the most frequently involved valves. In Group 1 we observed normalization of the ECHO/Doppler in 3 patients, improvement in 2, no change in 2, and worsening in one. Twelve of 14 patients without clinical carditis were reevaluated, including the 5 patients with ECHO/Doppler abnormalities during the initial evaluations; normalization or improvement was observed in 2 patients, no change in 2, and worsening in one. We observed no ECHO/Doppler abnormalities in the control group.


CONCLUSIONS
This blind prospective study suggests the existence of asymptomatic carditis in some patients with rheumatic fever and the role ECHO/Doppler investigation could play in diagnosis and followup.
Hilário
M O
MO
Department of Pediatrics, Universidade Federal de São Paulo, Brazil. odete@nox.ne
Andrade
J L
JL
Gasparian
A B
AB
Carvalho
A C
AC
Andrade
C T
CT
Len
C A
CA
D000293:Adolescent; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler