title: Rheumatic heart disease occurrence, patterns and clinical correlates in children aged less than five years.
abstract: OBJECTIVE
  Rheumatic fever (RF) and chronic rheumatic heart disease (RHD) are common in developing countries. Two-thirds of RHD patients are school-children aged between 5 and 15 years. Pre-schoolers aged <5 years are not immune to RF however, and to date RHD patterns in this very young age group have not been studied systematically.
  
  
  METHODS
  Records of all RHD patients seen at the authors' institution between January 1999 and December 2000 were retrospectively reviewed. A special analysis was conducted among pre-school children aged <5 years.
  
  
  RESULTS
  Thirty-eight (6.8%) of the RF/RHD admissions were aged <5 years, and 28 of these patients (20 males, 8 females) presented with acute RF. The mean age of acute RF diagnosis was 4 years. All RF/RHD patients aged <5 years were in normal sinus rhythm. Joint pain and swelling (25 cases; characteristic migratory polyarthritis in six, monoarthritis in five) and fever (24 cases) were the most frequent symptoms. Arthritis, carditis and chorea occurred in 75%, 50% and 4% respectively, with no instances of erythema marginatum or subcutaneous nodules. Effort intolerance, chest discomfort and palpitations were reported by nine, five and three cases, respectively. Mitral regurgitation was the most common valvular lesion in RF. The youngest case of confirmed acute RF was an 18-month-old male. The only patient with mitral stenosis in the present series was a 4-year-old girl. None of the patients required surgical intervention, and there were no deaths.
  
  
  CONCLUSIONS
  RHD is common in very young age groups of <5 years. Pre-schoolers account for a significant proportion of acute RF and chronic RHD admissions among children. Mitral regurgitation is the most common cardiac manifestation, but obstructive valve disease is distinctly rare in this age group. Aortic regurgitation, left ventricular dysfunction and pulmonary hypertension may complicate the course of RF in these very young children.
authors.affiliation: Institute of Cardiology, Madras Medical College and Research Institute, Chennai, India. drcanands@yahoo.co.in
authors.forename: Anand
authors.initials: A
authors.lastname: Chockalingam
authors.forename: D
authors.initials: D
authors.lastname: Prabhakar
authors.forename: S
authors.initials: S
authors.lastname: Dorairajan
authors.forename: C
authors.initials: C
authors.lastname: Priya
authors.forename: G
authors.initials: G
authors.lastname: Gnanavelu
authors.forename: S
authors.initials: S
authors.lastname: Venkatesan
authors.forename: V
authors.initials: V
authors.lastname: Chockalingam
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000453:epidemiology