Evolution of valve damage in Sydenham's chorea during recurrence of rheumatic fever.
BACKGROUND
The evolution of valve damage during a recurrence, in a patient who did not have apparent carditis in the initial attack of Sydenham's chorea, has been a subject of debate.


METHODS
Thirty-six patients with an initial episode of acute rheumatic fever and Sydenham's chorea (3 patients with subclinical mitral regurgitation) were followed up prospectively for 5 years. Clinical examinations and transthoracic color Doppler echocardiography were done for each patient at initial attacks of Sydenham's chorea and at recurrences of rheumatic fever.


RESULTS
Six recurrences of rheumatic fever occurred in 6 of the 36 patients. One recurrence developed in the regular secondary prophylaxis group (27 patients) with a recurrence rate of 0.007 per patient-year. Three of the 18 patients who initially had no heart murmur and no echocardiographic finding of valvular regurgitation had three recurrences of pure chorea with no echocardiographic evidence of significant valvular regurgitation. Interestingly, one of the 3 patients with previous pure chorea and echocardiographic finding of significant mitral regurgitation had a recurrence of pure chorea and new echocardiographic evidence of mitral, aortic and tricuspid regurgitations. Furthermore, two recurrences occurring in 2 of the 15 patients with previous carditis developed echocardiographic evidence of new carditis.


CONCLUSIONS
Rheumatic recurrence can develop new valve damage evident by echocardiography for the patient with pure Sydenham's chorea who had previous subclinical valvulitis. Longer duration of secondary prophylaxis is recommended to prevent a recurrence of rheumatic fever in the patient with pure Sydenham's chorea who initially had subclinical valvulitis.
Panamonta
Manat
M
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. manat@kku.ac.th
Chaikitpinyo
Arnkisa
A
Auvichayapat
Narong
N
Weraarchakul
Wiboon
W
Panamonta
Ouyporn
O
Pantongwiriyakul
Aunejit
A
D000208:Acute Disease; D000293:Adolescent; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002819:Chorea / Q000150:complications*; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D009205:Myocarditis / Q000150:complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D055502:Secondary Prevention