Follow-up of rheumatic carditis treated with steroids.
OBJECTIVE
To present the long-term follow-up of children hospitalised for severe rheumatic carditis who were treated with corticosteroids.


METHODS
This is a retrospective analysis of the outcome of 242 patients with severe rheumatic carditis after discharge from two public hospitals in Niteroi, Brazil. We followed up 118 patients for 4 years or more, with an average of 7.7 years. They were treated with antibiotics to accomplish bacterial eradication and either intravenous methylprednisolone - 40 cases - or oral prednisone - 78 patients - to treat carditis. They were followed up in outpatient clinic.


RESULTS
Cardiac failure was categorised as classes III and IV according to the New York Heart Association classification. In the intravenous corticosteroid group, 21 cases (52.5%) had isolated mitral valve regurgitation, 12 (30%) had mitral plus aortic involvement, and seven (17.5%) had aortic lesion only. In the oral prednisone group, 45 (58%) had mitral valve regurgitation only, 27 (34%) had mitral plus aortic involvement, and six (8%) had aortic lesion only. A total of 28 children were in their first disease attack, of whom 19 (68%) had a rupture of chordae tendineae. A total of 58 patients (49%) sustained recurrence of carditis because of neglected secondary prophylaxis. In all, 19 cases (16%) underwent cardiac surgery - valve replacement or valvuloplasty. In 33% of the cases, the outcome was favourable - asymptomatic at follow-up. The overall mortality rate was 6.8%.


CONCLUSIONS
Many critically ill patients who complied with secondary prophylaxis were left with minor injuries, whereas those who neglected it or abandoned it had serious sequelae. The rate of abandonment and loss to follow-up was very high. Many cases (49%) were re-hospitalised because of carditis recurrence.
Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil. gesmarhaddad@uol.com.br
Gesmar V H
GV
Herdy
Rafael S
RS
Gomes
Anna E A
AE
Silva
Leandro S
LS
Silva
Vânia G S
VG
Lopes
D000293:Adolescent; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D016903:Drug Monitoring
D011241:Prednisone