The value of echocardiography in the diagnosis and followup of rheumatic carditis in children and adolescents: a 2 year prospective study.

摘要

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. CONCLUSION: 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.