Rheumatic fever in children: A 15-year experience in a developing country

Clinical data from 91 patients with rheumatic fever (RF), who were hospital ized at a tertiary hospital in Lebanon between 1980 and 1995, were reviewed retrospectively. Age on hospitalization was 11.1 +/- 2.9 years (mean +/- S D, range 3-17 years). Nineteen patients were <6 years of age. Manifestation s included carditis (93%), arthritis (39%), Sydenham's chorea (2%), erythem a marginatum (4%), subcutaneous nodules (1%), fever (62%), arthralgia (55%) , and acute congestive heart failure (CHF) on initial presentation (44%). P ericardial effusion occurred in 11%. There was positive family history of R F in 14%. Mitral insufficiency and aortic insufficiency occurred in 67 and 35%, respectively. Both mitral and aortic valves were involved in 30% of ca ses. Tricuspid insufficiency developed in 3% and pulmonary insufficiency in 1%. Mitral stenosis developed in 19%. Twenty-eight patients underwent surg ical intervention: mitral valve repair and commissurotomy in 9/91 (10%), mi tral valve replacement in 18/91 (20%), and aortic valve replacement in 9/91 (10%). Overall mortality was 12%: 5 following surgical intervention (3 aft er mitral valve surgery and 2 after mitral and aortic valve surgery). All p atients that died had CHF on initial presentation (p = 0.006). This study i ncludes hospitalized patients with predominant rheumatic heart disease. Ini tial presentation with CHF is a risk factor for surgical intervention and m ortality. A significant high surgical intervention rate is noted that is pr obably related to the nature of the selected group studied, This study emph asizes the significant morbidity and death in patients with RF and carditis .