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

Objective. To evaluate echocardiographic/Doppler findings in patients with rheumatic fever whether or not clinical manifestations of carditis were pre sent, and the followup of these findings 24 months after the acute phase. Methods. Twenty-two patients with rheumatic fever (13 boys, 9 girls, mean a ge 11.0 years) were evaluated at baseline Cat diagnosis) and after 3 and 6 mo of disease. Eighteen patients were reevaluated 24 mo later. The assessme nt included physical and cardiac examination, electrocardiogram, chest radi ography, and color ECHO/Doppler performed blindly by different investigator s. 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 abnormalitie s that persisted at least 6 mo in followup assessments. Mitral and aortic w ere the most frequently involved valves. In Group 1 we observed normalizati on of the ECHO/Dappler in 3 patients, improvement in 2, no change in 2, and worsening in one. Twelve of 14 patients without clinical carditis were ree valuated, including the 5 patients with ECHO/Doppler abnormalities during t he initial evaluations; normalization or improvement: was observed in 2 pat ients, no change in 2, and worsening in one, We observed no ECHO/Doppler ab normalities in the control group. Conclusion. This blind prospective study suggests the existence of asymptom atic carditis in some patients with rheumatic fever and the role ECHO/Doppl er investigation could play in diagnosis and Followup.