Subclinical rheumatic heart disease: A single center experience

Abstract

OBJECTIVE: Rheumatic heart disease (RHD) is still a major cause of morbidity and mortality in developing countries. Theaim of the present study was to investigate asymptomatic RHD cases diagnosed by echocardiography without any acuterheumatic fever (ARF) history and to present the follow-up results.METHODS: Children who had been admitted to the pediatric cardiology department between 2011 and 2017 for variousreasons (e.g., sport participation and palpitation) and diagnosed with RHD by echocardiography without a history of ARF wereincluded the study. Echocardiographic findings of the patients were evaluated retrospectively.RESULTS: A total of 75 (55 girls and 20 boys) patients were included in the study. The median age of the cases was 13.6(minimum 5 and maximum 18) years. The median follow-up period was 19.2 months, whereas the longest follow-up periodwas 66 months. At the time of admission, pathological valvular insufficiency was present only in the mitral valve in 69 (89.3%)cases, only in the aortic valve in 2 (2.7%) cases, and in both aortic and mitral valve in 6 (8%) cases. Of the cases, 40 (60%)were diagnosed as borderline RHD at the time of admission, and 30 (40%) as definite RHD according to the World Heart Federationcriteria. Of these cases, 88% remained the same as borderline RHD, and the findings of two patients improved fromdefinite to borderline RHD. RHD of four patients deteriorated from borderline to definite RHD, and in two patients, valvularinsufficiency completely resolved during the follow-up period. None of the cases needed valvular replacement.CONCLUSION: RHD is still a serious health problem in Turkey. The sensitivity of echocardiography in detecting subclinicalmild or asymptomatic cases is well known. For this reason, although it is not yet applied as a routine study, it is important tostart the nationwide echocardiographic screening program.