Subclinical rheumatic heart disease: A single center experience

INTRODUCTION: Rheumatic heart disease (RHD) is still a major cause of morbidity and mortality in developing countries. The aim of the present study was to investigate asymptomatic RHD cases diagnosed by echocardiography without any acute rheumatic 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 various reasons (e.g., sport participation and palpitation) and diagnosed with RHD by echocardiography without a history of ARF were included 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 period was 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 Federation criteria. Of these cases, 88% remained the same as borderline RHD, and the findings of two patients improved from definite to borderline RHD. RHD of four patients deteriorated from borderline to definite RHD, and in two patients, valvular insufficiency completely resolved during the follow-up period. None of the cases needed valvular replacement.
DISCUSSION AND CONCLUSION: RHD is still a serious health problem in Turkey. The sensitivity of echocardiography in detecting subclinical mild or asymptomatic cases is well known. For this reason, although it is not yet applied as a routine study, it is important to start the nationwide echocardiographic screening program.

Subklinik romatizmal kalp hastalýðý: Tek merkez deneyimi

GÝRÝÞ ve AMAÇ: Romatizmal kalp hastalýðý (RKH), geliþmekte olan ülkelerde halen önemli bir morbididite ve mortalite nedenidir. Bu çalýþmanýn amacý, daha önce akut romatizmal ateþ taný hikayesi bulunmayan, ekokardiyografi ile RKH tespit edilmiþ asemptomatik vakalarý irdelemek ve takip sonuçlarýný sunmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýza, hastanemiz Çocuk Kardiyoloji Polikliniði’ne 2011-2017 tarihleri arasýnda, farklý klinik nedenlerle baþvurup (spora katýlým ve çarpýntý gibi), ekokardiyografi ile RKH tanýsý konularak takibe alýnan, daha önce geçirilmiþ akut romatizmal ateþ öyküsü bulunmayan ve ekokardiyografi bulgularýna eriþilebilen olgular dahil edildi. Ekokardiyografi bulgularý geriye yönelik olarak incelendi.
BULGULAR: Elli beþ kýz, 20 erkek olmak üzere toplam 75 hasta çalýþmaya dahil edildi. Olgularýn ortalama yaþý 13,6 yýldý ( minimum 5, maksimum 18 yýl). Ortalama takip süresi 19,2 ay iken, en uzun takip süresi 66 ay olarak tespit edildi. Altmýþ yedi olguda (%89.3) baþvuru anýnda yalnýzca mitral kapakta patolojik yetersizlik mevcut iken, 2 olguda (%2,7) yalnýzca aort yetersizliði, 6 olguda (%8) hem aort, hem mitral kapakta patolojik yetersizlik akýmý mevcut idi. Olgularýn 45’i (%60 ) baþvuru anýnda Dünya Kalp Federasyonu kriterlerine göre sýnýrda RKH iken, 30 olgu (%40 ) kesin RKH tanýsý aldý. Takip sonrasý olgularýn, %88 ‘i baþlangýç ve takip sonu sýnýrda RKH olarak kalýrken, 2 olgunun bulgularý kesin RKH’dan sýnýrda RKH’ya gerilemiþ, 4 sýnýrda RKH olgusu kesin RKH‘ya ilerlemiþ, 2 olgu ise tamamen normale dönmüþ idi. Takip süresince, hiçbir olgunun kapak deðiþimine ihtiyacý olmadý.
TARTIÞMA ve SONUÇ: RKH, ülkemizde halen ciddiyetini koruyan bir saðlýk sorunudur. Ekokardiyografinin subklinik hafif veya asemptomatik vakalarý belirlemede duyarlýlýðý iyi bilinmektedir. Bu nedenle henüz rutin olmamasýna raðmen, ülke çapýnda ekokardiyografik tarama programlarýnýn baþlatýlmasý önem teþkil etmektedir.