Echocardiographic Screening Of Rheumatic Patints Presenting With Pure Chorea Or Arthritis For Detection Of Cardiac Affection:

Somia Abdel Samie Mohamed

165SUMMARYRheumatic fever is the commonest cause of valvular affection inchildren. It needs follow up and prophylaxis to prevent its recurrence withmore valvular damage. In recent studies which done on cases withrheumatic chorea and arthritis who have no auscultatory findings ofvalvular affection proved to have left sided valvular regurgitation with theuse of Doppler.This study aimed at studying the role of Doppler echocardiographyfor unmasking silent valvular affection in rheumatic chorea or arthritiswithout carditis. To achieve this aim, 100 rheumatic children, 41 malesand 59 females presented with either active or quiescent rheumatic choreaor arthritis were examined. They were examined by Dopplerechocardiography. They were clinically free and showed no evidence ofvalvular affection. 50 normal children of matched age and SeX were takenas control.Rheumatic patients were divided into two main b’TOUPS b’TOUP Ipatients with follow up (quiescent) were 69 cases. they were subdividedinto.a- Past arthritis, were 57 cases.b- Past chorea were 12 cases.group II patients with active rheumatic fever, they were 31 cases. Theywere subdivided into.a- Present arthritis were 13 cases.b- Present chorea were 18 cases.for all subjects careful history taking clinical examination, laboratoryinvestigations including (blood picture, ESR, eRP and ESR), were done to166active cases and control. while quiescent cases the laboratory data weretaken from their files. Plain X ray and ECG were done to rheumaticpatients only. Doppler echocardiography was done to all rheumatic andcontrol subjects. Data were tabulated, coded and entered into a computerthen analyzed.Results were expressed as mean ± standard deviation. The student’st-test, Z test and X2 tests were used for analysis.Results obtained were.We have 42 cases out of 100 rheumatic patients had left sidedvalvular affection by the use of Doppler echocardiography. we have 58rheumatic cases with no cardiac abnormalities while 42 cases with cardiacaffection. MRI were 25 cases, MRI + PRI were 2 cases, MRI + TRI were4 cases, MRII were 3 cases, ARI was one case, no ARB, MRI + ARIwere 2 cases, MRIJ + ARIJ were 3 cases and MRI + ARII were 2 cases.so left sided valvular affection are much more affected than right side ofthe heart. Mitral valve is much more affected than aortic valve.Patients with rheumatic chorea were 30 cases, 25 cases had cardiacaffection while 5 cases had no cardiac affection and the differencebetween both groups was statistically significant (P<0.05) There were 70cases with rheumatic arthritis, 53 cases had no cardiac affection while 17cases had cardiac affection and the difference between both l,’TOUpSwasstatistically significant (P<0.05). So patients with rheumatic chorea havehigh incidence of cardiac affection than rheumatic arthritis.167In echo measurements there was no statistical significant differencebetween rheumatic patients and control except in LYESD, SY, EF, FS.This may be due to the fact that many cases of our rheumatic patients (42cases) had MR, AR or MR + AR. In our study 42 cases with cardiacaffection, 2 I cases were active while 2 I cases were quiescent rheumaticfever. cases without cardiac affection were 58 cases, 10 cases were activewhile 48 cases were quiescent rheumatic fever. So cardiac affection canOccurs in the acute attack then may be improved in quiescent period orpersisted later on RF were done to cases with mitral regurgitation only.They were 34 cases. It was proved that RF can’t correlate well with thedegree of mitral regurgitation.Effect of regular prophylaxis was proved as we have 64 cases withregular prophylaxis, 14 cases of them had recurrence while 50 cases hadno recurrence. Partial failure of regular prophylaxis was due to that ourpenicillin products have variable concentrations as proved by someinvestigators in Alexandria University.We had 31 cases with active rheumatic fever, J I cases were activerecurrent attack 8 cases of them had cardiac affection while 3 cases had nocardiac affection. We also had 20 cases with acute first attack of rheumaticfever, 13 cases of them had cardiac affection while 7 cases had no cardiacaffection. This prove that cardiac affection can OCcurfrom first attack ofrheumatic fever without effect of recurrence which may increase thedegree of valvular regurgitation.