Chockalingam Anand, Prabhakar D, Dorairajan S, Priya C, Gnanavelu G, Venkatesan S, Chockalingam V
Institute of Cardiology, Madras Medical College and Research Institute, Chennai, India.
J Heart Valve Dis. 2004 Jan;13(1):11-4.
Rheumatic fever (RF) and chronic rheumatic heart disease (RHD) are common in developing countries. Two-thirds of RHD patients are school-children aged between 5 and 15 years. Pre-schoolers aged <5 years are not immune to RF however, and to date RHD patterns in this very young age group have not been studied systematically.
Records of all RHD patients seen at the authors' institution between January 1999 and December 2000 were retrospectively reviewed. A special analysis was conducted among pre-school children aged <5 years.
Thirty-eight (6.8%) of the RF/RHD admissions were aged <5 years, and 28 of these patients (20 males, 8 females) presented with acute RF. The mean age of acute RF diagnosis was 4 years. All RF/RHD patients aged <5 years were in normal sinus rhythm. Joint pain and swelling (25 cases; characteristic migratory polyarthritis in six, monoarthritis in five) and fever (24 cases) were the most frequent symptoms. Arthritis, carditis and chorea occurred in 75%, 50% and 4% respectively, with no instances of erythema marginatum or subcutaneous nodules. Effort intolerance, chest discomfort and palpitations were reported by nine, five and three cases, respectively. Mitral regurgitation was the most common valvular lesion in RF. The youngest case of confirmed acute RF was an 18-month-old male. The only patient with mitral stenosis in the present series was a 4-year-old girl. None of the patients required surgical intervention, and there were no deaths.
RHD is common in very young age groups of <5 years. Pre-schoolers account for a significant proportion of acute RF and chronic RHD admissions among children. Mitral regurgitation is the most common cardiac manifestation, but obstructive valve disease is distinctly rare in this age group. Aortic regurgitation, left ventricular dysfunction and pulmonary hypertension may complicate the course of RF in these very young children.
风湿热（RF）和慢性风湿性心脏病（RHD）在发展中国家较为常见。三分之二的RHD患者是5至15岁的学龄儿童。然而，年龄小于5岁的学龄前儿童并非对RF免疫，迄今为止，这一年龄极小的群体中的RHD模式尚未得到系统研究。
回顾性分析了1999年1月至2000年12月期间在作者所在机构就诊的所有RHD患者的记录。对年龄小于5岁的学龄前儿童进行了专项分析。
38例（6.8%）RF/RHD入院患者年龄小于5岁，其中28例患者（20例男性，8例女性）表现为急性RF。急性RF诊断的平均年龄为4岁。所有年龄小于5岁的RF/RHD患者均为正常窦性心律。关节疼痛和肿胀（25例；6例为典型的游走性多关节炎，5例为单关节炎）以及发热（24例）是最常见的症状。关节炎、心脏炎和舞蹈病的发生率分别为75%、50%和4%，无边缘性红斑或皮下结节病例。分别有9例、5例和3例报告了活动耐力下降、胸部不适和心悸。二尖瓣反流是RF中最常见的瓣膜病变。确诊急性RF的最年幼病例是一名18个月大的男性。本系列中唯一一例二尖瓣狭窄患者是一名4岁女孩。所有患者均无需手术干预，也无死亡病例。
RHD在年龄小于5岁的极年幼群体中较为常见。学龄前儿童在儿童急性RF和慢性RHD入院病例中占相当大的比例。二尖瓣反流是最常见的心脏表现，但在这一年龄组中梗阻性瓣膜病明显罕见。主动脉瓣反流、左心室功能障碍和肺动脉高压可能使这些极年幼儿童的RF病程复杂化。
