Karaaslan Sevim, Demirören Saadet, Oran Bülent, Baysal Tamer, Başpinar Osman, Uçar Canan
Department of Pediatrics, Meram Medicine Faculty, Selçuk University, Konya, Turkey.
Cardiol Young. 2003 Dec;13(6):500-5.
Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four. Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.
近年来，横断面超声心动图技术的改进使得在急性风湿热患者中检测出即使是轻度的二尖瓣和主动脉瓣器质性反流成为可能。为了确定亚临床瓣膜炎的患病率和预后，我们分析了转诊至我院的104例急性风湿热患者。在53例无杂音的患者中，22例患多关节炎，29例患舞蹈病，2例患多关节炎和舞蹈病，其中23例（43.4%）有亚临床瓣膜炎。单纯二尖瓣反流是最常见的瓣膜病变，82.6%的患者出现该病变。4.4%的病例检测到单纯主动脉反流，其余13%为二尖瓣和主动脉联合反流。随访期间，根据彩色血流束长度，二尖瓣反流程度改善的患者占59.1%，减轻的占18.2%，加重或不变的占22.7%。根据反流速度标准，86.4%的患者二尖瓣反流改善，其余13.6%加重或不变。根据彩色血流束长度和反流速度判断，6例患者（27.3%）的二尖瓣反流完全消失。所有有主动脉反流问题的患者病情均有改善，4例中有2例完全消失。基于这一经验，我们建议，对于亚临床风湿性瓣膜炎患者，不仅反流消失应被视为瓣膜反流改善的标准，而且超声心动图反流诊断标准的改善，如彩色血流束长度小于1 cm、速度小于2.5 m/s，或提示反流为间歇性或持续时间短，也应被视为瓣膜反流改善的标准。
