Folger G M, Hajar R, Robida A, Hajar H A
Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Doha, Qatar.
Br Heart J. 1992 Jun;67(6):434-8. doi: 10.1136/hrt.67.6.434.
To determine the frequency of occurrence of mitral and aortic valvar regurgitation in rheumatic children in whom there was no evidence of carditis acutely or at an earlier attack.
Colour flow Doppler imaging was used in a non-randomised study of sequentially admitted children who met the criteria for acute rheumatic fever without clinically evident carditis and patients in whom the disease was quiescent after a previous attack of rheumatic fever. Two separate control groups were used for comparison of the echocardiographic findings, and a group of patients with confirmed rheumatic carditis was included for comparison of acute phase and antistreptococcal reactants.
A general hospital with the only paediatric inpatient department in Qatar.
From November 1988 to October 1990, 11 children were studied during the acute rheumatic period. In seven additional children the disease was quiescent when they were studied 18 to 36 months after a documented episode of acute rheumatic fever in which there was no evidence of carditis. The control patients were all studied during the same period.
Detection of mitral and aortic regurgitation in patients without clinical evidence of rheumatic carditis in the acute or quiescent stages of the disease.
Mitral or mitral and aortic regurgitation was found in 10 of the 11 children studied in the acute rheumatic period. None had a murmur or other evidence of carditis. In all the cases studied the valvar insufficiency was mild. Four of the children studied late in the quiescent period had either aortic or mitral insufficiency by colour flow Doppler evaluation; two children who had previously had valvar insufficiency no longer showed this, and one child without positive findings in the acute phase remained without insufficiency. None of the non-rheumatic control subjects showed mitral or aortic regurgitation.
Colour flow Doppler imaging is a useful method of identifying subclinical mitral and aortic valvar disease at all stages of rheumatic fever when carditis cannot be otherwise detected and is a valuable addition to current diagnostic criteria.
确定在急性发作期或既往发作时均无心脏炎证据的风湿性儿童中二尖瓣和主动脉瓣反流的发生率。
对符合急性风湿热标准但无临床明显心脏炎的连续入院儿童以及既往风湿热发作后病情静止的患者进行非随机研究，采用彩色多普勒血流成像。使用两个独立的对照组比较超声心动图检查结果，并纳入一组确诊为风湿性心脏炎的患者以比较急性期和抗链球菌反应物。
卡塔尔唯一设有儿科住院部的综合医院。
1988年11月至1990年10月，11名儿童在急性风湿热期接受研究。另有7名儿童在记录到的急性风湿热发作且无心脏炎证据后18至36个月病情静止时接受研究。所有对照患者均在同一时期接受研究。
在疾病急性或静止期无风湿性心脏炎临床证据的患者中检测二尖瓣和主动脉瓣反流。
在急性风湿热期接受研究的11名儿童中，10名发现有二尖瓣或二尖瓣合并主动脉瓣反流。均无杂音或其他心脏炎证据。所有研究病例中瓣膜关闭不全均为轻度。在病情静止后期接受研究的4名儿童经彩色多普勒评估有主动脉瓣或二尖瓣关闭不全；2名既往有瓣膜关闭不全的儿童不再有此表现，1名在急性期无阳性发现的儿童仍无关闭不全。非风湿性对照受试者均未显示二尖瓣或主动脉瓣反流。
彩色多普勒血流成像在无法通过其他方法检测到心脏炎时，是识别风湿热各阶段亚临床二尖瓣和主动脉瓣疾病的有用方法，是对当前诊断标准的有价值补充。
