Huang Jennifer H, Favazza Michael, Legg Arthur, Holmes Kathryn W, Armsby Laurie, Eliapo-Unutoa Ipuniuesea, Pilgrim Thomas, Madriago Erin J
Division of Pediatric Cardiology, Oregon Health and Science University, CDRC-P, 707 SW Gaines St., Portland, OR, 97239, USA.
Department of Pediatrics, Lyndon B. Johnson Tropical Medicine Health Center, PO Box LBJ, Pago Pago, 96799, American Samoa.
Pediatr Cardiol. 2018 Jan;39(1):38-44. doi: 10.1007/s00246-017-1724-4. Epub 2017 Sep 20.
While rheumatic heart disease (RHD) is a treatable disease nearly eradicated in the United States, it remains the most common form of acquired heart disease in the developing world. This study used echocardiographic screening to determine the prevalence of RHD in children in American Samoa. Screening took place at a subset of local schools. Private schools were recruited and public schools underwent cluster randomization based on population density. We collected survey information and performed a limited physical examination and echocardiogram using the World Heart Federation protocol for consented school children aged 5-18 years old. Of 2200 students from two private high schools and two public primary schools, 1058 subjects consented and were screened. Overall, 133 (12.9%) children were identified as having either definite (3.5%) or borderline (9.4%) RHD. Of the patients with definitive RHD, 28 subjects had abnormal mitral valves with pathologic regurgitation, three mitral stenosis, three abnormal aortic valves with pathologic regurgitation, and seven borderline mitral and aortic valve disease. Of the subjects with borderline disease, 77 had pathologic mitral regurgitation, 12 pathologic aortic regurgitation, and 7 at least two features of mitral valve disease without pathologic regurgitation or stenosis. Rheumatic heart disease remains a major cause of morbidity and mortality worldwide. The prevalence of RHD in American Samoa (12.9%) is to date the highest reported in the world literature. Echocardiographic screening of school children is feasible, while reliance on murmur and Jones criteria is not helpful in identifying children with RHD.
虽然风湿性心脏病（RHD）在美国是一种几乎已被根除的可治疗疾病，但在发展中世界，它仍是后天性心脏病最常见的形式。本研究采用超声心动图筛查来确定美属萨摩亚儿童中RHD的患病率。筛查在当地部分学校进行。私立学校被招募，公立学校则根据人口密度进行整群随机分组。我们收集了调查信息，并按照世界心脏联盟的方案，对5至18岁同意参与的在校儿童进行了有限的体格检查和超声心动图检查。在来自两所私立高中和两所公立小学的2200名学生中，1058名受试者同意并接受了筛查。总体而言，133名（12.9%）儿童被确定患有明确的（3.5%）或临界的（9.4%）RHD。在确诊为RHD的患者中，28名受试者二尖瓣异常伴病理性反流，3名二尖瓣狭窄，3名主动脉瓣异常伴病理性反流，7名临界二尖瓣和主动脉瓣疾病。在患有临界疾病的受试者中，77名有二尖瓣病理性反流，12名有主动脉瓣病理性反流，7名至少有二尖瓣疾病的两个特征但无病理性反流或狭窄。风湿性心脏病仍然是全球发病和死亡的主要原因。美属萨摩亚RHD的患病率（12.9%）是迄今为止世界文献报道中最高的。对在校儿童进行超声心动图筛查是可行的，而依靠杂音和琼斯标准对识别患有RHD的儿童并无帮助。
