Wilson N J, Neutze J M
Int J Cardiol. 1995 Jun 2;50(1):1-6. doi: 10.1016/0167-5273(95)02325-q.
The diagnosis of carditis in acute rheumatic fever traditionally depends on characteristic auscultatory findings. The advent of pulsed and colour Doppler echocardiography provides a method of detecting minor degrees of pathological regurgitation without characteristic clinical signs. Using strict criteria, pathological left heart regurgitation can be differentiated from physiological regurgitation: colour Doppler must show a substantial colour jet in two planes extending well beyond the valve leaflets; pulsed Doppler must confirm a high velocity signal, holosystolic for mitral regurgitation, or holodiastolic for aortic regurgitation. Several centres have observed subclinical carditis in children with acute rheumatic fever. We are confident that we are not overdiagnosing valvulitis, having tested this in a blinded fashion. Subclinical valvulitis should be accepted as evidence of carditis, a major diagnostic criterion for acute rheumatic fever.
传统上，急性风湿热中心脏炎的诊断依赖于特征性的听诊发现。脉冲和彩色多普勒超声心动图的出现提供了一种检测无特征性临床体征的轻度病理性反流的方法。使用严格的标准，病理性左心反流可与生理性反流相鉴别：彩色多普勒必须在两个平面上显示出明显超出瓣膜小叶的彩色血流束；脉冲多普勒必须确认有高速信号，二尖瓣反流为全收缩期，主动脉反流为全舒张期。几个中心已经观察到急性风湿热患儿存在亚临床心脏炎。我们通过盲法检测，确信没有过度诊断瓣膜炎症。亚临床瓣膜炎症应被视为心脏炎的证据，这是急性风湿热的一项主要诊断标准。
