ABSTRACT
With the progress of Doppler echocardiography, many new findings have been accumulated concerning changes in valvular morphology and hemodynamics of rheumatic mitral valve disease. This study aimed to evaluate the ventricular function in children with rheumatic carditis, particularly in cases of silent carditis. The present study was carried out on thirty children suffering from rheumatic fever. Their ages ranged from 5-15 years [8.96 +/- 2.49]. They were 19 males and 11 females. They were selected from children who were admitted into Pediatric department and who were attending the Pediatric Cardiology Outpatient clinic of Tanta University Hospital during the period from September 1, 2000 to March 1, 2002. These children were classified into 2 groups based on the presence or absence of clinically heard organic murmurs. Group I included 20 children with clinical signs of carditis, evidenced by presence of organic murmurs, congestive heart failure, or pericarditis with or without other manifestations of rheumatic fever. Group II included 10 children with rheumatic fever but with no clinical signs of cardiac involvement [they were proved to have valvular lesions after examination by echocardiography, i.e., silent carditis. All children included in the present study were subjected to: 1] thorough histoiy taking and complete clinical examination with emphasis on cardiovascular system evaluation, 2] chest and heart X-ray, 3] routine laboratory investigations: ESR, ASOT, CRP, complete blood count, blood urea and serum creatinine, 4] determination of serum cardiac troponin-l [cTi] by sandwich immunoassay immediately at the time of diagnosis, 5] routine echo-Doppler evaluation, 6] Doppler tissue imaging [DTI] to evaluate ventricular diastolic function and compare it with transmitral flow pattern by conventional pulsed echo-Doppler. We concluded that children with rheumatic fever may present with carditis but with no clinically heard murmurs, i,e, silent carditis, and the use of echocardiography helps in detecting such cases. The use of DTI, a noninvasive technique, is considered as a great advance in evaluation of systolic and diastolic functions of the heart in children with rheumatic carditis to help planning for a perfect management of these children. It was also concluded that serum cTi, which is considered as a marker for myocardial cell injury significantly correlates with the degree of diastolic function [i.e., e/a ratio detected by DTI] of the left ventricle