Subclinical carditis in pure Sydenham's chorea: a color doppler study

Sydenham's chorea [SC] is a late manifestation of rheumatic fever [RF] and its presence alone warrants the diagnosis of RF. Although SC seems to be a benign condition, 27% of patients who present with "pure chorea" to develop most likely rheumatic valvular disease within thirty years of the initial attack. To study the cardiac involvement in chorea patients without clinical signs of carditis the following investigation was carried out: Seventeen patients with chorea aged 7-15 years [mean +/- SD: 11.3 +/- 1.9] and 17 neurologic patients together with 28 normal children were surveyed with color flow imaging [CFI]. All chorea patients had left sided valvular regurgitation, whereas only one in each control group had the same finding, [p< 0.001]. We conclude that many, if not all, of the Sydenham's chorea patients have subclinical carditis. Doppler study is a valuable tool for detection of cardiac involvement. This underlines the rationale for patients with SC and "normal" heart to be placed on chemoprophylaxis, despite the absence of auscultatory findings on physical examination. To further evaluate these findings a larger group of children should be studied

Prevalence of Valvular regurgitation in normal children: a 2-dimensional and color doppler echocardiographic study

Doppler echocardiography in normal children by two-dimensional echocardiography [2D echo], shows some abnormal findings. Two hundred and eighteen normal children 1-15 years old with a mean +/- SD of 8.9 +/- 3.4 with normal 2D echo were examined by pulsed continuous and color Doppler echocardiography [152 children with conventional and 66 with color Doppler echocardiography]. Valvular regurgitation was detected in 82 children [37.1%]. Tricuspid regurgitation was the most commonly detected abnormality [22.4%]. Left-sided valvular regurgitation was rare [2.3%]. Color flow imaging [CFI] revealed higher prevalence [51.5%], and specificity [p < 0.005]. This study showed a high prevalence of right-sided valvular regurgitation. There was no significant age and sex difference between groups, and CFI was more sensitive

Rheumatic valvulitis without auscultatory findings: doppler echocardiography study

In order to evaluate the value of pulsed Doppler echocardiography in acute rheumatic fever valvulitis with negative auscultatory findings, we studied 25 patients prospectively in a 2 year period. Eighteen patients [72%] had significant Doppler findings at a single or more valves. In a period of one to three months, 50% of the patients had no more significant flow by Doppler studies and no change in findings on the third follow-up performed 18 months after second evaluation in 24% of the patients. It is concluded that valvular regurgitation as detected by Doppler in patients with ART and negative auscultatory findings can be used as evidence of valvulitis during the acute phase of the disease. It may also help to monitor the treatment and follow-up of such cases