Reversibility of mitral regurgitation following rheumatic fever: clinical profile and echocardiographic evaluation

ABSTRACT

The clinical disappearance of the murmur of rheumatic mitral regurgitation after a period of time has been documented by many researchers. However no studies have related the disappearance of the murmur with the functional or anatomical state of the mitral valve. This study was done to elucidate the mitral valve status using Doppler and color coded echocardiography among those children who have lost their apical pansystolic murmur on auscultation following.a documented attack of rheumatic fever. The study sample consisted of 51 patients including 31 patients in whom the murmur has disappeared [group I], and 20.patients with persistent isolated isolated mitral regurgitation [group II]. Patients of group I had significantly lower grades of murmur intensity, lower incidence of cardiomegaly, and had no heart failure in the initial attack. They were compliant with prophylaxis and had less recurrences than patients of group II. The murmur disappeared in patients of group I from ' to 14 years after the initial attack. Echocardiography revealed that such patients had a normal mitral valve apparatus, and a normal heart size and function. Only5patients of this group had a significant regurgitant jet demonstrated by colour Doppler. We conclude that recovery of the mitral valve and return of cardiac functions to normal is possible in patients inaudible mild regurgitation. Patients who have lost their murmur maybe allowed to exercise freely, yet penicillin prophylaxix should not be discontinued