Table 1
2012 WHF criteria for echocardiographic diagnosis of RHD for individuals aged ≤ 20 years.
| Definite RHD (either A, B, C, or D) |
|
| Borderline RHD (either A, B, or C) |
|
| Normal echocardiographic findings (all of A, B, C, and D) |
|
[i] *Congenital MV anomalies must be excluded. Furthermore, inflow obstruction due to nonrheumatic mitral annular calcification must be excluded in adults. ‡Bicuspid AV, dilated aortic root, and hypertension must be excluded. §Combined AR and MR in high prevalence regions and in the absence of congenital heart disease is regarded as rheumatic. Abbreviations: AR, aortic regurgitation; AV, aortic valve; MR, mitral regurgitation; MS, mitral stenosis; MV, mitral valve; RHD, rheumatic heart disease; WHF, World Heart Federation.
Table 2
Valve severity based on American College of Cardiology/American Heart Association recommendations.
| ECHOCARDIOGRAPHIC PARAMETERS | MITRAL REGURGITATION | ||
|---|---|---|---|
| MILD | MODERATE | SEVERE | |
| Color Doppler jet area | Small central jet area <20% LA1 area | Central jet MR 20%–40% LA or late systolic eccentric jet MR | Central jet MR2 > 40% LA or holosystolic eccentric jet MR |
| Vena contracta width (cm) | Small vena contracta <0.3 cm | 0.3–0.6 cm | ≥0.7 cm |
| Regurgitant volume | Less than 30 ml | 30–59 mL | ≥60 mL |
| Regurgitant fraction | Less than 30% | <50% | ≥50% |
| AORTIC REGURGITATION | |||
| MILD | MODERATE | SEVERE | |
| Jet width | <25% of LVOT3 | 25%-64% of LVOT | ≥65% of LVOT |
| Vena contracta | <0.3 cm | 0.3–0.6 cm | ≥0.7 cm |
| Regurgitant volume | Less than 30 ml | 30–59 mL | ≥60 mL |
| Regurgitant fraction | Less than 30% | <50% | ≥50% |
[i] 1LA, Left atrium.
2MR, Mitral regurgitation.
3LVOT, Left ventricular outflow tract.
Table 3
Baseline characteristics of 155 children with RHD.
| CHARACTERISTICS | SUBJECTS (n = 155) |
|---|---|
| Age in years, mean (SD) | 11.9 (2.9) |
| Sex, n (%) | |
| 90 (58.1) |
| 65 (41.9) |
| Complications, n (%) | |
| 2 (1.3) |
| 4 (2.6) |
| 27 (17.4) |
| 11 (7.1) |
| 2 (1,3) |
| 1 (0.6) |
| 38 (24.5) |
| NYHA functional class at initial presentation, n (%) | |
| 29 (18.7) |
| 40 (25.8) |
| 64 (41.2) |
| 22 (14.2) |
| Echocardiography parameter: | |
| 51.2 (32.5–85.0) |
| 64.4 (15.0–82.0) |
| |
| Severe | 96 (61.1) |
| Moderate | 34 (22.1) |
| Mild | 25 (16.8) |
[i] AV, atrioventricular.
LVIDd, Left Ventricular Internal Diameter end distole;
EF, Ejection Fraction.
NYHA, New York Heart Association.
Table 4
Cause of deaths and comorbidities of patients with RHD.
| CAUSE OF DEATH | n (%) |
|---|---|
| Intracranial hemorrhage | 1 (0.6) |
| Cardiogenic shock | 12 (7.7) |
| Pulmonary hypertension crisis | 1 (0.6) |
| COMORBIDITY | n (%) |
| Endocarditis | 1 (0.6) |
| Thyroid malignancy | 1 (0.6) |
| Pneumonia | 4 (2.4) |
| Scabies | 1 (0.6) |
| Total atrioventricular block | 1 (0.6) |
Figure 1
Study flow chart and follow up.
Table 5
Characteristics of valves lesions in children with RHD (n = 155).
| VALVES LESIONS | n (%) |
|---|---|
| a. Single valve lesion | |
| Mitral valve: | |
| 41 (27.5) |
| 0 (0.0) |
| Aortic valve | |
| 3 (2.0) |
| 0 (0.0) |
| 0 (0.0) |
| b. Multiple valve lesions | |
| 41 (26.5) |
| 20 (12.9) |
| 2 (1.4) |
| 1 (0.7) |
| 3 (2.0) |
| 21 (13.5) |
| 8 (5.4) |
| 1 (0.7) |
| 14 (9.0) |
[i] Notes:
aMR, Mitral Regurgitation; bMS, Mitral Stenosis; cAR, Aortic Regurgitation; dAS, Aortic Stenosis; eTR, Tricuspid Regurgitation; fPR, Pulmonal Regurgitation.
Figure 2
Survival analysis of children with RHD.
Figure 3
Kaplan-Meier curve stratified by valve severity.
Figure 4
Kaplan-Meier curve stratified by NYHA functional class at first diagnosis.
Table 6
Predictors of mortality in children with RHD with Cox Proportional Hazard Model.
| PREDICTORS | DIED (n = 14) | ALIVE (n = 141) | UNADJUSTED HAZARD RATIO (CI 95%) | p | ADJUSTED HAZARD RATIO (CI 95%) | p |
|---|---|---|---|---|---|---|
| Age in years, mean (SD) | 12.8 (2.8) | 11.8 (2.9) | 1.2 (0.9–1.5) | 0.06 | ||
| Severe malnutrition, n (%) | 8 (57.1) | 13 (9.2) | 7.3 (2.5–21.5) | <0.0001 | 1.6 (0.2–14.1) | 0.95 |
| Atrial fibrillation, n (%) | 3 (21.4) | 1 (0.7) | 1.4 (0.8–22.3) | 0.07 | ||
| Congestive heart failure, n (%) | 10 (71.4) | 16 (11.3) | 11.5 (3.6–36.7) | <0.0001 | 8.9 (0.7–118.8) | 0.09 |
| Pulmonary hypertension, n (%) | 11 (78.6) | 28 (19.9) | 10.1 (2.8–36.3) | <0.0001 | 0.9 (0.1–9.7) | 0.98 |
| Poor adherence to penicillin prophylaxis | 8 (88.9) | 40 (28.6) | 34.6 (4.3–282.8) | <0.0001 | 14.3 (1.3–156.6) | 0.02 |
| EF < 55%, n (%) | 4 (28.6) | 16 (11.3) | 2.9 (0.8–9.4) | 0.07 | ||
| Z-scores LVIDd, mean (SD) | 3.2 (2.1) | 1.6 (1.9) | 1.5 (1.1–2.1) | 0.02 | 1.1 (0.6–2.3) | 0.71 |
[i] Severe malnutrition, Body mass index-per-age ≤ –3SD based on WHO 2006 growth chart.
‘Non-adherent’ or ‘poor adherent’ referred to the consumptions of oral penicillin were less than 80% of described doses based on patients’ self-reports for 12 months.
LVIDd, Left Ventricular Internal Diameter end distole body surface area-adjusted z-scores
EF, Ejection Fraction