Two Years of Follow-Up Validates the Echocardiographic Criteria for the Diagnosis and Screening of Rheumatic Heart Disease in Asymptomatic Populations

Abstract

Out of 1,059 school children aged 6-15 years, screened 2 years ago, 54 children were diagnosed with rheumatic heart disease (RHD) and put on penicillin prophylaxis. Significant regurgitation of mitral valves was detected in 39 cases of echocardiography diagnosed RHD, and in 15 cases significant regurgitation was detected to coexist with valve deformities. Three children had isolated mitral valve thickening without regurgitation. They were not given penicillin prophylaxis. These cases were followed up for 2 years. After 2 years, 54 children diagnosed with RHD and three children with isolated mitral valve thickening, were evaluated again. Lot quality assurance sampling was employed to screen a selected group of school children declared normal during the earlier evaluation. Lot was to be rejected, if, one child with significant regurgitation of mitral valve was found among the first 10 screened children of each of the 10 lots. No lot was rejected and thus it was inferred that the prevalence of new onset RHD was negligible in the subset declared normal 2 years ago. Isolated significant mitral regurgitation disappeared more often when present (35.9%) in comparison to when it (26.7%) was originally found coexistent with valve deformities. Highlight of the study is the greater reversibility of earlier lesions as compared to the later stages of RHD. Spontaneous regression of isolated mitral valve thickening in two-thirds of the cases even without antibiotic prophylaxis, undermines the value of morphological criteria for the diagnosis of RHD.