بررسی 290 کودک مبتلا به بیماری دریچه‌ای قلبی روماتیسمی

    Background & Aim: Acute rheumatic fever and its cardiac involvement is one of the most prevalent acquired pediatric heart diseases in developing countries needing long hospitalization, cardiac surgery, prophylaxis, and delicate management and causing death in some cases. A paucity of information about this disease in our country made us perform the present study in one of the largest pediatric cardiac centers of Iran. Patients & Method: 290 pediatric rheumatic cases with cardiac involvement admitted from April 1985 until March 1999(15 years) were assessed in terms of the age of first involvement and admission, sex, valvar involvement, type of surgery, recurrence of infectious endocarditis, and mortality. Results: There was no sexual predominance(51% male versus 49% female). The age of first involvement ranged from 4 to 16 years with the mean of 9.7. 65% of cases showed their first involvement between the ages of 7 and 12. The age of admission ranged from 4 to 18 years with the mean of 11.1. 80% of cases were admitted over the age of 11. cardiac valvar involvement was diagnosed by physical exam, electrocardiogram, chest x-ray, and echocardiography. Angiography was done for most patients. The results indicated isolated mitral disease in 49%, combined aortic and mitral involvement in 39.5%, isolated aortic involvement in 3.5%, and the involvement of 3-4 valves in 7% of the patients. In other words, mitral valve was involved in 90% and aortic valve in 44% of the patients(isolated or combined). Of 190 patients who underwent valvar surgery, 96(51%) had operation on mitral valve, 83(43.5%) on mitral and aortic valves, and 10(5.2%) on aortic valve. Recurrence of rheumatic fever occurred in 42 cases(14%), infectious endocarditis in 16(5.5%), and mortality in 4(1.3%). Conclusion: Afflicting girls and boys equally, rheumatic heart disease is most commonly found among children of school age. 65% of the studied patients underwent surgery and often needed valve replacement. Therefore, it is recommended that special attention be paid to diagnosis and early treatment of streptococcal infection so that its grievous complications will be avoided.