Objectives- To analyse the pattern of clinical presentation and evolution of valvar lesions.

Methods- This study investigated 1066 acute episodes of rheumatic fever and 585 episodes of carditis were seen in 489 patients, followed-up from 1.3 to 16.9 years (mean=6.8±2.6years), resulting in 3325 patients-year (1977-2000). The following variables were analysed: frequency, type, association, degree of involution of valvar lesions, recurrences, and response to anti-inflammatory medication. To compare recurrences and progress of valvar disease the Fisher and the Qui-Square Tests were used, α<0,05.

Results- The mean age at the first episode was 9.1±4.1 years. Regurgitation valvar lesions were observed in 72.9% and mixed lesions in 27.1% (MR=44.2%, MR+AR=65.0%; MR+MS=8.8%; MR+MS+AR=6.1%). Carditis was classified as severe in 39.8%, moderate in 28.6%, and mild in 31.6% Severe carditis was more prevalent in children with two or more recurrences, and valvar sequels more significant in those with severe carditis (p<0,0001). The period of improvement using prednisone ranged from 2.0 to 42.0 days (mean=14.0; mode=14.2. Total regression in valvar lesions was seen in 34.4% of the patients, mostly mild ones and without recurrences. The pattern/ frequency/association of the valvar lesions remained unchanged after the control of recurrences following the implementation of the Prophylactic Programme; however, significant reductions were observed in the occurrence of severe carditis, surgery and death (p<0.001) .

Conclusions- Cardiac involvement was frequent and the sequels influenced by the severity of the carditis and by the number recurrences, reinforcing the need for effective strategies of secondary prophylaxis to reduce morbimortality.