Objective- to investigate the mortality and morbidity of children and adolescents with rheumatic heart disease (RHD) in a tertiary center in Rio de Janeiro
Methods – observational study of an hospital based population. Medical file of 3 to18y old patients with RHD, followed-up for at least 2 years from 1988-2007 were reviewed. RHD diagnosis- revised Jones criteria for rheumatic fever and/or Doppler-echocardiography chronic mitral/aortic lesions. Statistic analysis considered significant alpha=0.05.
Results – n-139, 52,5% female, median age at beginning follow-up-11 y , FC II-IV (NYHA) 47,4%. Clinical presentation: 45,3% first attack; 14,4% recurrence; 40,3% chronic. Median age of chronic/ recurrent was superior to first attack patients (p-0,0001). Mean follow-up time 9.9 years (2-21y).
Main valve lesions: mitral regurgitation 82,7%, aortic regurgitation 55,9%. Secondary prophylaxis:10,8% irregular;15,1% no prophylaxis. Recurrence rate 32,3%, higher in patients under irregular/no prophylaxis (p-0,0009).
Mortality rate-4,3%, all had prosthesis. Lost of follow-up 14%.
Interventional procedure 45,3%: balloon mitral valvuloplasty 3%; surgery 42,4%. Main procedures: mitral mechanical prosthesis 31,3%; aortic mechanical prosthesis 20,9%; mitral repair 18,6%; tricuspid annuloplasty 15%. Reoperation: 2nd surgery 8,6%; 3rd surgery 2,8%. Infectious endocarditis 8,6%; prosthesis endocarditis 3,6% - letality rate 25%. Another causes of death: biological prosthesis stenosis (n=1); mechanical prosthesis stenosis (n=1), biological prosthesis thrombosis (n=1).
Conclusions – RHD remains prevalent in Brazil with high morbidity/mortality, often demanding orovalvar surgery. Secondary prophylaxis compliance is a challenge in industrializing countries. Regular benzathine penicillin administration should be recommended until adult life. National RHD programmes are needed for control of this disease in Brazil.