Objective: The incremental value of echocardiography with Doppler (echo) in diagnosing acute rheumatic carditis (ARC) has been highlighted in several reports, but it is still not included in Jones criteria. We studied the role of echo in 175 children < 12 years of age with ARC.
Methods: Hospital records of consecutive children diagnosed as rheumatic heart disease (RHD) over the last 5 years at this government funded, tertiary care centre were reviewed for clinical, laboratory and echo data.
Results: A total of 500 children had RHD. 197 had ARC (39.4%), 175 of these had echo and form the basis of this report. Their age ranged from 2 to 12 years (mean 9.7 ± 2 years), 112 were males. 71 were in NYHA class III or IV and 14 were in heart failure. Mitral regurgitation (MR) was present in 161, significant in 87. Based on the modified Jones criteria, a diagnosis of ARC could be made in 152/175 cases (87%). In addition to MR/AR, echo revealed multiple small nodules on mitral valve leaflets in 43 (24.5%), including 6/23 suspected ARC cases. Mild pericardial effusion was seen in 13 (7%), including 4/23 suspected ARC cases. These two findings were not observed in the inactive group of 249 children who underwent echo.
Conclusion: Our data shows that echo is required in a minority of patients to diagnose carditis in communities with high prevalence of RHD. In addition to MR/AR, small nodules on the mitral valve and pericardial effusion are helpful pointers to carditis.