Muhammad Younas, Ahsan Beg, Tauseef Asma, Sajid Mustafa.
Valvular lesions in children with rheumatic heart disease.
Pak Paed J Jan ;33(4):245-9.

Objectives: To determine frequency and type of valvular lesions in children below 12 years of age with Rheumatic Heart Disease. Design: Analysis of all children undergoing echocardiography for possible Rheumatic Heart Disease (RHD) in a single centre from October 2005 to December 2008. Setting: This study was conducted at Paediatric Cardiology Department, Ch. Pervaiz Elahi Institute of Cardiology Multan- Tertiary referral centre for paediatric and adult cardiac services in South Punjab. Material and Methods: The data on all children below 12 years of age undergoing detailed transthoracic two-dimensional echo and doppler studies was reviewed. Only new cases of RHD were studied for age of presentation, gender, type and severity of valvular lesions. The data was analyzed with SPSS 11 version. Results: Out of 3905 new echocardiograms during the study period, 455 (11.65 %) patients were diagnosed as RHD. Male to female ratio was equal (1.02:1). Mean age was 10 years (range: 4 -12). Mitral regurgitation (MR) was the predominant valvular lesion affecting 429 (94%) patients. Of these, 37 (08 %) had mild MR, 106 (23 %) had moderate MR, 129 (28.4%) had moderate to severe MR and 157 (34.5%) patients had severe MR. Aortic regurgitation (AR) was present in 272 (60%) patients and almost always (98%) in combination. Of those, 131 (29 %) had mild AR, 79 (17.4 %) had moderate AR, 40 (08.8%) had moderate to severe AR and 22 (05 %) patients had severe AR. Mitral stenosis (MS) was noted only in 68 (15%) patients, of which 11(2.4 %) had isolated MS and rest were in combination with MR or AR. Severe MS (isolated or combined) was observed in 40 patients (9 %). Out of combined lesions, MR+AR were found in 52 % cases, MS+AR in 9.2% and MR+ MS in 9.5 % of cases. Conclusion: The prevalence of RHD in a tertiary care cardiology referral center was 11.65% of all children under 12 years presenting for echocardiography. Most of the patients had more than one valves involved. The most common lesion was mitral regurgitation followed by aortic regurgitation. Mitral stenosis was present in 15% of the patients at such young age.

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