Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-24T06:45:18.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Follow-up of rheumatic carditis treated with steroids

Published online by Cambridge University Press:  21 October 2011

Gesmar V. H. Herdy ,
Rafael S. Gomes ,
Anna E. A. Silva ,
Leandro S. Silva  and
Vânia G. S. Lopes
Gesmar V. H. Herdy*
Affiliation:
Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil
Rafael S. Gomes
Affiliation:
Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil
Anna E. A. Silva
Affiliation:
Departamento de Cardiologia, Hospital Getulio Vargas Filho, Fundação Municipal de Saúde, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil
Leandro S. Silva
Affiliation:
Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil
Vânia G. S. Lopes
Affiliation:
Departamento de Patologia, Faculdade de Medicina da Universidade Federal Fluminense, Niterói, Brazil
*
Correspondence to: G. V. H. Herdy, Departamento de Pediatria da Faculdade de Medicina, Universidade Federal Fluminense, Travessa Antonio Pedro 10/301, Niteroi, Rio de Janeiro CEP-24230030, Brazil. Tel: +55 21 27106382; Fax: +55 21 27106382; +55 21 99421798; E-mail: gesmarhaddad@uol.com.br
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To present the long-term follow-up of children hospitalised for severe rheumatic carditis who were treated with corticosteroids.

Methods

This is a retrospective analysis of the outcome of 242 patients with severe rheumatic carditis after discharge from two public hospitals in Niteroi, Brazil. We followed up 118 patients for 4 years or more, with an average of 7.7 years. They were treated with antibiotics to accomplish bacterial eradication and either intravenous methylprednisolone – 40 cases – or oral prednisone – 78 patients – to treat carditis. They were followed up in outpatient clinic.

Results

Cardiac failure was categorised as classes III and IV according to the New York Heart Association classification. In the intravenous corticosteroid group, 21 cases (52.5%) had isolated mitral valve regurgitation, 12 (30%) had mitral plus aortic involvement, and seven (17.5%) had aortic lesion only. In the oral prednisone group, 45 (58%) had mitral valve regurgitation only, 27 (34%) had mitral plus aortic involvement, and six (8%) had aortic lesion only. A total of 28 children were in their first disease attack, of whom 19 (68%) had a rupture of chordae tendineae. A total of 58 patients (49%) sustained recurrence of carditis because of neglected secondary prophylaxis. In all, 19 cases (16%) underwent cardiac surgery – valve replacement or valvuloplasty. In 33% of the cases, the outcome was favourable – asymptomatic at follow-up. The overall mortality rate was 6.8%.

Conclusion

Many critically ill patients who complied with secondary prophylaxis were left with minor injuries, whereas those who neglected it or abandoned it had serious sequelae. The rate of abandonment and loss to follow-up was very high. Many cases (49%) were re-hospitalised because of carditis recurrence.

Keywords

Rheumatic feverchildrheumatic cardiac diseaseimmunosuppression therapy
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 3 , June 2012 , pp. 263 - 269
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Herdy, GVH. The challenge of secondary prophylaxis in rheumatic fever. Arq Bras Cardiol 1996; 67: 317.Google ScholarPubMed
2. Ministério da Saúde. Datasus. www.datasus.gov (accessed on 1 June, 2010).Google Scholar
3.Herdy, GVH, Pinto, CAM, Olivaes, AC, Herdy, AH, Carvalho, EA, Tchou, H. Rheumatic carditis treated with hig dosis of methylprednisolone (pulsotherapy). Results in 70 children over 12 years. Arq Bras Cardiol 1999; 72: 604–606.CrossRefGoogle Scholar
4.Commitee on rheumatic fever and bacterial endocarditis of American Heart Association. Jones criteria (revised) for guidance in the diagnosis and treatment of rheumatic fever. Circulation 1984; 69: 204A–208A.Google Scholar
5.Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosis of acute rheumatic fever: Jones criteria, 1992 update. JAMA 1992; 268: 2069–2073.CrossRefGoogle Scholar
6. American College of Cardiology Foundation, American Heart Association. Methodologies and policies from the ACCF/AHA task force on practice guidelines. Methodology Manual for ACCF/AHA Guideline Writing Committees. http://www.americanheart.org/presenter.jhtml?identifier=3039683 (accessed on 1 June, 2010).Google Scholar
7.World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO expert consultation on rheumatic fever and rheumatic heart disease. Geneva, WHO, 2004.Google Scholar
8.Sampaio, RO, Fae, KC, Demarchi, LMF, et al. Rheumatic heart disease: 15 years of clinical and immunological follow-up. Vasc Health Risk Manag 2007; 3: 1007–1017.Google ScholarPubMed
9.Araújo e Silva, AE. Perfil clínico de pacientes com cardiopatia reumática atendidos em hospital pediátrico da rede pública. Dissertação de Mestrado em Saúde da Criança e do Adolescente. UFF, Niteroi, 2006.Google Scholar
10.Herdy, GVH, Couto, AA, Fernandes, JCM, et al. Pulsoterapia (altas doses de metilprednisolona venosa) em crianças com cardite reumática. Estudo prospectivo de 40 episódios. Arq Bras Cardiol 1993; 60: 377–381.Google Scholar
11.Majeed, HA, Youseof, AM, Khuffash, FA, Yusuf, R, Fawana, S, Khan, N. The natural history of rheumatic fever in Kuwait: a prospective six year follow-up report. J Chronic Dis 1986; 39: 361–369.CrossRefGoogle ScholarPubMed
12.Pelajo, CF, Lopez-Benitez, JM, Torres, JM, Oliveira, SK. Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever. Pediatr Rheumatol Online 2010; 26: 8–22.Google Scholar
13.SBC. Diretrizes Brasileiras para o diagnóstico, tratamento e prevenção da Febre Reumática. Coord. Paulo José Bastos Barbosa e Regina Elizabeth Müller. Arq Bras Cardiol 2009; 93 Suppl 4: 1–18.Google Scholar
14.Velloso, LG, Mansur, AJ, Grinberg, M. Fatal active rheumatic disease. Study of 13 necropsy cases. Arq Bras Cardiol 1991; 56: 269–273.Google ScholarPubMed
15.Gerber, MA, Baltimore, RS, Eaton, CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis. A scientific statement from the AHA rheumatic fever, endocarditis and Kawasaki disease. Circulation 2009; 119: 1541–1551.CrossRefGoogle Scholar
16.Baltimore, RS. Re-evaluation of antibiotic treatment of streptococcal pharyngitis. Curr Opin Pediatr 2010; 22: 77–82.CrossRefGoogle ScholarPubMed
17.Dajani, A, Taubert, K, Ferrieri, P, Peter, G, Shulman, S. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics 1995; 96: 758–764.CrossRefGoogle ScholarPubMed
18.Steer, AC, Carapetis, JR. Acute rheumatic fever and rheumatic heart disease in indigenous populations. Ped Clin N Am 2009; 56: 1401–1419.CrossRefGoogle ScholarPubMed
19.Cillers, AM, Manyemba, J, Saloojee, H. Anti-inflammatory treatment for carditis in acute rheumatic in acute rheumatic fever. Cochrane Database Syst Rev 2003; 2: CD003176.Google Scholar
20.Cillers, AM. Rheumatic fever and its management. Br Med J 2006; 333: 1153–1156.CrossRefGoogle Scholar
21.Bittar, FF, Hayek, P, Obeid, M, Gharzeddine, W, Mikati, M, Dbaibo, GS. Rheumatic fever in children: a 15 year experience in a developing country. Pediatr Cardiol 2000; 21: 119–122.CrossRefGoogle Scholar
22.Guilherme, L, Fae, KC, Oshiro, SE, Kalil, J. Molecular pathogenesis of rheumatic fever and rheumatic heart disease. Expert Rev Mol Med 2006; 7: 1–15.CrossRefGoogle Scholar
23.Guilherme, L, Kalil, J. Rheumatic fever and rheumatic heart disease: cellular mechanisms leading autoimmune reactivity and disease. J Clin Immunol 2010; 30: 17–23.CrossRefGoogle ScholarPubMed
24.Rocha e Silva, A, Herdy, GVH, Vieira, AA, Simões, LC. Plastia mitral cirúrgica em crianças com febre reumática. Arq Bras Cardiol 2009; 92: 400–404.Google Scholar
25.Pomerantzeff, PMA, Brandão, CMA, Faber, CM, et al. Plástica da valva mitral: resultados após 17 anos de experiência. Rev Bras Cir Cardiovasc 1999; 14: 185–190.CrossRefGoogle Scholar
26.Gilinov, AM, Cosgrove, DM, Lytle, BW, et al. Reoperation for failure of mitral valve repair. J Thorac Cardiovasc Surg 1997; 113: 467–475.CrossRefGoogle Scholar
27.Travancas, PR, Dorigo, AH, Simôes, LC, Fonseca, SC, Block, KV, Herdy, GVH. Comparison of mechanical and biological prostheses when used to replace heart valves in children and adolescents with rheumatic fever. Cardiol Young 2009; 19: 192–197.CrossRefGoogle ScholarPubMed
28.Decourt, IV. Aspetos de la cardiopatia reumatica apreciados con biopsia de las orejelas. Prensa Med Arg 1966; 53: 320–327.Google Scholar
29.Edwards, WD, Peterson, K, Edwards, JE. Active valvulitis associated with chronic rheumatic valvular disease and active myocarditis. Circulation 1978; 57: 181–185.CrossRefGoogle ScholarPubMed
30.Hwang, WS, Lam, KL. Rupture of chordae tendineae during acute rheumatic carditis. Br Heart J 1968; 30: 429–431.CrossRefGoogle ScholarPubMed
31.Sauders, CA, Austen, WG, Harthorme, JK, et al. Diagnosis and surgical treatment of mitral regurgitation secondary to rupture of chordae tendineae. N Engl J Med 1967; 176: 943–949.CrossRefGoogle Scholar