Long-term Follow-up of Valvular Involvement in Children with Acute Rheumatic Fever Carditis: 15-year Results

Aim: Acute rheumatic fever (ARF) is a multisystemic inflammatory disease and remains an important health problem in low-and middle-income countries. The most important and potentially permanent adverse effect of the disease is cardiac involvement. This study aims to investigate the course of valvular lesions in ARF carditis and the factors that may affect their course during a long-term follow-up. Methods: In this cross-sectional study, which is a type of observational study, the records of children diagnosed with ARF in our hospital between August 2003 and December 2018 were retrospectively reviewed. Valvular insufficiency was examined on echocardiography and compared with the previous findings. The changes in the valvular lesions and the factors that could affect them were evaluated. The results were analyzed statistically. Results: The study included 90 patients with ARF who had been followed up for over a year. Of our patients, 37 (41%) were male and 53 (59%) were female. The mean age of our patients was 16.5±3.2 years. The mean age at diagnosis was 11 (4.2-18 years). The mean follow-up period was 67 (14-184) months. Carditis was present in 86 (95.6%) patients. Echocardiographically, mitral regurgitation (MR) was present in 83 (96.5%) patients and aortic regurgitation (AR) was present in 56 (65%) patients. 54 (62.7%) patients had both MR and AR. During the follow-up, MR persisted or progressed in 19 (22.9%) patients, regressed in 39 (47%) patients, and completely recovered in 25 (30.1%) patients. Aortic regurgitation persisted or progressed in 13 (23.2%) patients, regressed in 4 (7.1%) patients, and completely recovered in 39 (69.7%) patients. Conclusion: The recovery rate of aortic valve lesions was found to be much higher than that of mitral valve lesions. Initially, The high rate of mild involvement in aortic valve lesions maybe effective in this context. Apart from this, the valve lesion types that have a negative course and the factors affecting them still need to be studied further. Benzathine penicillin prophylaxis remains the most effective method of preventing recurrence.