Echocardiographic Screening of Rheumatic Heart Disease in American Samoa


While rheumatic heart disease (RHD) is a treatable disease nearly eradicated in the United States, it remains the most common form of acquired heart disease in the developing world. This study used echocardiographic screening to determine the prevalence of RHD in children in American Samoa. Screening took place at a subset of local schools. Private schools were recruited and public schools underwent cluster randomization based on population density. We collected survey information and performed a limited physical examination and echocardiogram using the World Heart Federation protocol for consented school children aged 5–18 years old. Of 2200 students from two private high schools and two public primary schools, 1058 subjects consented and were screened. Overall, 133 (12.9%) children were identified as having either definite (3.5%) or borderline (9.4%) RHD. Of the patients with definitive RHD, 28 subjects had abnormal mitral valves with pathologic regurgitation, three mitral stenosis, three abnormal aortic valves with pathologic regurgitation, and seven borderline mitral and aortic valve disease. Of the subjects with borderline disease, 77 had pathologic mitral regurgitation, 12 pathologic aortic regurgitation, and 7 at least two features of mitral valve disease without pathologic regurgitation or stenosis. Rheumatic heart disease remains a major cause of morbidity and mortality worldwide. The prevalence of RHD in American Samoa (12.9%) is to date the highest reported in the world literature. Echocardiographic screening of school children is feasible, while reliance on murmur and Jones criteria is not helpful in identifying children with RHD.

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Special thanks to Carrie Dishner, Heather Perry, Timothy Taber, Dawn Fleming, and Kim Lowman for their support in performing the echocardiographic studies, Reid Burch for data entry, and Dr. Beth Parker, Amber Rogers, Dr. Jim Marrone, Rachel Sunstrom, Lynn Johnson, Ashley Armsby, and Brandy Turnbull for their assistance during the clinical follow-up.

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Correspondence to Jennifer H. Huang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Huang, J.H., Favazza, M., Legg, A. et al. Echocardiographic Screening of Rheumatic Heart Disease in American Samoa. Pediatr Cardiol 39, 38–44 (2018).

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  • Rheumatic heart disease
  • Pediatric cardiology
  • Echocardiography
  • Global health
  • Streptococcus