Skip to main content
SpringerLink
Log in

Reversibility of mitral regurgitation following rheumatic fever: Clinical profile and echocardiographic evaluation

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The clinical disappearance of the murmur of rheumatic mitral regurgitation after period of time has been documented by many researchers. However no studies have related the disappearance of the murmur with the functional or anatomical state of the mitral valve. This study was done to elucidate the mitral valve status using doppler and color coded echocardiography among those children who have lost their apical pansystolic murmur on auscultation following a documented attack of rheumatic fever. The study sample consisted of 51 patients including 31 patients in whom the murmur has disappeared (group I), and 20 patients with persistent isolated mitral regurgitation (group II). Patients of group I had significantly lower grades of murmur intensity, lower incidence of cardiomegaly, and had no heart failure in the initial attack. They were more compliant with prophylaxis and had less recurrences than patients of group II. The murmur disappeared in patients of group I from 1/2 to 14 years after the initial attack. Echocardiography revealed that such patients had a normal mitral valve apparatus, and a normal heart size and function. Only 5 patients of this group had a significant regurgitant jet demonstrated by colour doppler. We concluded that recovery of the mitral valve and return of cardiac functions to normal is possible in patients who had mitral regurgitation following rheumatic fever. Some of them may still have an inaudible mild regurgitation. Patients who have lost their murmur may be allowed to exorcise freely, yet penicillin prophylaxis should not be discontinued.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Selzer A, Katayoma F. Mitral regurgitation: Clinical patterns, pathophysiology and natural history.Medicine 1972; 51: 337–366.

    Article  PubMed  CAS  Google Scholar 

  2. Markowitz M. Rheumatic fever. In: Behrman RE, Vaughan VC, Nelson WE. eds.Nelson Textbook of Pediatrics 13th ed. Philadelphia: WB Saunders Company 1987: 540.

    Google Scholar 

  3. Bland EF, Jones TD. Rheumatic fever and rheumatic heart disease. A twenty year report on 1000 patients followed since childhood.Circulation 1951; 4: 826.

    Google Scholar 

  4. Wilson MG, Lim WN. Natural history of rheumatic heart disease in third, fourth and fifth decades of life. I Prognosis with special reference to survivorship.Circulation 1957; 16: 700.

    PubMed  CAS  Google Scholar 

  5. Braunwald E. Mitral regurgitation: Physiologic, clinical and surgical considerations.N Engl J Med 1969; 281: 425.

    Article  PubMed  CAS  Google Scholar 

  6. Tompkins DG, Boxerbaum B, Liebman J. Long term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin.Circulation 1972; 45: 542.

    Google Scholar 

  7. Sanyal SK, Berry AM, Duggol S, Hooja V, Ghosh S. Sequelae of initial attack of acute rheumatic fever in children from north India.Circulation 1982; 65 (2): 375.

    PubMed  CAS  Google Scholar 

  8. Kitada M, Uheda K, Nakagawa R, Yamaguchi Y. Follow-up study of acquired valvular heart disease.Japanes Circulation J 1986; 50: 1298.

    CAS  Google Scholar 

  9. Aravains C. Silent mitral insufficiency.Am Heart J 1965; 70 (5): 620.

    Article  Google Scholar 

  10. Elkin M, Sosman MC, Harben ED, Dexter L. Systolic expansion of left auricle in mitral regurgitation.N Engl J Med 1952; 246: 958.

    Article  PubMed  CAS  Google Scholar 

  11. Committee to revise the Jones Criteria of the council on rheumatic fever and congenital heart disease of the American Heart Association. Jones (Criteria (Revised) for guidance in the diagnosis of rheumatic fever.Circulation 1965; 32: 664–666.

    Google Scholar 

  12. Sahn DJ, Demaria A, Kisslo J, Weyman A. Recommendations regarding quantification in M-mode echocardiography: rsults of a survey of echocardiographic measurements.Circulation 1978; 58: 1072–83.

    PubMed  CAS  Google Scholar 

  13. Feigenbaum H. Echocardiography. 5th ed. Philadelphia, Baltimore, London, sydney, Tokyo: Lea and Febiger, 1994.

    Google Scholar 

  14. Gutgesell HP, Paquet M, Duff DF, McNamara DG. Evaluation of left ventricular size and function by echocardiography: results in normal children.Circulation 1977; 56: 457–62.

    PubMed  CAS  Google Scholar 

  15. Wann L, Feigenbaum H, Weyman AE, Dillon JC. Cross sectional echocardiographic detection of rheumatic mitral regurgitation.Am J Cardiol 1978; 41: 1258.

    Article  PubMed  CAS  Google Scholar 

  16. Kostucki W, Vandenbossche JL. Pulsed doppler regurgitant flow patterns of normal valves.Am J Cardiol 1986; 58: 309.

    Article  PubMed  CAS  Google Scholar 

  17. Helmcke F, Nanda N, Hsiung M, Soto B, Adey C, Goyal R, Gatewood R. Color Doppler assessment of mitral regurgitation with orthogonal planes.Circulation 1987; 75: 175–183.

    PubMed  CAS  Google Scholar 

  18. Czer LSC, Maurer G, Trento A et al. Comparative efficacy of ring and suture annuloplasty for ischemic mitral regurgitation.Circulation 1992; 86 (II): 46–52.

    Google Scholar 

  19. Massel BF, Thaveri S, Czoniczer G. Therapy and other factors influencing the course of rheumatic heart disease.Circulation 1959; 20: 737.

    Google Scholar 

  20. Kassem AS, Badrel Din MK, Abdel Moneim MA et al. Pattern of rheumatic fever in Alexandria within 10 years follow-up of the valvular lesions. The Gazette of the Egyptian Pediatric Association 1982; 30 (3): 69–78.

    Google Scholar 

  21. Kassem AS, El-Azzouni OF, Zaher SR, FArghal S. Evaluation of rheumatic fever in Egyptian children: A fifteen years follow up study. The Egyptian Heart Journal 1995; In press.

  22. UK and USA Joint report on Rheumatic heart disease: the natural history of rheumatic fever and rheumatic heart disease: ten-year report of a cooperative clinical trial of ACTH, cortisone and aspirinCirculation 1965; 32: 457.

    Google Scholar 

  23. Feinstein AR, Wood HF, Spanguolo M, Tarant A. Rheumatic fever in children and adolescents: a long term epidemiology study of subsequent prophylaxis, streptococcal infections and clinical sequelae. VII: Cardiac changes and sequelae.Ann Inter Med 1964; 60 (suppl 5): 87.

    Google Scholar 

  24. El-Khy A et al. The clinical pattern of rheumatic fever in an Egyptian community. In: Haverkorn MJ, ed. Proceedings of the Fifth International Symposium in Streptococcus Pyogenes. Amsterdam:Excerpta Medica, 1972; 329–333.

    Google Scholar 

  25. Kassem AS, adkour AA, Massound BZ, Zaher SR. Benzathine penicillin G for rheumatic fever propylaxis: 2-weekly versus 4-weekly regimens.Indian J Pediatr 1992; 59: 741–748.

    PubMed  CAS  Google Scholar 

  26. Anderson WAD, Scotti TM, eds. Synopsis of pathology. St Lowis, Toronto, London: The CV Mosby Company, 1980; 13: 279.

    Google Scholar 

  27. Levy MJ, Edwards JE. Anatomy of mitral insufficiency.Prog Cardiovasc Dis 1962; 5: 119.

    PubMed  CAS  Google Scholar 

  28. Edwards JE, Bruchell HB. Pathologic anatomy of mitral insufficiency.Proc Mayo Clin 1958; 33: 497.

    CAS  Google Scholar 

  29. Bentivoglio L, Urichio J, Goldberg H. Clinical and hemodynamic features of advanced rheumatic mitral reguargitation.Am J Med 1961; 30: 372.

    Article  Google Scholar 

  30. Steinfeld I, Ritter S, Rappaport II, Martinez E. Silent rheumatic mitral regurgitation unmarsked by Doppler studies.Circulation 1986; 74: 385.

    Google Scholar 

  31. Veasy LG. Resurgence of acute rheumatic fever in the inter-mountain area of the United States.N Engl J Med 1987; 319: 421–7.

    Article  Google Scholar 

  32. Rahko PS. Prevalnce of regurgitant murmurs in patients with valvular regurgitation detected by Doppler echocardiography.Ann Inter Med 1989; 111: 466–472.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics and Cardiology Unit Faculty of Medicine, University of Alexandria, Egypt

    Ahmed S. Kassem, Tarek M. El-Walili, Salah R. Zaher & Mohammad Ayman

Authors
  1. Ahmed S. Kassem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarek M. El-Walili
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Salah R. Zaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Ayman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kassem, A.S., El-Walili, T.M., Zaher, S.R. et al. Reversibility of mitral regurgitation following rheumatic fever: Clinical profile and echocardiographic evaluation. Indian J Pediatr 62, 717–723 (1995). https://doi.org/10.1007/BF02825126

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02825126

Key words

Search

Navigation