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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: [email protected]
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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

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