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LETTER TO EDITOR
Year : 2002  |  Volume : 48  |  Issue : 3  |  Page : 238

Congenital heart disease with rheumatic fever and rheumatic heart disease: a coincidence or an association?




Correspondence Address:
S S Bokhandi


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Source of Support: None, Conflict of Interest: None


PMID: 12432207

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Keywords: Age Distribution, Child, Child, Preschool, Comorbidity, Heart Defects, Congenital, diagnosis,epidemiology,surgery,Human, India, epidemiology,Infant, Male, Prevalence, Prognosis, Retrospective Studies, Rheumatic Fever, diagnosis,epidemiology,Rheumatic Heart Disease, diagnosis,epidemiology,surgery,Risk Assessment, Sampling Studies,


How to cite this article:
Bokhandi S S, Tullu M S, Shaharao V B, Bavdekar S B, Kamat J R. Congenital heart disease with rheumatic fever and rheumatic heart disease: a coincidence or an association?. J Postgrad Med 2002;48:238

How to cite this URL:
Bokhandi S S, Tullu M S, Shaharao V B, Bavdekar S B, Kamat J R. Congenital heart disease with rheumatic fever and rheumatic heart disease: a coincidence or an association?. J Postgrad Med [serial online] 2002 [cited 2019 Aug 23];48:238. Available from: http://www.jpgmonline.com/text.asp?2002/48/3/238/94


Sir,

The incidence of congenital heart disease (CHD) is about 8 per 1000 live births.[1] The prevalence of rheumatic heart disease (RHD) in school-aged children is estimated to be in the range of 2-11 per 1000.[2],[3] Hence, the occurrence of both these conditions in the same patient can be considered to be uncommon. We carried out a retrospective study in a tertiary referral centre with an aim to analyse the co-existence of CHD and Rheumatic fever (RF)/ RHD.

The case sheets of 285 consecutive patients admitted with a diagnosis of CHD or RF/ RHD in the one-year period beginning December 2000 were analysed. The Revised Jones Criteria were used for the diagnosis of RF.[2] Five boys aged 8-12 years were diagnosed to have CHD as well as RF/ RHD in this population [Table]. The diagnosis of CHD was made prior to the rheumatic affection in two patients while these disorders were simultaneously diagnosed in the remaining three patients.

The occurrence of CHD is related to events occurring in the embryonal stage while RHD occurs as result of immune-mediated damage following infection with streptococci. We came across 5 (1.8%) children among 285 children with congenital or acquired heart disease who happened to have both types of lesions. Thakur et al[4] have reported this phenomenon amongst school children of Shimla hills. They found that the prevalence of RF/ RHD was significantly higher in children with CHD (8.8%) as compared to those without CHD (0.3%).

It is not possible to determine whether the presence of CHD with RHD is a mere coincidence or whether the presence of CHD actually predisposes to RHD. Thakur et al[4] believe that the presence of CHD predisposes the child to the occurrence of RF/ RHD. These findings imply that the physician should always undertake Colour Doppler study to make sure that additional lesions are not present once CHD or RF/ RHD has been diagnosed clinically. This will allow simultaneous correction of both the lesions during a single surgical intervention.[5] In fact, Thakur et al have gone further and advised special care and regular follow- up of patients with CHD for occurrence of RF/ RHD.[4]

 
 :: References Top

1.Bernstein D. The cardiovascular system. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics. 15th ed. Bangalore: Prism Books Pvt Ltd; 1996. p. 1262-374.  Back to cited text no. 1    
2.Taranta A, Markowitz M. Rheumatic Fever. 2nd ed. USA: Kluwer Academic Publishers; 1989.   Back to cited text no. 2    
3.Padmavati S. Present status of rheumatic fever and rheumatic heart disease in India. Indian Heart J 1995;47:395-8.  Back to cited text no. 3    
4.Thakur JS, Negi PC, Ahluwalia SK, Sharma R, Bhardwaj R. Congenital heart disease among school children in Shimla hills. Indian Heart J 1995;47:232-5.  Back to cited text no. 4    
5.Befeler B, Hildner FJ, Cohen LS, Javier RP, Samet P. Combined rheumatic and congenital heart disease in adult patients. J Fla Med Assoc 1971;58:24-7.  Back to cited text no. 5    


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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