The relationship of carditis to the initial attack of Sydenhamʹs chorea

Background: The natural history of valvular regurgitation detected by echocardiography in Sydenhamʹs chorea has been lacking. Methods: Clinical assessment and transthoracic color Doppler echocardiography were independently performed for each patient with an initial attack of Sydenhamʹs chorea and also for each normal control (Khon Kaen University, Thailand; 1991–2001) at the time of their presentations. Serial clinical examinations and echocardiography were done for each patient at 1- and at 5-year follow-up. Results: Of 44 patients, 17 (39%) had carditis (valvulitis) evident by auscultation at the time of the initial attack. Three (11%) of the 27 patients with no clinical evidence of carditis had echocardiographic evidence of acute mitral regurgitation (subclinical valvulitis). All 17 patients with carditis had echocardiographic evidence of acute mitral regurgitation. None of the 88 control children had evidence of pathologically significant valvular regurgitation. Of the 15 patients with carditis regularly followed, the persistence of a mitral regurgitation murmur and of pathologically significant valvular regurgitation by echocardiography were 33% (5/15) and 60% (9/15), respectively, at 1-year follow-up, but the persistence of both was 25% (1/4) at 5-year follow-up. Conclusions: Color Doppler echocardiography is a useful tool in the early diagnosis of rheumatic carditis (valvulitis) and at 1-year follow-up of rheumatic valvular heart disease in the patients with initial Sydenhamʹs chorea but the incremental benefit beyond 5 years after the initial attack might be minimal.