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A pilot study on the prevalence of rheumatic heart disease among children of 5-15 years in Ballabhgarh block of Haryana using echocardiography with doppler.

A cross sectional survey was carried out on children aged 5-15 years, from government and private schools, in a pre identified rural area to diagnose rheumatic heart disease (RHD) in asymptomatic children using portable echocardiography. After a history and physical examination, echo-doppler was performed, using a bedside portable echocardiography machine. A diagnosis of RHD was made by echo-doppler if one or more of the following were present: a) Mitral stenosis; b) Mitral regurgitation (MR) and / or aortic regurgitation (AR) with regurgitation jet length of more than 2 cm in at least two echo planes, along with abnormal valve morphology (a bicuspid aortic valve to be excluded in cases with AR); c) MR and / or AR with regurgitant jet length of 1 -2 cm, and abnormal valve morphology, in the presence of a history suggestive of rheumatic fever. Of the 2600 children (age 5-15 years), 1035 were studying in government schools and 1565 were from private schools (1340 males and 1260 females). The mean age was 11.39 [+ or -] 2.76 years. All children were asymptomatic.

History suggestive of rheumatic fever was obtained in 85 cases. MR was diagnosed by clinical examination in two cases only (clinical prevalence of RHD 0.8/1000). Echo-doppler diagnosed RHD in 51 cases, giving a prevalence of 19.6/1000. Thickening of the valve was present in all cases. Doppler revealed mild MR in 40 and moderate MR in 4 cases. Mild AR was detected in 3 and combined MR and AR in 4 cases. Seven of these 51 cases had a history suggestive of rheumatic fever. Other cardiac lesions identified by echo-doppler were atrial septal defect (5), bicuspid aortic value (2, one with AR), ventricular septal defect (1), patent ductus arteriosus (2) and other congenital cardiac lesions (2). On univariate analysis, older age, lower socioeconomic status and living in houses made of mud, bamboos were found to be significant predictors of high prevalence of RHD.

It may be concluded that the prevalence of RHD was several folds higher, when screening echo-doppler was used. Prevalence is likely to be higher in children who are older and less privileged economically.

Dr. Anita Saxena

Department of Cardiology

All India Institute of Medical Sciences

New Delhi

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Title Annotation:ABSTRACTS: Some Research Projects Completed Recently
Author:Saxena, Anita
Publication:ICMR Bulletin
Article Type:Author abstract
Date:Nov 1, 2010
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