Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 48, Num. 3, 2002, pp. 238

Journal of Postgraduate Medicine, Vol. 48, Issue 3, 2002 pp. 238

Letter to the Editor

Congenital Heart Disease with Rheumatic Fever and Rheumatic Heart Disease: A Coincidence or an Association?

Bokhandi SS, Tullu MS, Shaharao VB, Bavdekar SB, Kamat JR

Department of Paediatrics, Seth GS Medical College & KEM Hospital, Parel, Mumbai 400012, India. E-mail: milindtullu@vsnl.net

Code Number: jp02079

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 al⁴ 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 al⁴ 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

Bokhandi SS, Tullu MS, Shaharao VB, Bavdekar SB, Kamat JR

Department of Paediatrics, Seth GS Medical College & KEM Hospital, Parel, Mumbai 400012, India.

E-mail: milindtullu@vsnl.net

References

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.
2. Taranta A, Markowitz M. Rheumatic Fever. 2nd ed. USA: Kluwer Academic Publishers; 1989.
3. Padmavati S. Present status of rheumatic fever and rheumatic heart disease in India. Indian Heart J 1995;47:395-8.
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.
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.

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