Search

Objectives Rheumatic heart disease (RHD) continues to be major public health burden in developing world. Echocardiographic screening in school children has shown that subclinical RHD cases are several times more than clinical cases. Recent reports have used World Heart Federation (WHF) criteria. Objective of present study was to determine RHD prevalence using WHF criteria in Indian children. Methods Children (5–15years) from randomly selected schools across four sites were included. After focused clinical evaluation, echocardiography was performed using WHF criteria in all children. Images/loops of abnormal cases were analyzed independently by an additional experienced cardiologist. Children with murmur and confirmatory echocardiography were categorized ‘clinical RHD'; those with abnormal echocardiography alone were labeled ‘subclinical RHD'. Results Among 16,294 children included, mean age was 10.8 ± 2.9years; 55.1% were males; 11,405 (70%) were from rural areas and 3978 (24.4%) were from government schools. We detected RHD by echocardiography in 125 children [prevalence: 7.7/1000 (95% CI 6.3, 9.0)]. Borderline RHD was present in 93 children (5.7/1000, 95% CI 4.6, 6.9), definite RHD in 32 (2/1000, 95% CI 1.2, 2.6), and clinical RHD in six [0.36/1000, 95% CI: 0.1–0.7]. On univariate analysis, older age, female gender, and higher waist circumference were associated while on multivariate analysis, older age (OR 1.18, 95% CI: 1.09, 1.26) and female gender (OR 1.61, 95% CI: 1.13, 2.3) were associated with RHD. Conclusion RHD prevalence varies in different parts of India. Echocardiographic prevalence is several times higher than clinical and underscores importance of echocardiographic screening in community.

Ebstein's anomaly is a rare congenital heart defect (CHD) that occurs approximately once in 20,000 live births and is characterized by significant apical displacement of septal tricuspid leaflet. An increased risk of CHDs, about 40-50%, has been reported among children with Down syndrome. However, an association of Down syndrome with Ebstein's malformation is extremely unusual. Only four cases, to the best of our knowledge, have been previously reported. Tandem translocation 21;21 is rare in Down syndrome in comparison to Robertsonian translocations. A Down infant having a tandem 21;21 translocation trisomy 21 with Ebstein's anomaly is described in this report.

Three cases of infective endocarditis were encountered following balloon dilatation of the mitral valve. The diagnosis was difficult due to negative blood cultures and nondiagnostic transthoracic echocardiogram, the latter the consequence of the preexisting severe rheumatic valvar disease. Transoesophageal echocardiography proved superior in diagnosis. The possible causes and means of preventing this potentially lethal complication are discussed.