Table 1.

Diagnostic criteria for rheumatic heart disease in children

Definite Rheumatic Heart Disease (either A or B):

A. Significant mitral stenosis, defined as echocardiographic evidence of mitral stenosis with a mean diastolic pressure gradient across the mitral valve of greater than 4 mm and clinical findings of mitral stenosis with or without other valvular lesions. Such abnormalities as dog-leg deformity of the anterior mitral valve leaflet, fixed or restricted mitral leaflet abnormality, calcification, and commissural thickening were expected.

B. The presence of a heart murmur consistent with any combination of mitral regurgitation or aortic regurgitation and echo-Doppler evidence of rheumatic valvular damage, defined as any of:

(1) significant mitral regurgitation, with a mitral regurgitation jet of at least 2 cm from the coaptation point of the valve leaflets, seen in 2 planes, high velocity (mosaic pattern), holosystolic, plus thickened mitral valve leaflets and/or dog-leg deformity of the anterior mitral leaflet. Additional changes might include multiple regurgitant jets, especially posterolaterally directed.

(2) Significant aortic regurgitation, defined as an aortic regurgitation jet at least 1 cm from the coaptation point of the valve leaflets, of high velocity, seen in 2 planes, plus thickened mitral leaflets and/or dog-leg deformity, without another apparent etiology for the aortic insufficiency, such as a bicuspid aortic valve or annuloaortic ectasia. Aortic stenosis might be associated, but aortic stenosis without associated rheumatic mitral valve disease was not accepted as evidence of rheumatic valvular disease.

Probable Rheumatic Heart Disease

The presence of a heart murmur consistent with any combination of mitral regurgitation or aortic regurgitation, and the subject comes from a population with known or suspected high rates of acute rheumatic fever and/or rheumatic heart disease and no past history of definite or probable acute rheumatic fever, and any of the following findings are present on echocardiography:

(1) Thickened mitral valve leaflets and/or dog-leg deformity of the anterior mitral valve leaflet without significant mitral stenosis.

(2) Significant mitral regurgitation, as defined under Definite rheumatic heart disease, without thickened mitral valve leaflets and/or dog-leg deformity of the anterior mitral valve leaflet.

(3) Significant aortic regurgitation, as defined under Definite rheumatic heart disease, without thickened mitral valve leaflets and/or dog-leg deformity of the anterior mitral valve leaflet.

Possible Rheumatic Heart Disease

The absence of a valvular heart murmur in a subject from a population with known or suspected high rates of acute rheumatic fever and/or rheumatic heart disease with any of the following echo-Doppler changes:

(1) Thickened mitral valve leaflets and/or dog-leg deformity of the anterior mitral valve leaflet.

(2) Significant mitral regurgitation, as defined under Definite rheumatic heart disease.

(3) Significant aortic regurgitation, as defined under Definite rheumatic heart disease.