Table 1. World Heart Federation 2012 criteria for echocardiographic diagnosis of rheumatic heart disease as applied to this study (modified from reference 10).
| Echo criteria for children ≤ 20 years of age | |
| Definite RHD (either A, B, C or D): | |
| A) Pathological MR and at least two morphological features of RHD of the MV | |
| B) MS mean gradient ≥ to 4 mmHg (NB – exclude congenital MV anomalies) | |
| D) Borderline disease of both the aortic and mitral valves as defined below Borderline RHD (either A, B or C): | |
| A) At least two morphological features of RHD of the MV without pathological MR or MS | |
| B) Pathological MR | |
| C) Pathological AR | |
| Normal echocardiographic findings (all A, B and C); | |
| A) MR that does not meet all four Doppler criteria (physiological MR) | |
| B) AR that does not meet all four Doppler criteria (physiological AR) | |
| C) An isolated morphological feature of RHD of the MV or the AV (e.g. valvar thickening) without any associated pathological stenosis or regurgitation | |
| Echo criteria for adults > 20 years of age | |
| Definite RHD (either A, B, C or D): | |
| A) Pathological MR and at least two morphological features of RHD of the MV | |
| B) MS mean gradient ≥ to 4 mmHg (NB – exclude congenital MV anomalies) | |
| C) Pathological AR and at least two morphological features of RHD of the AV in those under 35 years of age only. (Bicuspid AV and dilated aortic root must first be excluded) | |
| D) Pathological AR and at least two morphological features of RHD of the MV | |
| Pathological regurgitation | |
| Mitral regurgitation (all four Doppler criteria must be met) | Aortic regurgitation (all four Doppler criteria must be met) |
| 1. Seen in two views | 1. Seen in two views |
| 2. In at least one view jet length ≥ 2 cm | 2. In at least one view jet length ≥ 1 cm |
| 3. Peak velocity ≥ 3 m/s | 3. Peak velocity ≥ 3 m/s |
| 4. Pansystolic jet for at least one envelope | 4. Pandiastolic jet for at least one envelope |
| Morphological features of RHD | |
| Mitral valve | Aortic valve |
| 1. AMVL thickening ≥ 3 mm (age-specific) | 1. Irregular or focal thickening |
| 2. Chordal thickening | 2. Coaptation defect |
| 3. Restricted motion | 3. Restricted motion |
| 4. Excessive leaflet tip motion during systole (hypermobile or flail leaflet) resulting in abnormal coaptation | 4. Prolapse |
RHD, rheumatic heart disease; MR, mitral regurgitation; MV, mitral valve; MS, mitral stenosis; AR, aortic regurgitation; AV, aortic valve; AMVL, anterior mitral valve leaflet.