IJCS | Volume 31, Nº6, November / December 2018

DOI: 10.5935/2359-4802.20180059 578 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(6)578-584 Mailing Address: Fernanda Maria Correia Ferreira Lemos Departamento de Cardiologia Pediátrica do Instituto Estadual de Cardiologia Aloysio de Castro Rua David Campista, 326, 5º andar. Postal Code: 22261-010, Humaitá, Rio de Janeiro, RJ – Brazil. E-mail: drafmcf@ig.com.br Evolutive Study of Rheumatic Carditis Cases Treatedwith Corticosteroids in a Public Hospital Fernanda Maria Correia Ferreira Lemos, 1 Gesmar Volga Haddad Herdy, 2 Cristina Ortiz Sobrinho Valete, 2 Maria Eulália Thebit Pfeiffer 1 Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), 1 Rio de Janeiro, RJ - Brazil Universidade Federal Fluminense (UFF), 2 Niterói, RJ - Brazil Manuscript received December 23, 2017, revised manuscript May 07, 2018, accepted May 14, 2018. Abstract Background: Rheumatic carditis is a challenge for treatment and secondary prophylaxis, due to severe valve sequelae. Objective: To evaluate the cases of rheumatic carditis in patients under 18 years old treated with corticosteroids. Methods: An observational, longitudinal and retrospective study was carried out on the profile of patients, in the period of 2000-2015. We selected those who received corticosteroid therapy at immunosuppressive doses, for the treatment of carditis and were aged 5 to 18 years. Data were extracted from medical records. Calculations of: averages, standard deviations, medians and interquartile ranges, ratios and 95% confidence intervals were obtained. Chi-square and Wilcoxon tests were applied for comparisons. The level of significance was 5%. Results: Of the 93 cases, 93.53% developed moderate or severe carditis. Mitral regurgitation was detected in 100% of the sample. Pulse therapy was administered in 11.83%. Surgery was performed in 23.69% of patients: mitral, aortic and/or tricuspid valve repair or replacement. The evolution of the cases was favorable in 70.96%. There was a good response among those who received only clinical treatment and those who belonged to the surgical group. The comparison of the initial and posterior valve lesions to the corticoid use was statistically significant (p < 0.001). A difference between the ejection fraction medians was observed (p = 0.048). Hospitalization was required twice or more for 45.16% of the patients. The mortality rate was 5.38%. Conclusions: The patients showed significant clinical improvement. The treatment was effective, reducing trivalvular impairment. (Int J Cardiovasc Sci. 2018;31(6)578-584) Keywords: Myocarditis/physiopathology; Myocarditis/complications; Rheumatic Fever; Mitral Valve Insufficiency; Adrenal Cortex Hormones; Penicilin G Benzathine. Introduction Although rheumatic fever (RF) occurs all over the world, in developing countries (such as Brazil), it is still a major cause of acquired heart disease among children and adolescents, which unfortunately still remains underreported. 1-3 According to the National Census conducted by the Brazilian Institute of Geography and Statistics (IBGE), some 10 million cases of streptococcal tonsillitis are diagnosed each year, of which 0.3 to 10% develop into RF. 1,4 This indicates that, around 15,000 people must live with carditis each year. 1,5,6 Rheumatic damage to heart valves accounts for 40% of valve replacement operations, 7 costing the nation an average of R$ 89 million (close to US$ 28 million) a year. 8 Information from Brazil Unified National Health System database (DATASUS), indicates a cardiac mortality rate of about 7.87% from chronic RF. 8 The dissemination of projects, such as the Rheumatic Fever Prevention Program (PREFERE), by the Ministry of Health (MH), aims to raise awareness among medical