Mitral Valve Regurgitation in child

[matty_boston]

My daughter has mild to mild plus mitral valve regurgitation as a result of Rheumatic Fever. I came across an article written by Dr.Thomas Chin on March 27,2006 and wanted to get your opinion of.

He states:

"Insufficiency from acute rheumatic valve disease resolves in 70-80% of patients if they adhere to antibiotic prophylaxis."

Does this mean my daughter's valve has a 70-80% chance of healing if she keeps taking her penicillin?

Also another paragraph states:

"In patients who developed murmurs from valve insufficiency from acute RF, numerous factors (eg, severity of initial carditis, presence or absence of recurrences, amount of time since episode of RF) affected the likelihood that valve abnormalities and the murmur would disappear. The type of treatment and the promptness of its initiation did not affect the likelihood that the murmur would disappear. In general, incidence of residual RHD at 10 years was 34% in patients without recurrences but was 60% in patients with recurrent RF. In patients in whom the murmur disappeared, it did so within 5 years in 50%. Thus, a significant number of patients experience resolution of valve abnormalities even 5-10 years after their episode of RF"

I wasn't aware that her valves if they heal, could take 5-10 years before we see healing. I thought that once the carditis is healed then her valves, if they were going to heal would do so after the carditis healed? Is this true?

Thanks so much!

[CCF-M.D.-MJM]

Hi Matty,

I am sorry to hear your daughter was sick.  As a parent I find this one of those uncontrollable factors that causes hours of worrying.

The mitral regurgitation can get better if she is still in the acute phases of carditis or in the immediate period afterward.  She absolutely should finish her antibiotics and follow appropriate antibiotic phrophalaxis here after.  It is worth seeing a cardiologist if you haven't already done so.

I am not familiar with Dr. Chin's article, but if it was in a reputable journal, I would trust it.  Your daughter should still be followed occassionally by a cardiologist and have an echo if there are any changes in her symptoms or murmur.  It is possible for the valvular problems to progress over time even when they aren't evident at the time of diagnosis of acute rheumatic fever.  There are many people that never develop any valvular problems, but others that do.  She should be aware of this for life and see physicions aware of the process.  The good news is that the success of surgery, when needed, for valvular repair or replacement is excellent.  I have a grandfather that would have lived another 20 years had these modalities been available in the 1970's.

The best approach is to do exactly what you are doing.  Be educated about the possibilities and know what to watch for but also know that there are excellent treatments available should she ever need them.

Thanks for posting.  I hope this helps.

[dande4]

Matty,

Wishing your daughter all the best for a speedy, full recovery. This must be very stressful but keep thinking positive.:)

[matty_boston]

Thanks for all of the support! She is doing well and her cardiologist said she many never have any symptoms with her regurg, but its possible it could get worse in time. After looking at all of the advancements that valve repair/replacement, especially at the Cleveland Clinic, it at least gives me hope that if she needs it, at that point in her life, it could be considered routine surgery!

Thanks again!

[Karonnie]

Matty

I think the article might be differentiating acute RF - where valves become thickened and cause murmurs AS well as regurgitant, usually referred to as mixed valve disease because the valve is both stenotic and insufficient to that of rheumatic fever with carditis but resultant regurgitation only (ie insufficiency).

If the mitral valve is only regurgitant there is a greater chance that it may resolve - unless recurrances (as opposed to relapses) occur - why he says if you continue to take your antibiotics it's more likely to resolve - ie taking the antibiotics unfortunately doesn't change the course of the Rheumatic Fever itself or make it go away - it has to burn itself out BUT taking the preventative penicillin should in most cases prevent the patient getting any further Strep A infections in the future therefore from getting a recurrance of RF and may indirectly mean that a patient's regurgitation may repair over time.

Apparently if the aortic valve is affected this always causes permanent damage and does not resolve.

I think the Doc mentioned this above but even if your daughter's regurgitation does resolve she should still always ensure she tells her doctors, as this can become especially important when she is older and more so when she decides to have a family because pregnancy can cause a similair symptomatic carditis to that of RF in patients with past history of carditis and RF.

I hope your daughter's RHD is one of those which resolves!  If it doesn't you may want to keep an eye on the latest research using antibiotics from the tetracycline family such as minocycline, tetracycline and doxycycline to reduce or stop calcification of valves. Studies have been very positive especially when treated early. There have been some amazing discoveries and technological advances within these areas.

Karen

[matty_boston]

Thanks so much for the info Karen! You seem to be very knowledgable in the area of RHD. Do you as well have RHD?

-Matty