Profile and prediction of severity of rheumatic mitral stenosis in children

In developing countries such as Indonesia, rheumatic heart disease (RHD) is still an important community health problem. Rheumatic mitral stenosis (RMS) occurs more rapidly and severe RMS could occur at age as early as 15 years old in Asia-Africa country. The physical examination is not accurate enough to predict the severity of RMS. The aims of this study are to explore RMS clinical, ECG, CXR, echocardiographic features, and to evaluate the value of ECG or CXR as a diagnostic tool predict the RMS severity compared to echocardiography as a gold standard. Cross-sectional study was done on 28 RMS patients at Child Health Department Dr Cipto Mangunkusumo Hospital. Mean of age was 13.5 years. Unfortunately 2 patients were excluded from diagnostic test due to incomplete examination. The severity of RMS based on 2 D echo was classified as mild, moderate and severe in 1, 15 and 10 patients, respectively. The specificity of RMS severity prediction by RVH and RAD on ECG was 75%, and negative predictive value was 90.9%. Sensitivity of CXR in prediction of RMS severity was 80%, specificity was 81.2%, while negative predictive value was 86.7%. The combination of ECG or CXR gave 90% sensitivity that would be beneficial to screen RMS patient in rural area. The negative predictive value was 92%. This means that if there is no severe RMS sign on ECG nor CXR, then the RMS is most probably not severe.