DOI: 10.1111/j.1540-8175.2011.01487.x C  2011, Wiley Periodicals, Inc. ORIGINAL INVESTIGATIONS Two Years of Follow-Up Validates the Echocardiographic Criteria for the Diagnosis and Screening of Rheumatic Heart Disease in Asymptomatic Populations Maneesha Bhaya, M.B.B.S., M.D., D.N.B. (Cardiology), ∗ Rajesh Beniwal, M.B.B.S., M.D.,† Sadiak Panwar, M.B.B.S., M.D.,‡ and Raja Babu Panwar, M.B.B.S., M.D., D.N.B. (Cardiology)§ ∗ Pediatric and Adult Cardiology, Fortis Escorts Hospital, Jaipur, Rajasthan, India; †Department of Community Medicine, SSR Medical College, Belle rive, Mauritius; ‡Department of Cardiology, Sunny Downstate University, Brooklyn, New York; §Head of Department, Cardiology, Sardar Patel Medical College, Bikaner, Rajasthan, India Objectives: Out of 1,059 school children aged 6–15 years, screened 2 years ago, 54 children were diag- nosed with rheumatic heart disease (RHD) and put on penicillin prophylaxis. Significant regurgitation of mitral valves was detected in 39 cases of echocardiography diagnosed RHD, and in 15 cases significant regurgitation was detected to coexist with valve deformities. Three children had isolated mitral valve thickening without regurgitation. They were not given penicillin prophylaxis. These cases were followed up for 2 years. Methods: After 2 years, 54 children diagnosed with RHD and three children with isolated mitral valve thickening, were evaluated again. Lot quality assurance sampling was employed to screen a selected group of school children declared normal during the earlier evaluation. Lot was to be rejected, if, one child with significant regurgitation of mitral valve was found among the first 10 screened children of each of the 10 lots. Findings: No lot was rejected and thus it was inferred that the prevalence of new onset RHD was negligible in the subset declared normal 2 years ago. Isolated significant mitral regurgitation disappeared more often when present (35.9%) in comparison to when it (26.7%) was originally found coexistent with valve deformities. Conclusions: Highlight of the study is the greater reversibility of earlier lesions as compared to the later stages of RHD. Spontaneous regression of isolated mitral valve thickening in two-thirds of the cases even without antibiotic prophylaxis, undermines the value of morphological criteria for the diagnosis of RHD. (Echocardiography 2011;28:929-933) Key words: mitral regurgitation, diagnostic imaging tools, Doppler echocardiography In developed countries, the incidence of acute rheumatic fever (ARF) and the prevalence of rheumatic heart disease (RHD) is considered low. Control has been achieved by a strategy of main- taining community registers to ensure secondary antibiotic prophylaxis for cases with a docu- mented episode of ARF or those diagnosed with RHD. 1 This strategy was also employed variably in developing countries for control of RHD. In India, reported prevalence of RHD was at times less than 1 per 1,000 during nineties and last decade. In- creased antibiotic use, changing natural course of the disease, and improvement in socioeconomic Address for correspondence and reprint requests: Maneesha Bhaya, M.B.B.S., M.D., D.N.B. (Cardiology), Pediatric and Adult Cardiology, Fortis Escorts Hospital, Jaipur, Rajasthan, India. Fax: 0091-151-2525741; E-mail: maneeshabhaya@ gmail.com conditions were considered to be important de- terminants for this observed phenomenon. 2,3 When suspecting a diagnosis of ARF, echocar- diographic detection of significant regurgitation of mitral and/or aortic valves has not been in- corporated in the criteria to diagnose ARF. How- ever, in a case presented with audible murmur, echocardiography detected typical mitral or aor- tic valve deformities are considered diagnostic for RHD. 4 Echocardiography has much higher speci- ficity than careful cardiac auscultation in confirm- ing a diagnosis of RHD, and accordingly echocar- diography has also been used to confirm a clinical diagnosis of RHD in the school surveys. 2,3 Detection of significant regurgitation of mitral valve in a significant proportion of school chil- dren has been accepted as a proof of high preva- lence of RHD. Different authors have interpreted this phenomenon in different ways. 5–7 Majority considered this finding highly sensitive (high false 929