RHD affects ≈20 million people worldwide highest in developing countries significant morbidity and mortality Subclinical detection adds to of secondary prophylaxis echocardiographic definitions evolving In 2012, the WHF published evidence-based guidelines for the echocardiographic diagnosis of RHD but these criteria have not yet been applied

1. Echocardiographic
Screening for
Rheumatic Heart
Disease
World Heart Federation Criteria for the Echocardiographic Diagnosis of
RHD in Individuals Aged ≤20 Years

2. Clinical Perspective
 RHD affects ≈20 million people worldwide
 highest in developing countries
 significant morbidity and mortality
 Subclinical detection adds to of secondary prophylaxis
 echocardiographic definitions evolving
 In 2012, the WHF published evidence-based
 guidelines for the echocardiographic diagnosis of RHD
 but these criteria have not yet been applied

3. Effective evaluation
Echocardiography search Clinical search
90% RHD detection 10% of detection

4. Definite echocardiographic Criteria for
RHD
 A) Pathologic MR and at least 2 morphologic features of RHD
of the MV
 B) MS mean gradient ≥4 mm Hg
 C) Pathological AR and at least 2 morphological features of RHD of
the AV
 D) Borderline disease of both the AV and MV

5. Keywords
 Definite RHD
 Pathological MS
 Pathological MR
 Pathological AR
 Borderline RHD
 Morphological RHD

6. Borderline RHD (A, B, or C)
 A) At least 2 morphologic features of RHD of the MV without pathologic MR or
MS
 B) Pathologic MR
 C) Pathologic AR

7. Echocardiographic criteria for pathologic
regurgitation (all 4 Doppler criteria must be met)
Pathological MR Pathological AR
1. Seen in 2 views
2. In at least 1 view jet length ≥2 cm
3. Peak velocity ≥3 m/s for 1 complete
Envelope in systole
4. Pansystolic jet in at least 1 envelope
Seen in 2 views
2. In at least 1 view jet length ≥1 cm
3. Peak velocity ≥3 m/s for 1 complete
Envelope in diastole
4. Pandiastolic jet in at least 1
envelope

8. Morphologic features of RHD
Features in the MV Features in the AV
1. AMVL thickening ≥3 mm
2. Chordal thickening
3. Restricted leaflet motion
4. Excessive leaflet tip motion during
systole
1. Irregular or focal thickening
2. Coaptation defect
3. Restricted leaflet motion
4. Prolapse

9. Reference
Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson
J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J,
Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zühlke
L, Carapetis J. World Heart Federation criteria for echocardiographic diagnosis
of rheumatic heart disease–an evidence-based guideline. Nat Rev
Cardiol. 2012;9:297–309.

10. Clinical application
 http://circ.ahajournals.org/content/early/2014/03/12/CIRCULATIONAHA.113
.003495.abstract

11. Hard work adds comfortable orientation