A 10-year-old child presents with acute rheumatic fever. Echocardiography shows mitral regurgitation. Jones criteria are met. Which of the following findings on echo would indicate severe carditis with a high risk of permanent valve damage?
- A Severe mitral regurgitation with left ventricular dilation and reduced ejection fraction ✓
- B Grade I mitral regurgitation jet in parasternal long axis
- C Pericardial effusion without ventricular dysfunction
- D Trivial tricuspid regurgitation
Correct answer: A. Severe mitral regurgitation with left ventricular dilation and reduced ejection fraction
Explanation
Severe mitral regurgitation with left ventricular dilatation and reduced ejection fraction represents severe rheumatic carditis with haemodynamic compromise and the highest risk of permanent valvular damage and chronic rheumatic heart disease. Pericardial effusion reflects pericarditis, which is a minor form of rheumatic carditis and generally resolves without sequelae. Trivial regurgitation is a physiological finding. Mild regurgitation has a good prognosis with secondary prophylaxis.
Reference: Ghai Essential Pediatrics, 10th ed.
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