Severe rheumatic carditis in children: clinical profile and outcomes from a prospective Indian cohort

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BACKGROUND: Acute rheumatic fever (ARF) with severe carditis remains a major cause of non-procedural pediatric cardiology admissions in low- and middle-income countries. Data describing the clinical profile and outcomes of children with severe carditis are limited. METHODS: This prospective study included 100 children admitted with ARF and severe carditis between 2015 and 2022. Clinical presentation, severity of shock, valvular involvement, ventricular function and management strategies were documented. Outcomes studied included requirement of inotropes, mechanical ventilation, duration of intensive care and hospital stay, intractable heart failure, mortality and need for surgery. RESULTS: Children were categorized into three groups according to hemodynamic severity. The duration of anti inflammatory treatment was 12 weeks. Group A included 18 children with decompensated shock, severe regurgitation of at least two valves and biventricular dysfunction. These children received pulse methylprednisolone followed by oral prednisolone, inotropes, diuretics and afterload reduction. Intractable heart failure was noted in 9 (50%) with a mortality of 4 (24%) and 5 (28%) requiring emergency surgery. Group B included 32 children with compensated shock and preserved ventricular function. They were treated with oral prednisolone tapered with addition of aspirin. Group C included 50 children without shock or ventricular dysfunction and treated with aspirin. Sixteen and ten children underwent surgery during one year follow-up in groups B and C respectively. CONCLUSION: Severe rheumatic carditis continues to cause substantial morbidity and mortality in children. Recurrent disease and multivalvular involvement are associated with poor outcomes. Early recognition, strict secondary prophylaxis and strengthened public health strategies are essential to reduce disease burden.