Response to Letters Regarding Article, “Rheumatic Heart Disease Screening by Echocardiography: The Inadequacy of World Health Organization Criteria for Optimizing the Diagnosis of Subclinical Disease”
We acknowledge the points made by these correspondents, particularly that the absence of a “gold standard” test for early rheumatic heart disease can create the potential for false-positive and false-negative ultrasounds in children in endemic areas. As we noted in our article,1 follow-up studies of the “natural history” of early valve abnormalities (whether defined by Doppler and/or morphological criteria) are vital, as are eventual studies on the role of antibiotic prophylaxis in cases when early rheumatic heart disease is considered likely. Distinguishing rheumatic heart disease from mitral valve prolapse should be based on clinical and ultrasound criteria, and obviously the prevalence of each will depend enormously on the part of the world in which the screened children are located.
Marijon E, Celermajer DS, Tafflet M, El-Haou S, Jani DN, Ferreira B, Mocumbi AO, Paquet C, Sidi D, Jouven X. Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease. Circulation. 2009; 120: 663–668.