الفهرس 
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Abstract
Rheumatic fever (RF) is an inflammatory disease caused by autoimmune response to a preceding group A streptococcal infection (GAS). It is an important public health problem associated with poor living conditions and reduced access to appropriate health care services throughout developing countries.
Echocardiography along with colour Doppler imaging is now worldwide used for early detection of cardiac involvement even in the absence of clinical evidence murmur. This entity, called silent carditis or subclinical (SCC) was reported to cause similar consequences to clinically evident carditis (4). And there is a strict criteria of pathological murmur and specific morphological valvular change. Many studies detect 7 to 8 times higher prevalence of RHD by using echo rather than by clinical auscultation alone.
Aim of the work:
The aim of the present work was to evaluate the natural history and determine the outcome of subclinical carditis in children diagnosed to have rheumatic fever. The study covered patients having their follow-up at Alexandria University Children’s Hospital (AUCH).
Subject and methods:
The current study was carried on 35 patients previously diagnosed to have RF and subclinical RHD and attending the cardiology clinic at Alexandria University Children’s Hospital (AUCH) for the past 2 years to detect the natural history of their disease and for assessment, follow-up and management. The prevalence and outcome of SCC was thoroughly assessed.
Results:
We found 35 patients had SCC detected by echocardiography during initial presentation compromising 23.3% (35/150) of all patients with RF, SCC constituted 44.4% (4/9) of patients diagnosed with chorea and 36.3 % (29/80) of patients presented with rheumatic arthritis, Our study demonstrated that MV was the most common valve affected in (97%) of cases, then aortic valve in (34.4%), in the form of regurgitation, In our study 22 patients (66%) resolved completely, 10 patients (30%) had persistent valvular disease, and one patient (3%) had progressive valve lesions mainly due to recurrence,
On studying different parameters that would affect the natural history of the disease, we found out that Recurrence is the most important predictors of the disease outcome. This finding is consistent with different studies performed worldwide. There was significant association between the LAP compliance and the rheumatic recurrence which influences the outcome.