Publicações Científicas

The Rheumatic fever (RF) and the rheumatic heart disease (RHD) remain important health problems among populations of developing countries1. The number of studies is scarce, and public and private investments are practically inexistent. In addition, the cases of rheumatic fever are underdiagnosed, and are recognized only following permanent valve damage through the manifestation of carditis, more frequently represented by mitral stenosis.

Rheumatic fever (RF) remains endemic in many countries and frequently causes heart failure due to severe chronic rheumatic valvular heart disease, which requires surgical treatment. Here, we report on a patient who underwent an elective surgical correction for mitral and aortic valvular heart disease and had a post-operative diagnosis of acute rheumatic carditis. The incidental finding of Aschoff bodies in myocardial biopsies is frequently reported in the nineteenth-century literature, with prevalences as high as 35%, but no clinical or prognostic data on the patients is included.The high frequency of this finding after cardiac surgery in classical reports suggests that these patients were not using secondary prophylaxis for RF. We discuss the clinical diagnosis of acute rheumatic myocarditis in asymptomatic patients and the laboratorial and imaging methods for the diagnosis of acute rheumatic carditis. We also discuss the prognostic implications of this finding and review the related literature.

Infective endocarditis (IE), a microbial infection of the cardiac or adjacent vascular endothelium, remains a feared disease, although the modern diagnosis systematizations date back to 1885 by Osler.1

Although relatively uncommon, 2 with approximately 3-10 cases per 100,000 individuals/year, 3 the mortality remains high: more than one-third of patients die in the first year after the diagnosis.1,4 Only early diagnosis and treatment, whether exclusively clinical or associated with cardiac surgery, may interfere to reduce this high mortality rate. IE used to be more frequent in young and middle-aged adults with rheumatic or congenital heart disease.3 However, recent studies have shown a significant reduction in the incidence of IE in these groups, especially in more developed countries.

The recently promulgated 2017 “Cairo Accord on Rheumatic Heart Disease—From Molecules to The Global Community” was a land‐ mark in global cardiology wherein stakeholders from low and mid‐ dle per capita income countries (LMIC) set international priorities for a disease largely affecting their own populations, in lieu of di‐ rectives from high income country experts.1 The Accord addresses the consequences of rheumatic fever (RF) which affects the most

disadvantaged LMIC citizens who are often impoverished, living in overcrowded circumstances, with marginal health literacy and inad‐equate health care access. 2 While the Accord does not give detailed arguments for the recommendations endorsed, on balanced reading, invested stakeholders may fret over a possible opportunity lost.