الفهرس 
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Abstract
Rheumatic valvular heart disease remains the most common acquired heart disease worldwide. It’s the major cause of cardiovascular death in pediatric age group, so an accurate diagnosis of RF is very important. Our study aims to provide prevalence of rheumatic heart disease after rheumatic fever affection in children from 6 through 15years of age in El-Mahala El-Kobra district which were selected randomly.
The present study was done to detect the prevalence of rheumatic heart disease among the primary and preparatory school children 6-15 years old in El-Mahala El-Kobra district. EL-Gharbia Governorate screening survey was done on 5000 students in 10 primary and 7 preparatory schools in El-Mahala El-Kobra district in urban and rural areas.
Careful cardiovascular examination was done for all students and any suspected students 124 from 5000 were subjected to the following:
Through history taking, full clinical and echo examination, It was found that:
Out of 124 suspected students who examined by expert pediatric echocardiographic. 10 suspected students refused to be examined by echocardiography. the remaining 114 students underwent echocardiographic examination
We had found (5) children of them have RHD (5) had physiologic MR (5) had mitral valve prolapse (1) had congenital heart disease and (98) had normal echo (10) suspected student refuse echo examination with the prevalence rate of rheumatic heat disease in primary (10) and (7) preparatory schools children in in El-Mahala El-Kobra district EL-Gharbia Governorate is found to be 0.1% (1/1000) according to this study.
The results of revealed the following:
The female gender was predominant than male in this study the rheumatic heart disease occurred in 3cases of females and 2cases of male with prevalence rate (60%) were females and (40%) were males (80%) lived in rural areas while (20%) in urban areas and (20%) 0f them of middle socioeconomic state and (80%) 0f low socioeconomic state.
Cardiac examination of selected students revealed that 3cases (60%) had apical holo-systolic murmur on mitral area and 2 cases (40%) had early diastolic murmur on aortic area.
RHD patients were more common in the children aged 9-15 years than in those aged 6-9 years. In our study There is therefore a need to identify cases early when the valvular lesion is less severe and to give them secondary prophylaxis with penicillin there by preventing recurrence and progression of the severity of the valvular lesion.
The low specificity of clinical observation. Hence, identification of RHD by clinical criteria is bound to over diagnose the disease in community surveys. The roles of echocardiography as highly sensitive and specific tools in the assessment of RHD
The low awareness of the health care providers regarding the diagnosis of rheumatic fever and rheumatic heart disease as many patients were on long acting penicillin without fulfillment of the criteria of diagnosis or need for LAP.
The mitral valve was the commonest valve affected in chronic rheumatic valvulitis followed by aortic valve. Mitral regurgitation was the commonest echocardiographic diagnosis present in (60%) of the patients and then aortic regurgitation in patient (40%) patients.
All RHD cases were taking secondary prophylaxis with penicillin regularly. These patients need to be educated about the importance of secondary prophylaxis.
There is a significant effect of overcrowding and low socioeconomic indices on the prevalence of rheumatic heart disease. The patients from rural areas represent the majority of cases (80%), and less in urban areas (20%) This could be explained that in the rural the more prevalent of risk factors.
The high frequency of RHD in the developing world and Egypt necessitates aggressive prevention and control measures
The major interventions for prevention and control include:
Reduction of exposure to group A streptococci.
Primary prophylaxis to prevent initial episodes of RF.
Secondary prophylaxis to prevent recurrent episodes.