الفهرس 
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Abstract
Rheumatic fever is associated with high morbidity and mortality of children,particularly when it affects the heart (rheumatic heart disease) (Gostman, 1985]J091. In many developing countries, including Egypt,rheumatic heart disease accounts for over 30% of cardiac patients and it is the main cause of death from *a> ~l~>$;,,a$ea %$ ’ ( ! A + f & @&& cardiovascular disease (~~,,comrni~ee~1980~~~, where it is responsible for more than 75% of cardiac death in the I young (Taran$ta & Markowitz, 1 981j461 . The relationship of rheumatic heart disease to atherosclerosis is still controversial (Zdanov, 1976j1121, but epidemiologic studies outline the risk factors for coronary artery disease and cholesterol metabolism abnormalities (Miller & Miller, I 975)(Newman, et al. 1989)”541’551 . In the present work, we aimed to outline the cholesterol and triglyceride metabolism in children with rheumatic ,heart disease with and without congestive heart failure (CHF) in an attempt to discover the importance of any abnormality in relation to this chronic disabling disease and the response to treatment . Moreover, the liver functions and its impact on cholesterol and triglyceride levels were correlated with the stage of rheumatic heart disease either with or without CHF . Our study was carried out upon 30 children with’ rheumatic heart disease, classified as follows : * *group (A): 10 children: rheumatic carditis without cardiomegaly . *group (B) : 10 children: rheumatic carditis with cardiomegaly, without CHF . *group (c): 10 children: rheumatic carditis with cardiomegaly, with CHF . Ten (10) healthy children served as a control group . All children included in this study were subjected to: proper history taking, thorough clinical examination, and laboratory investigations : 1) Erythrocyte sedimentation rate (ESR) . 2) C-reactive protein (CRP) . 3)Anti-streptolysin 0 titre (ASOT) . 4) Serum total cholesterol (TC) . 5) Serum HDL cholesterol (HDL-C) . 6) Serum triglycerides (TG) . 7)Serum transaminases : -SGOT. -SGPT. 8)Serum alkaline phosphatase . 9)Serum proteins : -albumin -globulin Also X-ray chest & . heart, E.C.G, and Echocardiography were done for every patient . and after treatment . -from t h i s study, our r e s u l t s s h o w e d the f o l l o w i n g : - *The ESR: there was significant increase in both groups A&B before treatment with significant decrease after treatment, but no significant change in group (C) children with CHF . *The CRP and ASOT titre: there was significant idcrease in the three studied groups before treatment, with significant decrease after treatment . *Serum total cholesterol (TC): there was no significant change in the three studied groups . *Serum .triglycerides (TG): there was significant increase in the three studied groups before treatment, with significant decrease after treatment . The serum triglyceride levels varied with the clinical severity of carditis (more increase in group C than group B and the latter than group A) . *Serum HDL-C: there was significant decrease in the three studied groups before treatment, with significant increase after treatment . The HDL-C varied inversely with the clinical severity of carditis (more decrease in kw.. a group C than group B a&c-kke group A i-wPMa-1-1; ,,F\i,i %, t *TG/TC ratio: there was significant increase in the three . studied groups before treatment, with significant decrease after treatment . * *TC/HDL-C ratio: there was significant increase in the three studied groups before treatment, with significant decrease after treatment . This ratio was directly proportional to the clinical severity of carditis . *Serum transaminases: there was significant increase of the SGOT in the three studied groups before treatment with significant decrease after treatment . The SGOT levels were directly proportional to the clinical severity of carditis . I As regards the SGPT, there was no significant change in both groups A and B, but there was significant increase in group C before treatment and this was significantly decreased after treatment . *Serum alkaline phosphatase: there was significant increase in the three studied groups before treatment, with sign’ificant decrease after treatment . The Serum alkaline phosphatase levels were directly proportional to the clinical severity of carditis . *Serum albumin: there was significant decrease in the three studied groups before treatment, with significant increase after treatment . The serum albumin levels varied inversely with the clinical severity of carditis . from this study, we can conclude that:- Children with rheumatic heart disease with active ’ carditis show abnormalities of cholesterol and triglyceride metabolism, which are corrected by corticosteroid treatment . 0 HDL-cholesterol and albumin levels varied inversely with the clinical severity of carditis; while, in contrast, triglyceride and some liver enzyme levels varied directly with this severity . 0 Hepatic dysfunction, especially in rheumatic CHF, might explain these observed differences in serum HDL-cholesterol and triglyceride levels in those groups of children . **We recommend screening of lipid profile in children with rheumatic heart disease at regular intervals, because of its crucial importance as risk factors for the development of atherosclerosis and premature coronary heart disease.