The Journal of the Arkansas Medical Society Issue 11 Vol 114 | Page 19

quently lost to follow-up despite multiple attempts
to contact the family. Nearly two years later, he re-
turned to cardiology clinic with worsening exercise
intolerance and had not taken his diuretics or pen-
icillin in several months. Repeat echocardiogram
showed worsened panvalvular insufficiency with
moderately thickened mitral valve, severe mitral
regurgitation, and left ventricular dilation. He un-
derwent mitral valve leaflet extension with annular
ring placement, posteromedial commissuroplasty,
and aortic valve repair with cusp augmentation. At
routine follow-up six months afterwards, he was
found to be in asymptomatic atrial fibrillation with
3:1 conduction. He required synchronized car-
dioversion and is maintained on digoxin and fle-
cainide in addition to his diuretics. Table 2. World Heart Federation criteria for echocardiographic diagnosis
of RHD in individuals aged 20 years or younger (2)
Patient 2. A 15-year-old Marshallese girl pre-
sented with several weeks of progressive cough,
fatigue, exercise intolerance, lower extremity
edema, and orthopnea. She was tachycardic and
hypotensive with widened pulse pressure. After
fluid resuscitation she developed pulmonary ede-
ma requiring intubation. Echocardiogram showed
severe left atrial dilation, severe mitral valve insuf-
ficiency, and severe aortic valve insufficiency with
rolled edges of valve leaflets. The mitral valve had
a shortened posterior leaflet and a “hockey-stick”
anterior leaflet. Laboratory studies were