Diagnosis of RHD:
To assess the echocardiographic RHD prevalence (including clinical and
subclinical cases), we used the 2012 World Heart Federation (WHF)
criteria (the Doppler and the morphological criteria) for diagnosis
(10). Only left-sided valves were examined for features of rheumatic
heart disease; mild tricuspid regurgitation and pulmonary regurgitation
were frequently noted but were not regarded as indicating rheumatic
heart disease. For a definite diagnosis of rheumatic heart disease,
these features had to be identified concordantly by each of the
echocardiographers. According to the 2012 WHF criteria; subjects were
classified into definite RHD, borderline (equivocal) RHD or non-RHD
(normal). Children with a definite RHD were reported and referred to a
specialized clinic in Suez Canal University Hospital for further
follow-up and possible intervention.