{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:40:37Z","timestamp":1789576837771,"version":"build-2803163510"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1047951126113316_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Acute rheumatic fever (ARF) with severe carditis remains a major cause of non-procedural pediatric cardiology admissions in low- and middle-income countries. Data describing the clinical profile and outcomes of children with severe carditis are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113316_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective study included 100 children admitted with ARF and severe carditis between 2015 and 2022. Clinical presentation, severity of shock, valvular involvement, ventricular function and management strategies were documented. Outcomes studied included requirement of inotropes, mechanical ventilation, duration of intensive care and hospital stay, intractable heart failure, mortality and need for surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113316_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Children were categorized into three groups according to hemodynamic severity. The duration of anti inflammatory treatment was 12 weeks. Group A included 18 children with decompensated shock, severe regurgitation of at least two valves and biventricular dysfunction. These children received pulse methylprednisolone followed by oral prednisolone, inotropes, diuretics and afterload reduction. Intractable heart failure was noted in 9 (50%) with a mortality of\u00a04 (24%) and 5 (28%) requiring emergency surgery. Group B included 32 children with compensated shock and preserved ventricular function. They were treated with oral prednisolone tapered with addition of aspirin. Group C included 50 children without shock or ventricular dysfunction and treated with aspirin. Sixteen and ten children underwent surgery during one year follow-up in groups B and C respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113316_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Severe rheumatic carditis continues to cause substantial morbidity and mortality in children. Recurrent disease and multivalvular involvement are associated with poor outcomes. Early recognition, strict secondary prophylaxis and strengthened public health strategies are essential to reduce disease burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1047951126113316","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:53:34Z","timestamp":1782212014000},"page":"1162-1169","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Severe rheumatic carditis in children: clinical profile and outcomes from a prospective Indian cohort"],"prefix":"10.1017","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4219-5067","authenticated-orcid":false,"given":"Sowmya","family":"Kasturi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h7p4v21","id-type":"ROR","asserted-by":"publisher"}],"name":"Sri Jayadeva Institute of Cardiovascular Sciences and Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Marimuthu","sequence":"additional","affiliation":[{"name":"Sri Jayadeva Institute of Cardiovascular Sciences and Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3842-4410","authenticated-orcid":false,"given":"Priyadarshini","family":"Arunakumar","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h7p4v21","id-type":"ROR","asserted-by":"publisher"}],"name":"Sri Jayadeva Institute of Cardiovascular Sciences and Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7147-3732","authenticated-orcid":false,"given":"Anand","family":"Subramanian","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h7p4v21","id-type":"ROR","asserted-by":"publisher"}],"name":"Sri Jayadeva Institute of Cardiovascular Sciences and Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayranganath","family":"Mahimarangaiah","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h7p4v21","id-type":"ROR","asserted-by":"publisher"}],"name":"Sri Jayadeva Institute of Cardiovascular Sciences and Research"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"S1047951126113316_ref6","first-page":"438","article-title":"Sequelae of the initial attack of rheumatic fever","volume":"49","author":"Sanyal","year":"1974","journal-title":"Circulation"},{"key":"S1047951126113316_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-016-0773-2"},{"key":"S1047951126113316_ref11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39031.420637.BE"},{"key":"S1047951126113316_ref13","first-page":"179","article-title":"Training community healthcare providers for secondary prevention of rheumatic heart 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carditis","volume":"20","author":"Torres","year":"2000","journal-title":"Ann Trop Paediatr"},{"key":"S1047951126113316_ref16","first-page":"30","article-title":"Rheumatic heart disease in Uganda: the association between secondary prophylaxis and disease progression","volume":"17","author":"Okello","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"S1047951126113316_ref2","first-page":"100008","article-title":"SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies","volume":"1","author":"Naidu","year":"2021","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"S1047951126113316_ref7","first-page":"27","article-title":"Long-term follow-up of children with acute rheumatic fever and rheumatic heart disease using 2D echocardiography and Doppler echocardiography: the Indian Council of Medical Research\u2019s Rheumatic Heart Disease Registry","volume":"74","author":"Saxena","year":"2022","journal-title":"Indian Heart 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