Delayed gadolinium enhancement in the atrial wall: a novel finding in 3 patients with rheumatic heart disease.

Carditis is a well-recognized finding in rheumatic heart disease and is one of the major criteria in the diagnosis of rheumatic fever. Cardiovascular magnetic resonance with gadolinium enhancement has been used in the evaluation of several disease entities, most commonly in the imaging of myocardial infarctions. We retrospectively evaluated cardiovascular magnetic resonance studies within our institution to identify patients with rheumatic heart disease. Herein, we report the cases of 3 patients who had clinical and imaging findings of rheumatic heart disease, and in whom cardiovascular magnetic resonance revealed delayed gadolinium enhancement in the walls of 1 or both atria. In 1 patient, the delayed enhancement was also evident in both atrioventricular valves.To our knowledge, this is the 1st report of atrial-wall or atrioventricular-valve delayed gadolinium enhancement in the presence of rheumatic heart disease. Further studies may clarify whether atrial delayed gadolinium enhancement is seen in rheumatic heart disease more often than in other diseases that cause atrial fibrillation, and the diagnostic and prognostic significance of such a finding.