Roentgen ray therapy in rheumatic heart disease.

Abstract

In the course of rheumatic fever, cardiac involvement is frequent and constitutes the chief menace of the disease. No method is known whereby affection of the heart may be effectually prevented. Nor has it been possible significantly to modify the progressive character of the lesions initiated in the structures of the heart by the rheumatic process. These lesions are of two kinds: (1) exudative, representing the reaction to acute infection or intoxication and appearing characteristically in the myocardium as Aschoff bodies; (2) proliferative, the latter denoting attempts at healing, with the formation of scar tissue.

There are reasons for believing that roentgen rays, in suitable doses, might be expected to exercise an effect upon rheumatic lesions in the heart. Radiotherapy has been successfully employed in the treatment of certain low-grade infections and is now standard practice in the management of tuberculous lymphadenitis and acne. Even more acute inflammatory conditions, such as carbuncles and furuncles, are usually favorably influenced. The result of the treatment appears to be an increase in the local resistance to the invading organisms, but the mechanism by which this is brought about is not understood.

Another well-known effect of roentgen therapy is its action upon scar tissue. Cicatrices of the skin become softer and more flexible after irradiation and keloids may be greatly reduced in size. Hence, the possibility was considered that the physical condition of thickened, stiff valve leaflets might be altered. However, the dose necessary to modify cicatricial tissue is greater than that used in the treatment of infections and the time required for the change to appear is much longer. It is probable that this effect played no rôle in the results now reported. It is a problem which we propose to investigate.