Echocardiographic pattern and severity of valve dysfunction in children with rheumatic heart disease seen at Uganda Heart Institute, Mulago hospital.

Abstract

Abstract:Background: Rheumatic heart disease (RHD) is the commonest acquired heart disease in children worldwide but in Uganda, data is scarce regarding its morbidity and mortality. The disease has a progressive course and patients usually require valve repair/replacement in the future. Objectives:To describe the frequency of echocardiographic valvular dysfunction in children with RHD To explore the relationship between the severity of valvular dysfunction by the age and sex of the children with RHD Methods: Echocardiographic findings of children ≤15 years with RHD seen at Uganda Heart Institute from January 2007 to December 2011 were retrospectively analyzed. Results: 376 children had a diagnosis of RHD. The mean age of the children was 11.0±2.7 years and 216 (57.4%) were females. Mitral regurgitation was the commonest lesion seen in 98.9% (severe in 73.1%) of the children. Aortic regurgitation (AR) was found in 51.3% (severe in 7.2%), mitral stenosis (MS) was found in 10.6% (severe in 5.9%), tricuspid regurgitation was found in 86.7% (severe in 8.2%) while aortic stenosis was seen in 1.3% (severe in 0.3%). Severe AR was less common in females (OR=0.32, 95%CI 0.13-0.78) and children with MS were older than those without MS (12.7±2.0 Vs. 10.7±2.7 years, p<0.00). Conclusions: Mitral valve dysfunction was found in almost all the cases of RHD and majority of the children had severe valve disease at the time of their first presentations. Children with MS were predominantly above 10 years and severe AR was more common in males.

<p>Clinical, Echocardiographic Characteristics and Management Practices in Patients with Rheumatic Valvular Heart Disease</p>

“…This is comparable to a study done by Tadele et al from Ethiopia, where the mean mitral valve area was 1.1 ± 0.5 cm 2.20 Pulmonary hypertension was reported in 61.7% of patients. This is lower compared to the study by Lubega et al, 21 which was found in 77.4% of RHD children. The difference might be because of patients included in a study by Lubega et al were children aged ≤15 years.…”

Burden of Heart Diseases in Children Attending Cardiology Clinic in a Regional Referral Hospital in Uganda

“…Mitral regurgitation was the most frequent lesion among the valvular heart disease and there was associated left heart chamber dilatation in 44.8% of children. The predominance of MR was similar to studies done in Mozambique, Cambodia and at Mulago among RHD patients [15,16] There was a challenge of accessing referral services. Only 52% of 131 children referred arrived at the referral centre.…”

Pediatric cardiovascular care in Uganda

“…Rheumatic heart disease (RHD) is the most common acquired heart disease among children, accounting for about 45.5% of all acquired heart disease of all cases seen in the UHI, followed by dilated cardiomyopathy (22.4%) and pericarditis (8.8%). [8] Outpatient attendance shows a decreasing trend in the number of patients with endomyocardial fibrosis though it represented 7.1% of all acquired heart diseases in children seen between 2007 and 2014. [7]…”

“…[8] Most children present late with advanced disease, multiple valve involvement, and the development of complications. [810] Using the 2012 WHF criteria for diagnosis, the RHD prevalence rate in primary school children aged 5–15 ranges between 1.5% (Kampala) and 4% (Gulu) – with prevalence of “definite” RHD between 0.5% (Kampala) and 1.5% (Gulu) among primary school children.…”

“…[8] Most children present late with advanced disease, multiple valve involvement, and the development of complications. [810] Using the 2012 WHF criteria for diagnosis, the RHD prevalence rate in primary school children aged 5–15 ranges between 1.5% (Kampala) and 4% (Gulu) – with prevalence of “definite” RHD between 0.5% (Kampala) and 1.5% (Gulu) among primary school children. [11] With a population of 34.6 million and 30.2% of the population aged 5–14 years, it is estimated that as many as 50,000–150,000 of children in this age group in the country have definite RHD needing long-term care.…”