Rheumatic valvulopathies occurence, pattern and follow-up in rural area: the experience of the Shisong Hospital, Cameroon.

UNLABELLED

Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, broadly as many as half of the 2.4 million children affected by RHD live on the continent. We report on the occurrence and pattern of valve involvement in RHD using echocardiography in our centre and post surgical follow-up.

METHODS

In this retrospective study, transthoracic echocardiography (TTE) data collected from the Shisong cardiac centre over a period of 24 months (August 2005 to August 2007) were reviewed. Patients with a precordial murmur were selected. A total of 262 echocardiographic examinations were done in the centre over the two-year study period. The screening allowed us to see two categories of patients: 169 (64.5%), 79 male and 90 female, out of the 262 patients with abnormal results had an echocardiographic diagnosis of RHD, 80 (30.5%) patients had congenital heart disease. The 13 (5%) patients left had innocent murmur. Mitral valve regurgitation was the commonest echocardiographic diagnosis present in 101 patients (59.7%). Thirty-six (13.7%) patients had mixed mitral valve disease, 40 (23.7%) had mixed aortic and mitral valve disease, 42 (25%) had pure mitral stenosis and 26 (15.3%) had pure aortic regurgitation. The complications of RHD being observed included secondary pulmonary hypertension in 20 patients (11.8%) and functional tricuspid regurgitation was seen in 39 (21.9%). The congenital heart disease were: tetralogy of Fallot 29.1%, isolated ventricular septal defect 62.5%, isolated atrial septal defect 3.2%, atrioventricular canal 1.1%, patent ductus arteriosus 2.2%, common arterial trunk 1.9%. Our data showed that in children above 10-years-old in rural zone of Cameroon presenting with a precordial murmur RHD has to be suspected. Acute rheumatic fever primary and secondary prevention as well as rheumatic fever registers are important for the disease eradication in our countries. More surgical centres for a better management of the RHD complications are needed in sub-Saharan Africa. Due to poverty and illiteracy of parents, the post surgical follow up of patients is challenging.