Rwebembera Joselyn, Manyilirah William, Zhu Zhang Wan, Nabbaale Juliet, Namuyonga Judith, Ssinabulya Isaac, Lubega Sulaiman, Lwabi Peter, Omagino John, Okello Emmy
Uganda Heart Institute, Kampala, Uganda.
School of Medicine Makerere University, Kampala, Uganda.
BMC Cardiovasc Disord. 2018 May 4;18(1):82. doi: 10.1186/s12872-018-0813-5.
Although rheumatic heart disease remains the leading cause of valve heart disease (VHD) in developing countries, other forms of valve disease have been over shadowed and not regarded as a public health problem. However, several facts suggest that the role of non-rheumatic VHD as a significant cardiovascular disease should be reconsidered. We aimed to assess the prevalence and characteristics of different forms of primary left sided valve diseases from a series of 15,009 echocardiographic studies.
This was a retrospective review of echocardiographic reports for studies performed between January 2012 and December 2013 (24 months) at Uganda Heart Institute. All patients with primary left-sided valve disease were classified into one of five major diagnostic categories and in each diagnostic category; patients were sub-classified into stages A-D of primary valve disease as defined by the American College of Cardiology.
Three thousand five hundred eighty-two echocardiography reports qualified for final data analysis. The "sclerotic valve changes with normal valve function", a Stage A sub-class of "degenerative valve disease" overwhelmingly overshadowed all the other diagnostic categories in this stage. "Rheumatic Heart Disease", "Degenerative Valve Disease", "Bicuspid Aortic Valve", "Mitral Valve Prolapse" and "Endomyocardial Fibrosis" diagnostic categories accounted for 53.0%, 41.8%, 2.2%, 1.4% and 1.7% respectively in stages B-D of primary VHD. Rheumatic heart disease disproportionately affected the young, productive age groups. It was the major risk factor for infective endocarditis; and was the indication for valve surgery in 44 of 50 patients who had undergone valve replacement procedures.
We acknowledge that rheumatic heart disease remains a leading cause of progressive and severe primary left-sided valve disease among young adults in Uganda. But we bring to light the contemporary footprints of other forms of primary valve disease that require coordinated multidisciplinary approach to research, education and clinical management to ensure improved patient outcomes.
尽管风湿性心脏病仍是发展中国家瓣膜性心脏病（VHD）的主要病因，但其他形式的瓣膜疾病却被忽视，未被视为公共卫生问题。然而，有几个事实表明，非风湿性VHD作为一种重要的心血管疾病，其作用应重新审视。我们旨在通过一系列15009例超声心动图研究评估不同形式的原发性左侧瓣膜疾病的患病率及特征。
这是一项对乌干达心脏研究所2012年1月至2013年12月（24个月）期间进行的研究的超声心动图报告的回顾性分析。所有原发性左侧瓣膜疾病患者被分为五个主要诊断类别之一，在每个诊断类别中，患者再根据美国心脏病学会定义的原发性瓣膜疾病的A - D期进行细分。
3582份超声心动图报告符合最终数据分析要求。“瓣膜功能正常的硬化性瓣膜改变”，即“退行性瓣膜疾病”的A期亚类，在该阶段远远超过所有其他诊断类别。在原发性VHD的B - D期，“风湿性心脏病”“退行性瓣膜疾病”“二叶主动脉瓣”“二尖瓣脱垂”和“心内膜纤维化”诊断类别分别占53.0%、41.8%、2.2%、1.4%和1.7%。风湿性心脏病对年轻、有生产力的年龄组影响尤为严重。它是感染性心内膜炎的主要危险因素；并且是50例接受瓣膜置换手术患者中44例进行瓣膜手术的指征。
我们承认风湿性心脏病仍是乌干达年轻成年人中进行性和严重原发性左侧瓣膜疾病的主要病因。但我们揭示了其他形式原发性瓣膜疾病的当代特征，这些疾病需要通过多学科协调的方法进行研究、教育和临床管理，以确保改善患者预后。
