Mapelli Massimo, Zagni Paola, Calbi Valeria, Fusini Laura, Twalib Aliku, Ferrara Roberto, Mattavelli Irene, Alberghina Laura, Salvioni Elisabetta, Opira Cyprian, Kansiime Jackson, Tamborini Gloria, Pepi Mauro, Agostoni Piergiuseppe
Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy.
Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy.
Children (Basel). 2022 Sep 23;9(10):1451. doi: 10.3390/children9101451.
Rheumatic heart disease (RHD) is a major cause of cardiovascular disease in developing nations, leading to more than 230,000 deaths annually. Most patients seek medical care only when long-term structural and hemodynamic complications have already occurred. Echocardiographic screenings ensure the early detection of asymptomatic subjects who could benefit from prophylaxis, monitoring and intervention, when appropriate. The aim of this study is to assess the feasibility of a screening program and the prevalence of RHD in a Ugandan orphanage.
We performed an RHD-focused echocardiogram on all the children (5-14 years old) living in a north Ugandan orphanage. Exams were performed with a portable machine (GE Vivid-I). All the time intervals were recorded (minutes).
A total of 163 asymptomatic children were screened over 8 days (medium age 9.1; 46% male; 17% affected by severe motor impairment). The feasibility rate was 99.4%. An average of 20.4 exams were performed per day, with an average of 15.5 images collected per subject. Pathological mitral regurgitation (MR) was found in 5.5% of subjects, while at least two morphological features of RHD were found in 4.3%, leading to 1 "definite RHD" (0.6%) case and 13 "borderline RHD" cases (8.1%). Six congenital heart defects were also noted (3.7%): four atrial septal defects, one coronary artery fistula and one Patent Ductus Arteriosus.
We demonstrated the feasibility of an echocardiographic screening for RHD in an orphanage in Uganda. A few factors, such as good clinical and hygienic care, the availability of antibiotics and closeness to a big hospital, may account for the low prevalence of the disease in our population.
风湿性心脏病（RHD）是发展中国家心血管疾病的主要病因，每年导致超过23万例死亡。大多数患者仅在长期结构和血流动力学并发症已经出现时才寻求医疗护理。超声心动图筛查可确保早期发现无症状个体，这些个体在适当的时候可从预防、监测和干预中获益。本研究的目的是评估乌干达一家孤儿院筛查项目的可行性以及风湿性心脏病的患病率。
我们对居住在乌干达北部一家孤儿院的所有儿童（5至14岁）进行了以风湿性心脏病为重点的超声心动图检查。使用便携式机器（GE Vivid - I）进行检查。记录所有时间间隔（分钟）。
在8天内共筛查了163名无症状儿童（中位年龄9.1岁；46%为男性；17%患有严重运动障碍）。可行性率为99.4%。每天平均进行20.4次检查，每个受试者平均采集15.5张图像。5.5%的受试者发现病理性二尖瓣反流（MR），而4.3%的受试者发现至少两种风湿性心脏病的形态学特征，导致1例“确诊风湿性心脏病”（0.6%）和13例“临界风湿性心脏病”病例（8.1%）。还发现了6例先天性心脏病（3.7%）：4例房间隔缺损、1例冠状动脉瘘和1例动脉导管未闭。
我们证明了在乌干达一家孤儿院进行超声心动图筛查风湿性心脏病具有可行性。一些因素，如良好的临床和卫生护理、抗生素的可获得性以及靠近大医院，可能是我们研究人群中该病患病率较低的原因。
