Children with post-rheumatic valvulopathies in natural history: Five years follow-up

Abstract

Rheumatic heart disease is the most important sequelae of acute rheumatic fever, which is caused by group A streptococci and usually presents in childhood, affecting 5 to 14 years old although it can strike people up to the age of 30. In poor and developing nations, it remains a major cause of morbidity and premature death, imposing a substantial burden on healthcare systems with limited budgets. The aim of the study was to investigate the pattern of lesions, the mortality and the challenges in five years follow-up in children with post rheumatic valvulopathies in natural history in the Cardiac Centre Shisong. This retrospective analysis included 270 patients aged between 5 and 16 years old having post rheumatic valvulopathies from July 2008 through July 2013. Data from patients’ records, two-dimensional echocardiographic studies, electrocardiogram were reviewed. Patients aged between 5 and 16 years old with a mean age of 12.4 ± 4.5 years. Female gender was representing 63% (n = 170) of the population. In 95 patients surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 61,5%, n = 164 patients; 38.5%, n = 103 patients had aortic regurgitation. Clinically, complications of the disease included congestive heart failure (n = 229, 85%), growth retardation (n = 162, 60%), sudden death (n = 27, 10%). Mortality in two years was 35%, (P ≤ 0.05, 95% CI = 2.5–6.5), in five years was 65% (P≤0.05, 93% CI = 2.7–7.21). The challenges faced are patients’ negligence and poor discipline, wrong beliefs, poverty. Post-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow-up of patients is difficult.