Epidemiological Approach to Understand Rheumatic Heart Valve Disease: Case of Thoracic Cardiovascular Clinic of Fann Hospital (Dakar)

Abstract

Objective: Rheumatic heart disease is the major cause of heart valve disease in developing countries. In Senegal, cardiac pathology is dominated by rheumatic pathology whose hospital prevalence was estimated at 0.15% [1]. Epidemiological data on rheumatic heart valve disease (RHVD) are unfortunately imprecise due to the lack of good quality data collection in a large number of countries, especially in sub-Saharan areas and in Central Asia. The objective of this epidemiological study is to collect data about rheumatic heart valve disease in our clinic which is the only surgical center of Senegal. Patients and Methods: Our study conducted between 2014 and 2017 involved a population of one hundred and eighty-three patients with complete medical records, all followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital for rheumatic valve disease. This population was the subject of an epidemiological survey based on a questionnaire covering clinical parameters as consanguinity, clinical signs, diagnosis and surgical intervention. Results: Our work is an epidemiological study involving one hundred and eighty-three (183) patients with various types of rheumatic valve disease, followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital, and who responded to a questionnaire about clinical aspects of this disease. Our results showed 5.46% of family cases, of which 2.18% came from consanguineous marriages. Mean age at onset of clinical signs was 14 ± 9 years with 14.20% before 6 years of age, 65.91% between 6 and 21 years and 19.89% in adulthood. Average age of diagnosis was 21 ± 11 years with an average delay between diagnosis and intervention of 10 years ± 14. Mitral stricture (22.5%) was the most common diagnosis, followed by mitral disease (17.9%) and mitral regurgitation (6.9%). Surgical procedures involved 31.8% of mitral valve, 8.79% of aortic valve, 12.09% of mitral and aortic valves, 13.74% of mitral and tricuspid valves, 2.75% of 3 valves mitral, aortic and tricuspid. 27.49% of patients were awaiting surgery. Conclusion: It appears that a considerable effort should be made to prevent the pathology, to make population aware of the clinical signs and to improve the accessibility of patients to surgical procedure. These different actions would reduce the incidence and prevalence of the disease in Senegal.