Problems faced in the surgical management of rheumatic heart disease in Nepal

Abstract

Rheumatic heart disease (RHD) is a very common cardiac disease in Nepal. The public awareness among Nepalese population is negligible, therefore it is seen in very early age and in severe form. The majority of the patients are of low socio-economical condition, who cannot afford expensive valve replacement surgery. All these facts create a daunting problem in the surgical management of the disease for the newly established open heart surgery unit. The first regular open heart surgery in Nepal was started on 20 February 1997 in Tribhuvan University teaching Hospital (TUTH), Kathmandu. Closed heart surgery was the only procedure available for isolated mitral stenosis in the past. Since 1997 in three years, a total of 285 cases of RHD were referred for surgery. Male to female ratio was 1.1:1.0. The youngest patient was 3 years and oldest 58 years with a mean age of 30 years. There were 32 patients (11%) under the age of 16 years. The isolated mitral valve disease was found in 195 cases (68%), aortic valve disease in 28 cases (10%) and double valve disease in 62 cases (22%). In the mitral valve disease, severe subvalvular fusion and calcification were found in 101 (52%) and 76 patients (39%) respectively, whereas closed mitral commissurotomy (CMC) was possible in only 69 patients (35%). In 3 years, 104 cases of valve surgeries were performed at TUTH. CMC was perfomed in 55 cases whereas open heart surgery in 49 cases of RHD patients. Here we present our difficulties in beginning regular open heart surgery in Nepal and the problems faced by our patients.