Background: Rheumatic heart disease (RHD) remains
a major public health problem in developing countries.
Whereas Africa has 10% of the world’s population, as many
as half of the 2.4 million children affected by RHD globally
live on the continent. RHD accounts for a major proportion
of all cardiovascular disease in children and young
adults in African countries. While acute rheumatic fever is
on the decline even in the developing world, there are still
a large number of chronic rheumatic heart disease cases,
often complicated by chronic congestive heart failure and
recurrent thrombo-embolic phenomena, both posing greater
challenges for management. We report on the prevalence
and pattern of valve involvement in RHD using echocardiography
from our centre.
Methods: In this retrospective study, transthoracic echocardiography
(TTE) data collected from two echocardiography
laboratories in Kano over a period of 48 months (June 2002
to May 2006) were reviewed. Patients with a diagnosis of
rheumatic heart disease were selected. Information obtained
from the records included the age, gender, clinical diagnosis
and echocardiographic diagnoses.
Results: A total of 1 499 echocardiographic examinations
were done in the two centres over the four-year study period.
One hundred and twenty-nine of the 1 312 patients (9.8%)
with abnormal results had an echocardiographic diagnosis
of RHD. There were 47 males and 82 females (ratio 1:1.7)
and their ages ranged from five to 60 (mean 24.02 ± 12.75)
years. Mitral regurgitation was the commonest echocardiographic
diagnosis present in 49 patients (38.0%). Thirty-six
(27.9%) patients had mixed mitral valve disease, 25 (19.5%)
had mixed aortic and mitral valve disease, 10 (7.8%) had
pure mitral stenosis and four (3.1) had pure aortic regurgitation.
Complications of RHD observed included secondary
pulmonary hypertension in 103 patients (72.1%), valvular
cardiomyopathy in 41 (31.8%), and functional tricuspid
regurgitation was seen in 39 (30.2%).
Conclusion: Our data show that RHD is still an important
cause of cardiac morbidity and a large proportion of the
patients already had complications at diagnosis. There is
an urgent need to implement the ASAP programme of the
Drakensberg declaration to avert this scourge.