Pattern of Valvular Involvement in Rheumatic Heart Disease in Twoo Cardiology Center in Khartoum

Abstract

Rheumatic heart disease remains a leading cause for morbidity and mortality from cardiac diseases in Sudan. The objectives of this study were to describe the pattern of valvular involvement in patients with RHD, correlate the pattern of valvular involvement to the course of the disease and study the correlation between the social impact on the child and family to the pattern and severity of the valvular lesion. A cross – sectional hospital based study was conducted on three days a weak basis from the period of 24th of June to 24th of November 2003 in Ahmed Gasim Teaching Hospital and Al Shaab Teaching Hospital. One hundred cases with documented RHD were studied, full history, through examination and Doppler echocardiography were done for each child. The result showed that RHD was confined mainly to rural and periurban areas (in 94% of cases), with poor housing conditions and overcrowding. The number of persons/room was 6-15 in nearly two thirds of the cases. Most of the cases (93%) had mitral valve involvement : in form of MR in 36 cases, MS in nine cases, MR + AR in 23 cases, MR + MS in 15 cases, MR + MS + AR + AS in eight cases and MS + AS in two cases. There was no significant relationship between history of rheumatic fever and the severity of valvular involvement (P=0.202), while there was strong association between irregularity in prophylaxis and development of complications like pulmonary hypertension (P<0.001) and significant haemodynamic changes on the heart. Almost half of the cases (51%) had either pulmonary hypertension, severe lesions and significant haemodynamic changes on the heart, putting them as candidates for surgery with the hazards of complications of prosthetic valves in such a group of children living away from sophisticated medical services. There was a significant burden on the families and their children as almost all the families (98%) were affected by the money spent on treating their of children and two thirds of children had limited activities at home and school. We recommend improvement of housing conditions, early detection of cases with RHD and regular use of prophylaxis as it might be the only intervention that could be realistically implemented and cost effective.