title: Valvulopathies in sub-Saharan African children: patterns, humanitarian interventions and cardiac surgical problems.
abstract: Despite the high burden of rheumatic fever in sub-Saharan African, there is currently no sustained and comprehensive strategy to control the disease. Consequently in this area the number of patients affected by rheumatic valve disease (RVD), most with a surgical indication, is 10-20 fold higher than in industrialised countries and estimates indicate that more than 50% of African RVD patients will die before age 25. In this paper, we review clinical and management issues of RVD in children in sub-Saharan Africa. Severe heart failure and undergrowth are the prevalent presentation of the illness. Severe mitral regurgitation is the commonest rheumatic valvulopathy observed in the first and second decades. Valve repair, the approach of choice, may be associated with unfavourable outcomes in patients with extreme cardiomegaly. In young people, whenever correct anticoagulation may reasonably be achieved, mechanical mitral prostheses should be preferred, even in females. The early deterioration of biologic mitral prostheses strongly suggests limiting their use to those cases in which correct anticoagulation is not feasible. In most sub-Saharan countries, socioeconomic factors strongly limit access to health services and to cardiac surgery in particular. Efforts to overcome these barriers have resulted in humanitarian projects along two patterns: creation of high tech on site health care structures or transfer of children with complex diseases to receive highly specialised cardiac surgical care abroad. We summarise the experience of our programme that followed the latter approach.
authors.affiliation: Don Carlo Gnocchi Foundation, Rehabilitative Cardiology IRCCS Santa Maria Nascente Milan, Italy. mferratini@dongnocchi.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferratini
authors.forename: Stefano
authors.initials: S
authors.lastname: Marianeschi
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
authors.forename: Vittorino
authors.initials: V
authors.lastname: Ripamonti
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.forename: Anna
authors.initials: A
authors.lastname: Torri
authors.forename: Antonio
authors.initials: A
authors.lastname: Pezzano
authors.forename: Andrea
authors.initials: A
authors.lastname: Moraschi
authors.forename: Davide
authors.initials: D
authors.lastname: Tavano
authors.forename: Marilena
authors.initials: M
authors.lastname: Pesaresi
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
mesh_terms: D017954:Africa South of the Sahara / Q000208:ethnology; D000533:Altruism; D006348:Cardiac Surgical Procedures / Q000191:economics; D006349:Heart Valve Diseases / Q000191:economics / Q000208:ethnology* / Q000601:surgery*; D006801:Humans; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000191:economics / Q000208:ethnology* / Q000601:surgery*