title: Proportion of patients in the Uganda rheumatic heart disease registry with advanced disease requiring urgent surgical interventions.
abstract: BACKGROUND
  Since the establishment of the Uganda Rheumatic Heart Registry, over 900 patients have been enrolled. We sought to stratify the patients in the registry according to disease severity and optimal management strategy.
  
  
  METHODS
  We reviewed data of 618 patients who had enrolled in the Registry between March 2010 and February 2013. The 67 patients who had died were excluded leaving 551 patients who were recruited. The optimum management strategy was determined according to the 2012 European Society of Cardiology guidelines on the management of valvular heart disease.
  
  
  RESULTS
  Out of the 551 patient's records evaluated, 398 (72.3%) required invasive intervention, with 332(60.3%) patients requiring surgery and 66 (12.0%) requiring percutaneous mitral commissurotomy (PMC). This leaves only 27.7% of patients who required only medical management. Currently, majority of the patients (498, 90.4%) in the registry are on medical treatment. Of the 60.3% requiring surgical intervention, only 8.0% (44 patients) underwent valvular surgery and 5(1.0%) patients of the 66 (12.0%) underwent PMC successfully.
  
  
  CONCLUSIONS
  There is a high proportion of patients with severe disease that require surgical treatment yet they cannot access this therapy due to absence of local expertise.
authors.affiliation: Uganda Heart Institute, Cardiology.
authors.forename: WanZhu
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Uganda Heart Institute, Cardiology.
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.affiliation: Uganda Heart Institute.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nyakoojo
authors.affiliation: Uganda Heart Institute, Cardiology.
authors.forename: Peter
authors.initials: P
authors.lastname: Lwabi
authors.affiliation: Mulago Hospital, Medicine, Division of Cardiology.
authors.forename: Charles K
authors.initials: CK
authors.lastname: Mondo
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents
keywords: Rheumatic Heart Disease; percutaneuos intervention; surgical intervention