title: Children with post-rheumatic valvulopathies in natural history: five years follow-up in the cardiac centre, St. Elizabeth Catholic General hospital Shisong (Cameroon).
abstract: The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in five years follow-up in children with post-rheumatic valvulopathies in natural history in St. Elizabeth Catholic General hospital Shisong, cardiac centre. This retrospective analysis included 270 patients aged between 5 and 16 years old suffering from post-rheumatic valvulopathies who consulted in the cardiac centre from July 2008 through July 2013. Postrheumatic valvulopathies were diagnosed according to the World heart federation criteria. Data from patients' records, two-dimensional echocardiographic studies, and electrocardiograms were reviewed. Patients and their family were contacted every six months. The duration of the follow-up was 60months. Patients aged between 5 and 16 years old with a mean age of 12.4±4.5 years. Female gender was representing 63% (n=170) of the population. Surgery was indicated in 256 cases. Lesions of the valves needing prophylaxis with penicillin was diagnosed in 14 cases. In 95 patients surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 61.5%, n=164 patients; 38.5%, n=103 patients had aortic regurgitation. Mitral stenosis and mitral disease were also represented in 6%, n=16, and 8%, n= 21 patients respectively. Pulmonary hypertension was the common echocardiographic complication of the disease in=234, 87% of cases. Clinically, complications of the disease included congestive heart failure (n=229, 85%), growth retardation (n=162, 60%), sudden death (n=27, 10%). On presentation, n=210, 78% of cases were admitted. Mortality in two years was 35%, (p≤0.05, 95% CI=2.5-6.5), in five years was 65% (p≤ 0.05, 93% CI= 2.7-7.21). The challenges faced are patients' negligence and poor discipline, wrong beliefs, poverty. Post-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow up of patients is difficult.
authors.affiliation: Centre cardiaque de l'hôpital catholique Sainte Elisabeth de Shisong, P.O. Box 8, Kumbo, Cameroun. tantchouj@yahoo.fr.
authors.forename: J C
authors.initials: JC
authors.lastname: Tantchou Tchoumi
authors.affiliation: Centre cardiaque de l'hôpital catholique Sainte Elisabeth de Shisong, P.O. Box 8, Kumbo, Cameroun.
authors.forename: J C
authors.initials: JC
authors.lastname: Ambassa
authors.affiliation: Departement de chirurgie cardiaque, Istituto Policlinico San Donato, IRCCS Via Morandi 30, 20097, San Donato Milanese, Milan, Italie.
authors.forename: G
authors.initials: G
authors.lastname: Butera
mesh_terms: D000293:Adolescent; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D046688:Child Mortality; D002675:Child, Preschool; D003469:Culture; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000453:epidemiology*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000453:epidemiology*
keywords: Cameroon; Children; Hospital; Mortality; Post-rheumatic valvulopathy; Shisong; Sub-Saharan Africa