An echocardiographic study of Rheumatic Heart Disease amongst children in a Tertiary Centre
Background: Rheumatic Heart Disease (RHD) is a major form of acquired heart disease amongst children in developing countries, where it continues to be a cause of childhood morbidity and mortality.
Objective: To describe the prevalence and spectrum of valvular affectation in children with RHD from the echocardiography laboratory.
Methods: The records of echocardiographic scans conducted over a 10-year period in a tertiary health facility were reviewed. Children with RHD, diagnosed using standard criteria were identified. The pattern and severity of valvular involvement and other associated cardiac abnormalities were recorded.
Results: Forty-one of the 2742 (1.5%) children who had echocardiography had RHD. Their mean age was 10.9±3.1 years; 28 (68.3%) were aged ≥10 years while 21 (51.2%) were males. Mitral valve was the predominantly affected valve in 40 (97.6%) children and mitral regurgitation was the commonest valvular abnormality in 19 (46.3%) cases. Nineteen (46.3%) had severe valvular damage, 5 (12.2%) had pericardial effusion while 7 (17.1%) died. Only 2 (4.9%) children had valvular repair surgery.
Conclusion: Although the prevalence of RHD in this study is low, it is noteworthy that RHD still affects Nigerian children. The poor access to surgery emphasizes the need to strengthen both primary and secondary prevention of RHD while enhancing facilities for surgical intervention.
Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet 2005; 380: 2095–128.
Zuhlke L, Karthikeyan G, Engel M, Rangarajan S, Mackie P, Mauff BC, et al. Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low-and middle-income countries: two-year follow up of the global rheumatic heart disease registry (the REMEDY study). Circulation 2016; 134: 1456–1466.
Saidu H, Sani MU, Mijinyawa MS. Echocardiographic pattern of heart diseases in a North-Western Nigerian tertiary institution. Niger J Basic Clin Sci 2015; 12: 39–44.
Sadoh WE, Uzodimma C, Daniel Q. Childhood acquired heart disease in Nigeria: an echocardiographic study from three centres. Afr Health Sci 2014; 14: 602–609.
Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, regional and national burden of rheumatic heart disease 1990 – 2015. New Engl J Med 2017; 377: 713–722.
Gordis L. The virtual disappearance of rheumatic in the United States: lessons in the rise and fall of the disease. Circulation 1985; 72: 1155.
Ebong RD. Environmental health knowledge and practice survey among secondary school children in Zaria, Nigeria. Environ Health Perspect 1994; 102: 310-312
Bode-Thomas F, Ige OO, Yilgwan C. Childhood acquired heart diseases in Jos, Northcentral Nigeria. Niger Med J. 2013; 54: 51-58.
Henry WL, DeMaria A, Gramiak R, King DL, Kisso JA, Popp RL, et al. Report of the American Society of Echocardiography (ASE) Committee on the nomenclature of and standards in the two-dimensional echocardiography. Circulation 1980; 62: 212–217.
Sahn DJ, DeMaria A, Kisslo J, Weyman A. The committee on the M-mode standardization of the American Society of echocardiography recommendations regarding quantification in M-mode echocardiography, results of a survey of echocardiography measurements. Circulation 1978; 58: 1072–1083.
Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantifications of the Doppler echocardiography. A report from the Doppler quantification Task Force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 167–184.
Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al. World heart federation criteria for the echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297–309.
Bonow RO, Carabello BA, Kanu C, Chatterjee K, de Leon AC Jr, Faxon DP, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (writing committee to revise1998 guideline for the management of patients with valvular heart disease): developed in collaboration with the society of cardiovascular anaesthesiologists; endorsed by the society of cardiovascular angiography and interventions and the society of thoracic surgeons. Circulation 2006; 114: e84–e231.
Galie N, Hoeper MM, Humbert M, Torbicki A, Vadiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European respiratory society (ERS) endorsed by the international society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30: 2493–2537.
Omokhodion SI, Okolo CM, Obetoh C, Abowheyere J. Proposed severity index score (SIS) scheme for childhood heart failure. Abstract of the 4th world congress of heart failure: mechanism and management, Jerusalem, Israel, May 26 – 29 1996. J Cardiac Failure 1996; 3: Abstract 763.
Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in a developing country. West Afr J Med 1985; 4: 205-212.
Sani UM, Karaye KM, Borodo MM. Prevalence and pattern of rheumatic heart diseases in Nigerian Savannah: an echocardiographic study. Cardiov J Afri 2007; 18: 295–299.
Sadoh WE, Omokhodion SI. Streptococcal throat isolates in school children in an urban centre in Nigeria: are there other rheumatogenic strains. Niger J Cardiol 2006; 3: 22–26.
Owobu A, Sadoh WE, Oviawe O. Streptococcal throat carriage in a population of nursery and primary school pupils in Benin City. Niger J Paediatr 2013; 40: 389–394.
Uzodimma CC, Dedeke FI, Nwadike V, Owolabi O, Arifalo G, Oduwole O. A study of Group A streptococcal pharyngitis among children 3 – 15 years old children attending clinics for an acute sore throat. Niger J Cardiol 2017; 14: 97–102.
Sadoh WE, Israel-Aina Y, Omuemu C. Prevalence of rheumatic heart disease in primary school pupils in mid-Western Nigeria. East Afr Med J 2012; 90: 21–25.
Sadoh WE, Akinsete AM. Physicians’ management of sore throat in Benin City, Nigeria. Niger J Clin Pract 2009; 12: 407–411.
Sadoh WE, Sadoh AE, Eki-Udoko FE. Parental contribution to over-prescription of antibiotics for sore throat in children. Niger J Paediatr 2015; 42: 98–102.
Guilherme L, Ramasawmy R, Kalil J. Rheumatic fever and rheumatic heart disease: genetics and pathogenesis. Scand J Immuno 2007; 66: 199–207.
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