[Inflamatory heart diseases in childhood lebanese epidemiological study]

ABSTRACT

To study the frequency, prevalence, clinical presentation, management and out come of inflammatory heart diseases [IHD] in Lebanese children. Prospective survey of a group of children carriers [or at high risk] of an IHD [n 156] recorded over a period of six years, between May 1[st], 1999, and April 30[th], 2005, at the National Register of Paediatric and Congential Heart Disease, Lebanese Society of Cardiology. The diagnosis was confirmed in all cases by echocardiography. Cases related to cardiac surgery were excluded. Acute rheumatic fever [ARF] is the most frequent pathology 35.9%, followed by Kawasaki disease [KD] 24.4%, dilated cardiomyopathy [DCM] 22.4% pericardial effusion 10.9% and finally infective endocarditis [IE] 6.4%. There is a seasonal predominance for the ARF and KD during fall and early spring. Consanguineous marriage of first degree dosen't seem to be a factor predisposing for ARF and KD. ARF with carditis benefited from steroids with partial to total regresstion in 41/45 patients [91%], two patients under went valve repair or replacement, another patient died from severe pancarditis. All children affected with KD [except 2 cases] received IV immunoglobulins [2 g/kg, single dose], and coronary aneurysms were observed in 2 patients [5.3%]. Patients with DCM in whom there was a strong suspicion of viral myocarditis, were treated medically with complete recuperation of the cardiac function in 88% of cases. Among the patients with pericardial effusion, 3 needed urgent drainage because of a tamponnade. A child with IE was operated of his mitral valve and another one with cerebral palsy had a fatal outcome. No case of cardiac disease associated with HIV infection was found. In Lebanon, ARF remains the main cause of IHD during childhood, before KD. Currently, non-surgical treatments are highly efficient. Delayed diagnosis increased morbidity. Efforts are necessary for early recongnition and primary prevention