Rheumatic fever and valvular heart disease in four developing countries: an update

Rheumatic fever and rheumatic disease in the four developing countries of Saudi Arabia, Yemen, Sudan and Mauritius, has a relentless, malignant and accelerated course with significant morbidity and mortality. Children and young pre-teenage adults are affected most. Severe cardiac and valvular rheumatic pathological changes are usually found, which often make valve replacement necessary. Implantation of a prosthetic cardiac value in developing countries is associated with many potential complications. Infective endocarditis of native or prosthetic valves has a higher rate than seen in the West. Rheumatic activity found in patients presenting with N.Y.H.A. functional class IV and congestive heart failure, pulmonary edema or low cardiac output remains a serious practical problem with great morbidity and mortality in such countries. Cardiac surgery aims towards a valve preserving, reconstructive procedure, rather than a valve replacing procedure, as the majority of such patients are young. Primary and secondary prevention of rheumatic fever and rheumatic heart disease respectively must be urgently reorganized and optimised in these countries. Our experience with more than 2500 patients, seen, evaluated and operated upon in Saudi Arabia, Yemen, Sudan and Mauritius is analyzed and described and the epidemiological and actual problems seen with these patients in the daily medical and surgical practice are highlighted and updated