Rheumatic and nonrheumatic valvular heart disease: epidemiology, presentation and management

ABSTRACT

Valvular disease ranks among the major cardiovascular afflictions in Africa. Acute rheumatic fever and chronic rheumatic valvular disease in their most virulent form are still commonly encountered and impose a huge burden on the limited healthcare resources. There is scarce published data from the Sudan, although open heart surgery and interventional cardiology was re-established as a program in the Sudan in the country since1998. The aim of this study was to investigate the epidemiology and the presentations of patients with valvular lesions as well as the type of procedure expected to help them. The files of 235 patients presented at Ahmed Gasim Cardiac Centre during 1999-2000 were retrospectively reviewed. The study was based on echocardiographic assessment. 235 patients were enrolled; Patients with secondary MR, TR, PR or complex congenital lesions were excluded. Out of the 235 Pts assessed, 182 were young < 40 yrs of age and 185 [78%] had Rheumatic origin, which is preventable. 153 patients 65% were recommended for prosthetic valve replacement with the hazard of long term anticoagulant therapy, 49 patients [23%] with MS, were suitable for PTMC, with a possible risk of restenosis in 10 to 15 years, while 33 patients [12%] only has expected good long term results [patients with PS and elderly, patients for tissue valves or patients for valve repair or excision of a sub-aortic membrane. In conclusion, to launch a nation wide and a sustainable control program for rheumatic fever, the provision of a reliable anticoagulant monitoring and to continue the search for an ideal valve