The burden of rheumatic heart disease among children in Lagos: how are we fairing?

INTRODUCTION: Rheumatic heart disease still remains a cause of morbidity and mortality in low and middle income countries, despite its eradication in developed societies. The study aimed to document the features of children with rheumatic heart disease using clinical evaluation and echocardiography and compare it with reports from other part of the country. METHODS: A review of a prospectively collected data of patients with rheumatic heart disease who had echocardiography done from April 2007-Dec 2016. Information obtained from patients include age, sex, clinical indication for echocardiography, echocardiographic characterization of the valvular lesions and associated complications. RESULTS: A total of 324,676 patients were seen at the Paediatric unit of LASUTH from 2007 to 2016, out of which 36 had Rheumatic heart disease. This translates to a prevalence of 1.1 per 10,000 patients who presented at the study site during the study period. The prevalence of RHD amongst all the patients with structural heart disease was 2.6%. The mean age of patients was 9.12 ± 2.75 years with a male to female ratio of 1.6: 1. The most common valve affected was mitral valve. Heart failure was the most common mode of presentation found in 91.6%. Other complications were pulmonary hypertension and pericardial effusion. CONCLUSION: Rheumatic heart disease is still prevalent among children in Lagos although the prevalence is reducing. Heartfailure is the commonest mode of presentation and complication in them.

Cyanotic congenital heart diseases among Nigerian children.

BACKGROUND: There are only few reports on cyanotic congenital heart diseases (CCHD) among Nigerian and African Children. The current report aim to provide the most recent hospital based data on the distribution of CCHD in children less than 14 years of age, the demographic characteristics and risk factors identified. METHODS: Prospective and cross-sectional involving consecutive cases of CCHD diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Level of significance set at P<0.05. RESULTS: There were 352 subjects with CCHD with a male to female ratio of 1.34:1. The children were age 2 days to 14 years with a mean ± SD of 38.62±44.74 months and median of 21 months. The most common type of CCHD (both isolated and multiple CCHD) was tetralogy of Fallot (TOF) followed double outlet right ventricle (DORV) and transposition of the great arteries (TGA). The most common mode of presentation was cyanosis. CONCLUSIONS: TOF was found in almost half of the subjects. Cases of DORV which have been rarely reported were more than those with TGA. Most were diagnosed late. Cyanosis was the most common mode of presentation. Clinical features are protean; thus a high index of suspicion is required to make an early diagnosis.

Children with transposition of the great arteries: Should they actually be born in Nigeria?

AIM: To describe the clinical and echocardiographic features of Nigerian children with transposition of the great arteries and emphasize the need for collaboration with cardiac centres in the developed countries to be able to salvage the children. METHODS: Prospective and cross sectional involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos Nigeria as part of a large study between January 2007 and December 2015. RESULTS: There were 51 cases of transposition of the great arteries within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10000 among population of children who presented to centre during the study. Its proportion amongst children with congenital heart disease was 4.9%, while it was 15.4% among those with cyanotic congenital heart disease. The mean age ± SD of the subjects was 10.3 ± 21.8 mo. Up to 70% of the patients were less than 6 mo of age at initial presentation. The most common mode of presentation was cyanosis. The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56% of the patients. CONCLUSION: Transposition of the great arteries is as common in Nigeria as in the other parts of the world. The most common mode of presentation was cyanosis. There is an urgent need to establish paediatric cardiac centres in Nigeria if these children are to be salvaged.

Nigerian Children with Acquired Heart Disease: The Experience in Lagos.

Background: Most of the recent reports on acquired heart diseases (AHDs) among Nigerian children are either retrospective or cover a short period of time with fewer subjects. The last report on AHDs among children in Lagos was about a decade ago; it was, however, not specific to children with AHDs but was part of a report on structural heart diseases among children in Lagos. The present study was carried out to document the prevalence and profile of different AHDs in children and to compare the findings with those previously reported. Methods: We conducted a quantitative, nonexperimental, prospective, and cross-sectional review of all consecutive cases of AHDs diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Comparisons between the normally distributed quantitative data were made with the Student t test, while the χ2 test was applied for the categorical data. Results: The subjects with AHDs were 73 males and 52 females, with a male-to-female ratio of 1.4:1. The children were aged 15 days to 14 years, with a mean of 6.61 ± 4.26 years. Rheumatic heart disease was the most common AHD, documented in a quarter of the children, followed by dilated cardiomyopathy and pericardial effusion in 20.8% and 17.3%, respectively. Less common lesions encountered were Kawasaki disease, mitral valve prolapse, hyperdynamic circulation, and supraventricular tachycardia. Conclusion: Rheumatic heart disease was still the most common AHD in the children in the present study. Dilated cardiomyopathy and pericardial effusion are on the increase as has been reported earlier.

Children With Tetralogy of Fallot in an Urban Centre in Africa.

INTRODUCTION: There is a dearth of literature on tetralogy of fallot (TOF) in children in Sub-Saharan Africa. This study up aims to describe the prevalence, clinical profile and associated cardiac anomaly of children diagnosed with TOF documented over an eight year period in a tertiary hospital in South Western Nigeria. METHODS: A prospective review of all consecutive cases of TOF diagnosed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2014. Data were analyzed using SPSS version 20. Tables and charts were used to depict those variables. Descriptive statistic are presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the student t test and proportions using chi-square test. Skewed distribution were analyzed using appropriate non-parametric tests. Level of significance set at P < 0.05. RESULT: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 10 000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance and most children presented within 1-5 years of age. Chromosomal abnormalities such as Down syndrome, Turners syndrome and CATCH 22 syndrome were documented in some subjects. Some of the subjects had atypical presentation. CONCLUSION: TOF is as common in Nigeria as other parts of the world, there is a need to established cardiac centers to salvage these children. Collaboration from developed countries will be helpful in this resource limited region.