Prevalence of Rheumatic Valvular Heart Disease Among Egyptian School Children: An Echocardiographic Screening

Introduction: Rheumatic valvular heart disease remains a major cause of morbidity and premature death in developing countries. Exact prevalence data are still lacking and are also highly desirable to facilitate health care planning. Methodology: An indicative sample of school children in Egyptian Governorates was examined clinically and by echocardiographic Doppler examination for the presence of rheumatic valvular heart disease, in the period between Sept 2009 to May 2011. Definite rheumatic valvular affection as defined by the presence of any definite evidence of mitral and/or aortic valve regurgitation seen in two planes by Doppler echocardiography, accompanied by at least two of the following three morphologic abnormalities of the regurgitant valve: Restricted leaflet mobility, focal or generalized valvular thickening. Results: A total of 48930 school children, age ranged between 6 and 18 years, 49.1% males, were included. An abnormal cardiac examination or history suggestive of rheumatic affection was reported in 2712 students, only 1603 had an adequately imaged transthoracic echocardiography fulfilling the protocol. Definite rheumatic valvular disease was docu-mented in only 35 (2.2%), and probable affection in 107 (6.6%) of the total examined sample who underwent echocardiographic examination (n=1603). The prevalence rate of rheumatic valvular heart disease is 0.07% (7 in 10,000 of examined Egyptian students), abnormal combination of mitral valve affection was the dominant feature in 174 (65.9%, n=264); 34 had thickening of leaflets, 21 had subvalvular thickening, 16 had mitral stenosis, 86 had variable degree of mitral valve prolapse. Regurgitant jet area of more than lcm2 in two planes was reported in 125 students, and 17 had grade I mitral regurge of undertermined etiology. Aortic valve was reported abnormal in 43 students (16.3%), bicuspid in 6 (0.2%), and regurgitant of grade II severity in 8 students (0.3%), out of 1603 echo performed. Conclusion: Because rheumatic heart disease remains a major cause of morbidity and mortality in developing nations, these data have potentially important implications for case finding and early detection, delivery of effective primary and secondary prevention, and adequate planning of health services.