Echocardiographic pattern and severity of valve dysfunction in children with rheumatic heart disease seen at Uganda Heart Institute, Mulago hospital

Background: Rheumatic heart disease (RHD) is the commonest acquired heart disease in children worldwide but in Uganda, data is scarce regarding its morbidity and mortality. The disease has a progressive course and patients usually require valve repair/replacement in the future. Objectives: To describe the frequency of echocardiographic valvular dysfunction in children with RHD To explore the relationship between the severity of valvular dysfunction by the age and sex of the children with RHD Methods: Echocardiographic findings of children ≤15 years with RHD seen at Uganda Heart Institute from January 2007 to December 2011 were retrospectively analyzed. Results: 376 children had a diagnosis of RHD. The mean age of the children was 11.0±2.7 years and 216 (57.4%) were females. Mitral regurgitation was the commonest lesion seen in 98.9% (severe in 73.1%) of the children. Aortic regurgitation (AR) was found in 51.3% (severe in 7.2%), mitral stenosis (MS) was found in 10.6% (severe in 5.9%), tricuspid regurgitation was found in 86.7% (severe in 8.2%) while aortic stenosis was seen in 1.3% (severe in 0.3%). Severe AR was less common in females (OR=0.32, 95%CI 0.13-0.78) and children with MS were older than those without MS (12.7±2.0 Vs. 10.7±2.7 years, p 0.00). Conclusions: Mitral valve dysfunction was found in almost all the cases of RHD and majority of the children had severe valve disease at the time of their first presentations. Children with MS were predominantly above 10 years and severe AR was more common in males.