An Iceberg in Africa: Rheumatic Heart Disease requiring Surgery in Children

  • Dr Liesl Zuhlke, Western Cape Pediatric Cardiac Services, Red Cross and Tygerberg Hospitals, South Africa
  • Mark Engel, University of Cape Town, Cape Town, South Africa
  • Dr John Lawrenson, Western Cape Pediatric Cardiac Services, Red Cross and Tygerberg Hospitals, South Africa
  • Dr Rik De Decker, Western Cape Pediatric Cardiac Services, Red Cross and Tygerberg Hospitals, South Africa
  • Dr Kathie Walker, Western Cape Pediatric Cardiac Services, Red Cross and Tygerberg Hospitals, South Africa
  • Roeland Kraan, Medical Student, Rijks Universiteit Groeningen, The Netherlands
  • Dr wendy Matthiassen, Western Cape Pediatric Cardiac Services, Red Cross and Tygerberg Hospitals, South Africa
  • Prof Bongani Mayosi, Department of Medicine, University of Cape Town., South Africa

    • Introduction:
    RF/RHD affects about 15.6 million people worldwide, 2.4 million of whom are children between five and fourteen years old living in developing countries. RF/RHD leads to an estimated 350,000 deaths annually, and survivors are left disabled without access to the expensive medical and surgical care that the disease requires. Africa, which contains 10% of the world’s population, has a disproportionately high share of people living with RF/RHD. Of the 2.4 million children with RF/RHD living in developing countries, nearly half (>1 million) live in sub-Saharan Africa, making the continent the major hotspot of RF/RHD. However, there is a paucity of information on the prevalence, effect and outcomes of RHD in South Africa.
    Aim:
    To review patients within a tertiary paediatric cardiac unit that have undergone either surgery for valve repair or replacement or catheter intervention for valve disease.Parameters that were reviewed included age, age at diagnosis and at surgery,incidence of significant complications and mortality.
    Results:
    Within the past 15 years, more than 35 patients under the age of 18 have undergone valve repair/replacements or catheter valvuloplasty. The youngest patient at the time of intervention was 60 months old. There were 8 mitral valve and 5 double valve replacements, 3 catheter mitral valvotomies and 21 mitral valve repairs.

    Conclusions:
    We report on a cohort of Rheumatic Heart Disease patients in Cape Town, South Africa. These patients represent the most severely affected and we reflect on the admission criteria, intervention as well as short-and medium term outcomes for these patients.