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Open Access Highly Accessed Research article

Rheumatic mitral stenosis in Children: more accelerated course in sub-Saharan Patients

Henok Tadele1*, Wubegzier Mekonnen2 and Endale Tefera3

Author Affiliations

1 Department of Pediatrics & Child Health, School of Medicine, Hawassa University, Hawassa, Ethiopia

2 Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

3 Department of Pediatrics & Child Health, Addis Ababa University and Cardiac Center Ethiopia, Addis Ababa, Ethiopia

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BMC Cardiovascular Disorders 2013, 13:95  doi:10.1186/1471-2261-13-95

Published: 1 November 2013

Abstract

Background

Mitral stenosis, one of the grave consequences of rheumatic heart disease, was generally considered to take decades to evolve. However, several studies from the developing countries have shown that mitral stenosis follows a different course from that seen in the developed countries. This study reports the prevalence, severity and common complications of mitral stenosis in the first and early second decades of life among children referred to a tertiary center for intervention.

Methods

Medical records of 365 patients aged less than 16 and diagnosed with rheumatic heart disease were reviewed. Mitral stenosis was graded as severe (mitral valve area < 1.0 cm2), moderate (mitral valve area 1.0-1.5 cm2) and mild (mitral valve area > 1.5 cm2).

Results

Mean age at diagnosis was 10.1 ± 2.5 (range 3–15) years. Of the 365 patients, 126 (34.5%) were found to have mitral stenosis by echocardiographic criteria. Among children between 6–10 years, the prevalence of mitral stenosis was 26.5%. Mean mitral valve area (n = 126) was 1.1 ± 0.5 cm2 (range 0.4-2.0 cm2). Pure mitral stenosis was present in 35 children. Overall, multi-valvular involvement was present in 330 (90.4%). NYHA functional class was II in 76% and class III or IV in 22%. Only 25% of patients remember having symptoms of acute rheumatic fever. Complications at the time of referral include 16 cases of atrial fibrillation, 8 cases of spontaneous echo contrast in the left atrium, 2 cases of left atrial thrombus, 4 cases of thrombo-embolic events, 2 cases of septic emboli and 3 cases of airway compression by a giant left atrium.

Conclusion

Rheumatic mitral stenosis is common in the first and early second decades of life in Ethiopia. The course appeared to be accelerated resulting in complications and disability early in life. Echocardiography-based screening programs are needed to estimate the prevalence and to provide support for strengthening primary and secondary prevention programs.

Keywords:
Mitral stenosis; Valve area; Rheumatic heart disease; Sub-Saharan Africa