Clinical outcomes of Rwandan children operated for rheumatic heart disease followed up at tertiary level.

Abstract

Subject of the study: Clinical outcomes of Rwandan children who have undergone open heart surgery for rheumatic heart disease at the tertiary level of care. Background:The exact outcomes and follow-up aspects of children who have undergone open heart surgery for rheumatic heart disease living in developing countries are generally not known. Objective: To determine the outcomes and follow-up aspects of Rwandan children who have undergone open heart surgery for rheumatic heart disease and highlight challenges to care in order to improve the overall domestic management of pediatric rheumatic heart valve disease surgery pediatric patients in Rwanda. Study type:cross-sectionalanalytical study. Methods: A cross-sectional analytical study was conducted in the department of Pediatrics of University Teaching Hospitals: Kigali and Butare, Rwanda Military Hospital as well as King Faisal Hospital, Kigali. This study included all children, 18 years old or less at the time of surgery for rheumatic heart diseases during the study period,from January 2006 to March 2015. Data was collected from files and records of patients, from clinical and para-clinical examinations as well as interview. The information was filled in spreadsheet format. The data entry and analysis wasperformed using EpiData 3.1 and SPSS 20.0 for windows; recording and presentation of results was done using Microsoft Excel and Microsoft Word. Results: Sixty-nine patients were included in our study, now aged between 8 and 24 years, the mean was 15.5 years ±3.4 SD. Female patients were 56.5%. Majority of them were symptomatic before surgery (NYHA IV: 88.4%, NYHA III: 7.2%), Mitral valve regurgitation was predominant: 92.6%, aortic valve regurgitation: 20.5%. Tricuspid valve regurgitation was 29.4%. Mitral stenosis was present in 14.7%. The main surgical procedure done was mechanical valve replacement: mitral in 46 patients (66.7%), aortic in 8 patients (11.6%) tricuspid in 4 patients (5.8%). After surgery, most of children presented clinical improvement (NYHA I: 59.4% and NYHA II: 27.5%). Regularity of follow-up was 76.8%. The mean INR was2.53±1.25 SD. Secondary prophylaxis of ARF is mainly withBenzathin Penicillin G monthly injections (69.6%). Sixchildren (8.69%) died of different conditions, mainly due to heart failure for 3 viii patients (4.35%) and infective endocarditis in 2 patients (2.89%). Quality of life was reported to be generally good after surgery. Conclusion: Even though cardiac surgery in children suffering from severe heart valve rheumatic lesions is still challenging in third world, rheumatic heart disease surgery in children is associated with good outcomes. The causes of death are preventable in most of the cases.