Doenças Cardiovasculares e Diagnóstico

Prevalence of Pulmonary Arterial Hypertension among Children with Rheumatic Heart Disease Attending Follow up at the Cardiac Clinic of Jimma University Medical Center

Abstract

Yirga Y

Background: Acute rheumatic fever and its chronic sequele remain significant cause of morbidity and mortality in Ethiopia. Pulmonary hypertension is a frequent complication of left heart disease arising from a wide range of cardiac disorders. Epidemiological data are scarce, especially in the pediatric population of developing countries, regarding the prevalence of pulmonary hypertension among patients with rheumatic heart disease.

Objective: To determine prevalence of pulmonary arterial hypertension and associated factors among patients with rheumatic heart disease in Jimma university medical center.

Method: A cross sectional study was conducted by including patients who were 18 years and less and had been diagnosed with rheumatic heart disease and have Echocardiography report from January 2014 to August 2017. Their medical record was reviewed to retrieve relevant data to answer the study objectives. Data was entered and analyzed using SPSS for windows version 20. Descriptive statistics of categorical variables will be presented by frequencies and percentage and mean, and standard deviations will be estimated for continuous variables. Chi square test was performed to identify association between independent variables and pulmonary arterial hypertension.

Results: A total of 247 medical record of children with rheumatic heart disease were reviewed. Pulmonary hypertension occurred in 149 (60.3%) of the children with a mean age at 10.73 ± 2.837 years. Majority of the children were from rural area 99 (66.4%) and 88 (59.1%) were females. The average Tricuspid valve pressure gradient was 51.17 ± 18.67 mmHg. Heart failure was the presenting illness in 103 (69.1%) of children with PAH, having a significant association (p ≤ 0.001). All associated comorbidities were more prevalent among those who have PAH, malnutrition being the commonest followed by pneumonia. Mitral valve was the most commonly involved valve alone or combined with aortic valve. Mixed Mitral and Aortic valve involvement was seen in 93 (62.4%) cases. Severity of Mitral Regurgitation, Mitral Stenosis and Aortic Regurgitation was found to have statistically significant association with p ≤ 0.05. Medications were almost the only treatment modality, given to 147 (98.6%) children and a single child got a surgical repair.

Conclusion and Recommendations: Rheumatic heart disease related pulmonary hypertension is still the major problem in the center and mitral valve is the commonest valve to be affected. Children with heart failure at presentation are at increased risk of having pulmonary hypertension. Only one patient was operated for underlying valvular lesion. Introduction of standard treatment practices and further study to assess the reasons for late presentation of children with rheumatic heart disease before the development of pulmonary hypertension is recommended.