Pattern of rheumatic heart disease in Southern Yemen

OBJECTIVE: To determine the pattern of rheumatic heart disease in Aden city and surrounding areas by assessing its frequency distribution, severity and complications.

METHODS: We conducted this research in a sole regional echocardiographic department for Southern Yemen governorates at a referral hospital located in Aden city, from January 1999 to December 2003. It was a retrospective study focused on echocardiographic findings in 805 patients affected by rheumatic heart disease.

RESULTS: Out of 805 patients, 383 (47.6%) were male and 422 (52.4%) were female (age range, 4-70 years; mean age, 28.6 ± 14.5). Heart valve damage was distributed among patients as follow: mitral 459 (57.1%), aorta 70 (8.7%) and both valves 276 (34.2%); isolated lesions 55.2% and multiple 44.8%; mitral regurgitation 464 (57.6%), mitral stenosis 405 (50.3%), aortic regurgitation 327 (40.6%) and aortic stenosis 54 (6.7%). All children aged less than 10 years had regurgitation. Stenosis and multiple valve lesions predominated in adolescents and young adults. Complications were detected in 20.8% of cases. Pulmonary hypertension was the most common complication (80.4%). Lesions with moderate and severe degree were detected in 51% cases. Only 34.8% of patients at severe stage were operated.

CONCLUSION: Rheumatic heart disease takes an aggressive course in Southern Yemen. Children, adolescents and young adults of both gender are the victims. Complications appear early with scanty opportunity to reach advanced age. There is a little chance for palliative treatment.