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Rheumatic mitral stenosis in children: more accelerated course in sub-Saharan patients.
[acute rheumatic fever]
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
.
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
cm
2
)
,
moderate
(
mitral
valve
area
1
.
0
-
1
.
5
cm
2
)
and
mild
(
mitral
valve
area
>
1
.
5
cm
2
)
.
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
cm
2
(
range
0
.
4
-
2
.
0
cm
2
)
.
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
.
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
.
Diseases
Validation
Diseases presenting
"heart disease"
symptom
22q11.2 deletion syndrome
achondroplasia
acute rheumatic fever
adrenal incidentaloma
child syndrome
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
dentinogenesis imperfecta
esophageal adenocarcinoma
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kabuki syndrome
monosomy 21
omenn syndrome
phenylketonuria
sneddon syndrome
systemic capillary leak syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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