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Abstract Background Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania. Methods A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD. Results A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4–82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6–46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3–6.8, P = 0.009). Conclusion Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.

Background: Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania.Methods: A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD.Results: A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4-82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6-46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3-6.8, P = 0.009).Conclusion: Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening. [ABSTRACT FROM AUTHOR]

Objectives: To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low‐ and middle‐income countries, for North‐Central Nigeria. Methods: In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North‐Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. Results: A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13–15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7–36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3–37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1–13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. Conclusions: This study showed a high prevalence of RHD among secondary schoolchildren in North‐Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school‐based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted. [ABSTRACT FROM AUTHOR]

Objective: Echocardiographic screening for Rheumatic Heart Disease (RHD) in Africa has revealed prevalence rates in the range of 0.5-7.4%. There are no recent large population-based studies in Nigeria. The objective of the study was to determine the prevalence of RHD in a large sample of Nigerian school children.Methods: Using portable transthoracic echocardiography and auscultation, school children aged 5 years to 16 years in Lagos, Nigeria were screened for RHD. Diagnosis was based on the 2012 World Heart Federation echocardiographic criteria.Results: The 4107 children screened had mean age of 11.3 years (SD = 2.6) and 2206 (53.7%) were females. There were 38 children with abnormal echocardiograms, of which 11 (0.27%) showed RHD including two cases of definite RHD giving a prevalence of 2.7/1000 [2.9/1000 in the peri-urban, 2.4/1000 in the urban area). Echocardiography detected RHD 10 times better than auscultation [echocardiography 11 (0.27%) vs. auscultation 1 (0.02%); P = 0.003]. The remaining 27 children with abnormal echocardiograms had congenital heart defects (CHD) giving a prevalence of 6.6/1000 for CHD, a yield higher than for RHD.Conclusion: Prevalence of RHD among school children in Lagos, South West Nigeria is low compared to other African countries, possibly due to better access to medical care and antibiotic treatment for infections. Our data provides evidence that RHD prevalence may vary substantially within sub-Saharan Africa, necessitating targeted population-based sampling to better understand disease burden and distribution. Further work is needed to compare within- and between-country RHD prevalence as a basis for programme planning and control efforts. [ABSTRACT FROM AUTHOR]

Abstract Background Pulse oximetry screening for critical congenital heart disease (CHD) is inapplicable to high altitude due to the variedly decreased arterial saturations and rare complex CHD. We examined the incidence and spectrum of CHD in newborns using echocardiography at high altitude and followed up their outcomes. Methods A total of 1337 babies were studied. Echocardiography was performed in 1002 asymptomatic newborns (3–5 days). In the same period, retrospectively studied 394 newborns (≤2 days) admitted to the NICU where echocardiograph was performed in 335. In both groups, follow-up was made at 1–3, 6 and 12–18 months. Results The incidence of CHD in asymptomatic newborns was 27.8%, consisting secundum atrial septal defect (ASD) [175 (62.7%)], patent ductus arteriosus (PDA) [61 (21.9%)], ventricular septal defect (VSD) [8 (2.9%)] and multiple defects [35 (12.6%)]. And 19.4% in NICU patients with similar spectrum, except for 2 with complex CHD who died before discharge. By 12–18 months of follow-up, 30% of CHD remained open. Thirteen patients developed mild to severe pulmonary arterial hypertension (PAH), and 2 of them died of heart failure. Conclusions The incidence of CHD in newborns at high altitude is about 20 times higher than that at low altitude, consisting mostly of simple forms with left to right shunt, with rare complex CHD. By 12–18 months, the incidence of CHD is still about 10 times higher than that at low altitude. About 8% patients developed PAH or death. Follow-up must be reinforced in order to provide early intervention and prevent from PAH or death. [ABSTRACT FROM AUTHOR]

Assisted reproductive technology (ART) has become widespread, accounting for ∼2% of all births worldwide, with a similar proportion in Japan. Our goal was to determine whether ART is associated with an increased risk of congenital heart defect (CHD). The study subjects were 2716 pregnant women (2317 in a spontaneous conception [SC] group and 399 in an assisted conception [AC] group). Of patients in the AC group, 142 were treated with ovulation-inducing agents (OIAs), 56 with artificial insemination by the husband (AIH), 159 within vitrofertilization (IVF), and 42 with intracytoplasmic sperm injection (ICSI). CHD screening on the fetus or newborn was performed using two-dimensional echocardiography. Severe CHD was defined as requiring surgical treatment, or leading to death within one year. There were 2746 births (one of 31 twins was a still birth), 410 resulted from AC and within this group, 111 cases of CHD were found (AC group, 17 [4.1%]; SC group, 94 [4.0%]). Five cases of severe CHD were found in the AC group and 19 in the SC group, with no significant difference between the groups (p = 0.892). In conclusion, there was no evidence of increased CHD risk associated with ART treatment. [ABSTRACT FROM PUBLISHER]

Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries., Objective: To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening., Method/design: A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared., Results: Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6-3.3%) and non-anaemic children (1.3%, 95% CI 0.3-2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012)., Conclusion: Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.