Rheumatic Valve Disease in Children and Young Adults in Yaoundé: Diagnostic Profile and Impact of Surgical Delay on Prognosis: Valvulopathies Rhumatismales chez l’Enfant et l’Adulte Jeune à Yaoundé : Profil Diagnostique et Impact du Retard Chirurgical sur le Pronostic

Abstract

ABSTRACT
Introduction. Rheumatic heart disease remains a leading cause of preventable cardiovascular morbidity in sub-Saharan Africa, where delayed access to specialized care significantly compromises clinical outcomes. Despite the theoretical efficacy of primary prevention, diagnosis often occurs only at the stage of irreversible complications. This study aimed to evaluate the diagnostic characteristics, therapeutic modalities, and prognostic factors of rheumatic valve disease among children and young adults followed in three referral hospitals in Yaoundé. Methods. We conducted an analytical cross-sectional study with retro-prospective data collection over five years. The analysis included all patients with rheumatic valve disease confirmed by Doppler echocardiography in the cardiology departments of the General Hospital, the Central Hospital, and the Chantal Biya Foundation. Results. Of the 106 patients included (median age 10-15 years; 64.2% female), 72% reported a history of untreated sore throats. Mitral regurgitation (82.1%) and aortic insufficiency (42.9%) were the predominant lesions, accounting for the vast majority of the pathological spectrum. At diagnosis, 67% of patients already presented with left heart failure. Although surgery was indicated for 57.5% of subjects, only 23% underwent the procedure after a median delay of 24 months. Mortality stood at 6.3%. Left heart failure (aOR 18.5; 95% CI [1.1–306.1]) and dilation of the left chambers (aOR 21.5; 95% CI [1.4–334.5]) emerged as the primary determinants of a poor prognosis. Conclusion. The diagnosis of rheumatic valve disease in Cameroon occurs at stages of advanced decompensation, exacerbated by limited and delayed access to cardiac surgery. Generalizing the systematic treatment of pharyngitis and implementing early echocardiographic screening are imperative to reduce mortality associated with this disease of poverty.
RÉSUMÉ
Introduction. Rheumatic heart disease remains a leading cause of preventable cardiovascular morbidity in sub-Saharan Africa, where delayed access to specialized care significantly compromises clinical outcomes. Despite the theoretical efficacy of primary prevention, diagnosis often occurs only at the stage of irreversible complications. This study aimed to evaluate the diagnostic characteristics, therapeutic modalities, and prognostic factors of rheumatic valve disease among children and young adults followed in three referral hospitals in Yaoundé. Methods. We conducted an analytical cross-sectional study with retro-prospective data collection over five years. The analysis included all patients with rheumatic valve disease confirmed by Doppler echocardiography in the cardiology departments of the General Hospital, the Central Hospital, and the Chantal Biya Foundation. Results. Of the 106 patients included (median age 10-15 years; 64.2% female), 72% reported a history of untreated sore throats. Mitral regurgitation (82.1%) and aortic insufficiency (42.9%) were the predominant lesions, accounting for the vast majority of the pathological spectrum. At diagnosis, 67% of patients already presented with left heart failure. Although surgery was indicated for 57.5% of subjects, only 23% underwent the procedure after a median delay of 24 months. Mortality stood at 6.3%. Left heart failure (aOR 18.5; 95% CI [1.1–306.1]) and dilation of the left chambers (aOR 21.5; 95% CI [1.4–334.5]) emerged as the primary determinants of a poor prognosis. Conclusion. The diagnosis of rheumatic valve disease in Cameroon occurs at stages of advanced decompensation, exacerbated by limited and delayed access to cardiac surgery. Generalizing the systematic treatment of pharyngitis and implementing early echocardiographic screening are imperative to reduce mortality associated with this disease of poverty.