A new look at acquired heart diseases in a contemporary sub-Saharan African pediatric population: the case of Yaounde, Cameroon

Background: Acquired heart diseases (AHD) in children cause significant morbidity and mortality especially in low resource settings. There is limited description of acquired childhood heart diseases in Cameroon, making it difficult to estimate its current contribution to childhood morbidity and mortality. Echocardiography is the main diagnostic modality in low resource settings and has a key role in the characterization and management of these disorders. We aimed to determine the prevalence and spectrum of AHD in children in Yaounde-Cameroon, in an era of echocardiography. These data are needed for health service and policy formulation. Methods: Echocardiography records from August 2003 to December 2013 were reviewed. Echocardiography records of children <= 18 years with an echocardiographic diagnosis of a definite AHD were identified and relevant data extracted from their records. Results: One hundred and fifty eight children (13.4%) <= 18 years had an AHD. The mean [+/- standard deviations (SD)] age was 11.9 (+/- 4.4) years. The most common affected age group was 15-18 years (36.1%). Heart failure (20.3%), suspicion of rheumatic heart disease (RHD) (12.0%) and the presence of a heart murmur (8.9%) were the most common indications for echocardiography. RHD (41.1%), pericardial disease (25.3%), dilated cardiomyopathy (DCM) (15.8%) and endomyocardial fibrosis (EMF) (13.9%) were the most common AHD. Cor pulmonale was rare (1.3%). Fifty-seven (87.7%) children with RHD had mitral regurgitation alone or in combination with other heart valve lesions and 63.3% of the lesions were severe. Conclusions: RHD remains the most common AHD in children in this setting and is frequently severe. Multicenter collaborative studies will help to better describe the pattern of AHD and there should be a renewed focus on the prevention of RHD.