The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Wa... more The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www. WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery. Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Frontiers in cardiovascular medicine, May 10, 2024
Background: Rheumatic heart disease (RHD) is a preventable sequelae of group A beta hemolytic str... more Background: Rheumatic heart disease (RHD) is a preventable sequelae of group A beta hemolytic streptococcal infection leading to an immune reaction: acute rheumatic fever (ARF) and progressive heart valve dysfunction. RHD is the leading cause of acquired heart disease in children and young adults in Sudan and many low/middle-income countries. In 2018, the World Health Organization (WHO) issued a resolution for RHD mandating that each country adopt updated guidelines for ARF and RHD management. These current guidelines are mainly directed to primary healthcare workers. Methods: Sudan's Federal Ministry of Health (FMOH) in collaboration with the WHO East Mediterranean Regional Office (EMRO) assembled a committee for updating RHD guidelines. We conducted a systematic literature search from 2000 to 2022 in National Institute of Health Database (PubMed) under the following titles: streptococcal pharyngitis, acute rheumatic fever, rheumatic heart disease, benzathine penicillin. Best available, evidence-based practices for diagnosis and management of ARF/RHD were selected and adapted to Sudan's situation. The guidelines were critically appraised by the committee then endorsed to the FMOH and WHO EMRO Noncommunicable Disease Departments in January 2023. This paper describes the updated guidelines. Results: Simplified algorithms are provided for diagnosis of bacterial pharyngitis including two clinical criteria: sore throat and the absence of viral symptoms in the target age group. A simplified algorithm for diagnosis and management of ARF is adopted using two levels of diagnosis: suspected case at primary level where penicillin prophylaxis is started and secondary/tertiary care where echocardiography is performed and diagnosis confirmed or excluded. Echocardiography screening is recognized as the standard method for early diagnosis of RHD; however, due to the anticipated limitations, its implementation was not adopted at this time. Streptococcal skin infection is included as a precursor of ARF and a detailed protocol for benzathine penicillin administration is described. Conclusion: The Sudan guidelines for ARF/RHD management were updated. Endorsement of these guidelines to FMOH and WHO EMRO is expected to improve control of RHD in the region.
Patent ductus arteriosus (PDA) is a serious congenital heart disease that can lead to irreversibl... more Patent ductus arteriosus (PDA) is a serious congenital heart disease that can lead to irreversible pulmonary hypertension. Catheter closure has largely replaced surgical ligation and has the advantage of feasibility of test occlusion in patients with borderline operability. We present 3 cases of large PDA with severe pulmonary hypertension where test occlusion helped to verify operability and all cases had successful closure.
Background: Recently brain natriuretic peptide (BNP) level has been introduced as a screening tes... more Background: Recently brain natriuretic peptide (BNP) level has been introduced as a screening test for congestive heart failure (CHF) in children. The current CHF assessment scores are not satisfactory as they use a large number of variables. Objective: To evaluate two CHF scores: a modified clinical score and an echocardiographic score and compare them to BNP in paediatric patients. Design: Prospective, hospital based study. Setting: Two paediatric cardiac referral centres in Khartoum from April to July 2010. Subjects: All patients one month to 18 years of age with the clinical diagnosis of CHF were included. Results: Sixty seven patients were enrolled, 39 (58%) had congenital heart disease (CHD), 27 (32%) had rheumatic heart disease (RHD), and seven (10%) had dilated cardiomyopathy (DCM).Twenty four younger children (88%) and 29 older children (85%) had a high clinical score (severe CHF). Twenty one out of 23 younger children with high echo score (91%) had a high clinical score as well (p-value 0.001). In patients with RHD (all with a high clinical score), 81% had a high echo score. (p-value 0.001). All younger children with a high clinical score (n = 24) had a high level of BNP (p-value 0.00). In older children with a high clinical score 28 out of 29 (96%) had a high BNP level (p-value 0.00). Of patients with RHD and a high echo score (21), 16 (76.2%) patients had high BNP level and five (23.8%) had low level of BNP. All patients with DCM had high echo score and all of them had high levels of BNP (100%) (p-value.0.00). Conclusion: We tested clinical and echo scores and proved their value in assessment of CHF in children. The scores correlated well with BNP level. We recommend the use of these scores as well as BNP level in clinical practice.
International Journal of Cardiovascular Research, Aug 26, 2020
Background: Noncompaction Cardiomyopathy (NCCM) is a primary genetic cardiomyopathy with variable... more Background: Noncompaction Cardiomyopathy (NCCM) is a primary genetic cardiomyopathy with variable clinical and Echocardiographic (echo) features. Association with Mitral Regurgitation (MR) was reported but the mechanism of this association has not been well described in pediatric patients. Aims: To describe clinical and echo features of MR in NCCM. Methods: All pediatric patients with NCCM associated with MR and preserved ventricle function seen in one center from January 2015 to March 2020 were included. Clinical and echo features were described. Results: Twelve patients were identified (66% females), 8 (66%) presented with heart failure due to severe MR , and 4 were asymptomatic with mild-moderate MR. Echo features in all patients showed Papillary Muscle Noncompaction (PMNC). The Papillary Muscle (PM) base was discontinuous with the endocardium in 5 patients (41%) and PM were not well differentiated from the noncompacted myocardium in 3 patients (25%)There were variable degrees of chordal elongation and malcoaptation of the leaflets in all patients. Five patients (41%) had associated congenital heart disease including ventricular septal defects in 4 and patent ductus arteriosus in one patient. Conclusion: PMNC causes MV chordal abnormalities that lead to malcoaptation of the mitral leaflets resulting in MR. NCCM needs to be considered when evaluating patients with MR.
Abstract Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable complicati... more Abstract Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable complications of group A streptococcus (GAS) infection that is endemic in many countries. Prevention of ARF/RHD can be initiated at primordial, primary, and secondary levels. There has been a recent reappraisal of the role of primary prevention targeting early diagnosis and treatment of GAS pharyngitis. Strategies for primary prevention can be implemented at a population level by improving public awareness about the disease and at the health system level by training of health workers and integration into health programs. Although microbiological culture remains the gold standard to diagnose GAS pharyngitis, simple clinical predictive rules have proved to be adequately sensitive and specific as well as cost effective and more feasible in resource-limited settings. Treatment by a single injection of benzathine penicillin (BPG) is affordable; health workers need to be trained in penicillin administration, and the drug should be made available in primary health centers. New formulations of BPG with better safety margins and easier administration methods need to be developed.
The globalburdenof paediatric and congenital heart disease (PCHD) is substantial. We propose a no... more The globalburdenof paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children’s Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and s...
Introduction: Violation of the diastolic function of RV in patients with aortic regurgitation is ... more Introduction: Violation of the diastolic function of RV in patients with aortic regurgitation is associated with chronic overload of the volume and decrease in the pumping function of LV. This leads to hypertension in the small circle, expansion of the RV cavity and violation of its systolic function. At the same time, there is a change in the mechanics of the movement of the interventricular septum, which manifests itself in violation of the interventricular interaction of the right and left heart. LV overload in patients with aortic regurgitation has a mechanical effect on the interventricular septum, disrupting the diastolic function of RV. Objectives: The aim was to study the effect of severe chronic aortic regurgitation (AR) on right ventricular (RV) diastolic function by using echocardiography. Methods: This study examined 57 patients with AR. All patients were male with a mean age 35AE5 years. Patients had NYHA class II-III chronic heart failure. The control group consisted of 10 healthy volunteer. All patients underwent echocardiography. RV diastolic function was evaluated using PW-Doppler echocardiography. The calculated parameters of transtricuspid flow. Results: There was no significant difference in patients with AR and controls regarding echocardiographic parameters characterising the right chambers of the heart: RV fractional area change, RV anterior wall thickness and the area of the right atrium. Significant difference between controls and patients with AR was observed in the RV end-diastolic dimension. Transtricuspid flow parameters in patients with AR, namely E/A of RV, RV IVRT, and VTI, were significantly different from those in controls. A high correlation was observed between the degree of AR and the occurrence of RV diastolic dysfunction (r¼0.71). Conclusion: LV volume overload violates interventricular interaction and negatively affects RV diastolic function. It is necessary to analyse in detail transtricuspid flow in patients with severe chronic AR to assess the condition of their RV.
Background: Rheumatic heart disease (RHD) is an important public health problem in Sudan. Methods... more Background: Rheumatic heart disease (RHD) is an important public health problem in Sudan. Methods: Clinical and echocardiographic findings from an RHD registry in Khartoum (January 2005-March 2018) are described. Operated and un-operated children were prospectively followed. The quality of life (QOL) for children who had surgery was evaluated using pediatric QOL cardiac module. Results: A total of 818 children (51% males) were included, patients were clustered in White Nile and Kordofan area. RHD was found in 78% and acute rheumatic fever (ARF) in 22% of cases. RHD was severe in 65% and the most common lesion was mitral regurgitation (MR) in 37%. Followup of 107 un-operated children for a mean of 2 years revealed major complications in 38% including a mortality of 14%. Severe valve dysfunction tended to remain unchanged. There were 3 deaths in children with severe valve lesions immediately following benzathine penicillin injections. Only 19% of patients underwent surgery with an average post-operative mortality of 10.5% in the last 8 years. Of those, only 34 were reached for follow-up (23%), all were in New York Heart Association (NYHA) class 1, however adverse outcomes were observed including noncompliance with benzathine penicillin and warfarin (51% and 29% respectively) and more than mild valve dysfunction in 35%. All children who had valve surgery have a good QOL scores. In the last 3 years, the outpatient visits, admissions and mortality rates decreased by 20%, 48% and 22% respectively. Conclusions: RHD is clustered in certain areas and presents with severe valve lesions with a high mortality for un-operated patients. Operative mortality improved over the last years but the follow-up rates are poor and adverse outcomes are common. There is an apparent trend of decline in the number of patients with RHD seen at referral hospitals.
Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococca... more Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococcal infection, is highly prevalent in Sudan. Echocardiographic (echo) screening has an established role in disease surveillance. This study aims to measure the echo prevalence of RHD using handheld echo (HHE) in West and North Darfur and Kassala states and initiate control programs. School children 10-18 years of age were selected from the three states and HHE screening was performed by trained paediatric residents supervised by cardiologists using a pretested protocol. Health worker training and public awareness sessions were carried out. The study was conducted between November 2020 and December 2021. In West Darfur, 1,547 children were screened, echo prevalence was found to be 17.4/1,000, and 22% had moderate to severe disease. In North Darfur, 800 children were screened and echo prevalence was 16.2/1,000, 23% had moderate to severe disease while in Kasala 2,225 children were screened a...
Rheumatic heart disease (RHD) is a completely preventable, life-threatening complication of a gro... more Rheumatic heart disease (RHD) is a completely preventable, life-threatening complication of a group A streptococcal pharyngitis and the commonest cause of acquired heart disease in children and young adults in low and middle income countries. Conventional control measures are faced with many obstacles including the difficulty of early diagnosis of bacterial pharyngitis and acute rheumatic fever (ARF) leading to late presentation with established RHD which is not curable. Recent evidence confirmed the role of echocardiography screening of asymptomatic children in early detection of "latent" RHD. Benzathine penicillin prophylaxis was shown to be effective in halting the progression of latent RHD. There is enough evidence to warrant implementation of control strategies that use lower thresholds for diagnosis of GAS and ARF and we believe that it is high time to introduce echocardiography screen-to- treat policy in endemic areas.
Rheumatic heart disease (RHD) is the commonest cause of cardiac morbidity and mortality in young ... more Rheumatic heart disease (RHD) is the commonest cause of cardiac morbidity and mortality in young people in Sudan. A control program was initiated based on a framework (SUR I CAAN), standing for SURveillance, Integration, Collaboration, Awareness, Advocacy and traiNing. It utilised research funds to initiate sentinel sites for RHD control in rural endemic areas. Handheld echocardiographic screening of 12,000 subjects in five regions revealed a wide disparity in RHD prevalence ranging from 0.3/1,000 in Khartoum to 61/1,000 in North Kordofan. Training of health personnel and public awareness campaigns were conducted. We believe that RHD control is achievable using small funds targeted to endemic areas.
Pediatric cardiology (PC) is a rapidly advancing specialty addressing a large population of child... more Pediatric cardiology (PC) is a rapidly advancing specialty addressing a large population of children as well as adults with congenital heart disease. It requires huge technical and financial resources; therefore, establishing, maintaining, and developing such services in limited resource settings are challenging. A PC program that includes clinical aspects, echocardiography, diagnostic and interventional cardiac catheterization and cardiac surgery, and rheumatic heart disease control was established in Sudan in 2004. There are currently three public centers with facilities to evaluate and treat children with heart disease: two in Khartoum and one in Wad Medani. Major obstacles include the shortage of trained personnel and operation rooms, the deficiency of intensive care facilities, and the financial burden of interventional procedures. This paper details the establishment and progress of the program, its challenges, potential solutions, and future perspectives for PC programs in Su...
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Wa... more The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www. WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery. Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Frontiers in cardiovascular medicine, May 10, 2024
Background: Rheumatic heart disease (RHD) is a preventable sequelae of group A beta hemolytic str... more Background: Rheumatic heart disease (RHD) is a preventable sequelae of group A beta hemolytic streptococcal infection leading to an immune reaction: acute rheumatic fever (ARF) and progressive heart valve dysfunction. RHD is the leading cause of acquired heart disease in children and young adults in Sudan and many low/middle-income countries. In 2018, the World Health Organization (WHO) issued a resolution for RHD mandating that each country adopt updated guidelines for ARF and RHD management. These current guidelines are mainly directed to primary healthcare workers. Methods: Sudan's Federal Ministry of Health (FMOH) in collaboration with the WHO East Mediterranean Regional Office (EMRO) assembled a committee for updating RHD guidelines. We conducted a systematic literature search from 2000 to 2022 in National Institute of Health Database (PubMed) under the following titles: streptococcal pharyngitis, acute rheumatic fever, rheumatic heart disease, benzathine penicillin. Best available, evidence-based practices for diagnosis and management of ARF/RHD were selected and adapted to Sudan's situation. The guidelines were critically appraised by the committee then endorsed to the FMOH and WHO EMRO Noncommunicable Disease Departments in January 2023. This paper describes the updated guidelines. Results: Simplified algorithms are provided for diagnosis of bacterial pharyngitis including two clinical criteria: sore throat and the absence of viral symptoms in the target age group. A simplified algorithm for diagnosis and management of ARF is adopted using two levels of diagnosis: suspected case at primary level where penicillin prophylaxis is started and secondary/tertiary care where echocardiography is performed and diagnosis confirmed or excluded. Echocardiography screening is recognized as the standard method for early diagnosis of RHD; however, due to the anticipated limitations, its implementation was not adopted at this time. Streptococcal skin infection is included as a precursor of ARF and a detailed protocol for benzathine penicillin administration is described. Conclusion: The Sudan guidelines for ARF/RHD management were updated. Endorsement of these guidelines to FMOH and WHO EMRO is expected to improve control of RHD in the region.
Patent ductus arteriosus (PDA) is a serious congenital heart disease that can lead to irreversibl... more Patent ductus arteriosus (PDA) is a serious congenital heart disease that can lead to irreversible pulmonary hypertension. Catheter closure has largely replaced surgical ligation and has the advantage of feasibility of test occlusion in patients with borderline operability. We present 3 cases of large PDA with severe pulmonary hypertension where test occlusion helped to verify operability and all cases had successful closure.
Background: Recently brain natriuretic peptide (BNP) level has been introduced as a screening tes... more Background: Recently brain natriuretic peptide (BNP) level has been introduced as a screening test for congestive heart failure (CHF) in children. The current CHF assessment scores are not satisfactory as they use a large number of variables. Objective: To evaluate two CHF scores: a modified clinical score and an echocardiographic score and compare them to BNP in paediatric patients. Design: Prospective, hospital based study. Setting: Two paediatric cardiac referral centres in Khartoum from April to July 2010. Subjects: All patients one month to 18 years of age with the clinical diagnosis of CHF were included. Results: Sixty seven patients were enrolled, 39 (58%) had congenital heart disease (CHD), 27 (32%) had rheumatic heart disease (RHD), and seven (10%) had dilated cardiomyopathy (DCM).Twenty four younger children (88%) and 29 older children (85%) had a high clinical score (severe CHF). Twenty one out of 23 younger children with high echo score (91%) had a high clinical score as well (p-value 0.001). In patients with RHD (all with a high clinical score), 81% had a high echo score. (p-value 0.001). All younger children with a high clinical score (n = 24) had a high level of BNP (p-value 0.00). In older children with a high clinical score 28 out of 29 (96%) had a high BNP level (p-value 0.00). Of patients with RHD and a high echo score (21), 16 (76.2%) patients had high BNP level and five (23.8%) had low level of BNP. All patients with DCM had high echo score and all of them had high levels of BNP (100%) (p-value.0.00). Conclusion: We tested clinical and echo scores and proved their value in assessment of CHF in children. The scores correlated well with BNP level. We recommend the use of these scores as well as BNP level in clinical practice.
International Journal of Cardiovascular Research, Aug 26, 2020
Background: Noncompaction Cardiomyopathy (NCCM) is a primary genetic cardiomyopathy with variable... more Background: Noncompaction Cardiomyopathy (NCCM) is a primary genetic cardiomyopathy with variable clinical and Echocardiographic (echo) features. Association with Mitral Regurgitation (MR) was reported but the mechanism of this association has not been well described in pediatric patients. Aims: To describe clinical and echo features of MR in NCCM. Methods: All pediatric patients with NCCM associated with MR and preserved ventricle function seen in one center from January 2015 to March 2020 were included. Clinical and echo features were described. Results: Twelve patients were identified (66% females), 8 (66%) presented with heart failure due to severe MR , and 4 were asymptomatic with mild-moderate MR. Echo features in all patients showed Papillary Muscle Noncompaction (PMNC). The Papillary Muscle (PM) base was discontinuous with the endocardium in 5 patients (41%) and PM were not well differentiated from the noncompacted myocardium in 3 patients (25%)There were variable degrees of chordal elongation and malcoaptation of the leaflets in all patients. Five patients (41%) had associated congenital heart disease including ventricular septal defects in 4 and patent ductus arteriosus in one patient. Conclusion: PMNC causes MV chordal abnormalities that lead to malcoaptation of the mitral leaflets resulting in MR. NCCM needs to be considered when evaluating patients with MR.
Abstract Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable complicati... more Abstract Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable complications of group A streptococcus (GAS) infection that is endemic in many countries. Prevention of ARF/RHD can be initiated at primordial, primary, and secondary levels. There has been a recent reappraisal of the role of primary prevention targeting early diagnosis and treatment of GAS pharyngitis. Strategies for primary prevention can be implemented at a population level by improving public awareness about the disease and at the health system level by training of health workers and integration into health programs. Although microbiological culture remains the gold standard to diagnose GAS pharyngitis, simple clinical predictive rules have proved to be adequately sensitive and specific as well as cost effective and more feasible in resource-limited settings. Treatment by a single injection of benzathine penicillin (BPG) is affordable; health workers need to be trained in penicillin administration, and the drug should be made available in primary health centers. New formulations of BPG with better safety margins and easier administration methods need to be developed.
The globalburdenof paediatric and congenital heart disease (PCHD) is substantial. We propose a no... more The globalburdenof paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children’s Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and s...
Introduction: Violation of the diastolic function of RV in patients with aortic regurgitation is ... more Introduction: Violation of the diastolic function of RV in patients with aortic regurgitation is associated with chronic overload of the volume and decrease in the pumping function of LV. This leads to hypertension in the small circle, expansion of the RV cavity and violation of its systolic function. At the same time, there is a change in the mechanics of the movement of the interventricular septum, which manifests itself in violation of the interventricular interaction of the right and left heart. LV overload in patients with aortic regurgitation has a mechanical effect on the interventricular septum, disrupting the diastolic function of RV. Objectives: The aim was to study the effect of severe chronic aortic regurgitation (AR) on right ventricular (RV) diastolic function by using echocardiography. Methods: This study examined 57 patients with AR. All patients were male with a mean age 35AE5 years. Patients had NYHA class II-III chronic heart failure. The control group consisted of 10 healthy volunteer. All patients underwent echocardiography. RV diastolic function was evaluated using PW-Doppler echocardiography. The calculated parameters of transtricuspid flow. Results: There was no significant difference in patients with AR and controls regarding echocardiographic parameters characterising the right chambers of the heart: RV fractional area change, RV anterior wall thickness and the area of the right atrium. Significant difference between controls and patients with AR was observed in the RV end-diastolic dimension. Transtricuspid flow parameters in patients with AR, namely E/A of RV, RV IVRT, and VTI, were significantly different from those in controls. A high correlation was observed between the degree of AR and the occurrence of RV diastolic dysfunction (r¼0.71). Conclusion: LV volume overload violates interventricular interaction and negatively affects RV diastolic function. It is necessary to analyse in detail transtricuspid flow in patients with severe chronic AR to assess the condition of their RV.
Background: Rheumatic heart disease (RHD) is an important public health problem in Sudan. Methods... more Background: Rheumatic heart disease (RHD) is an important public health problem in Sudan. Methods: Clinical and echocardiographic findings from an RHD registry in Khartoum (January 2005-March 2018) are described. Operated and un-operated children were prospectively followed. The quality of life (QOL) for children who had surgery was evaluated using pediatric QOL cardiac module. Results: A total of 818 children (51% males) were included, patients were clustered in White Nile and Kordofan area. RHD was found in 78% and acute rheumatic fever (ARF) in 22% of cases. RHD was severe in 65% and the most common lesion was mitral regurgitation (MR) in 37%. Followup of 107 un-operated children for a mean of 2 years revealed major complications in 38% including a mortality of 14%. Severe valve dysfunction tended to remain unchanged. There were 3 deaths in children with severe valve lesions immediately following benzathine penicillin injections. Only 19% of patients underwent surgery with an average post-operative mortality of 10.5% in the last 8 years. Of those, only 34 were reached for follow-up (23%), all were in New York Heart Association (NYHA) class 1, however adverse outcomes were observed including noncompliance with benzathine penicillin and warfarin (51% and 29% respectively) and more than mild valve dysfunction in 35%. All children who had valve surgery have a good QOL scores. In the last 3 years, the outpatient visits, admissions and mortality rates decreased by 20%, 48% and 22% respectively. Conclusions: RHD is clustered in certain areas and presents with severe valve lesions with a high mortality for un-operated patients. Operative mortality improved over the last years but the follow-up rates are poor and adverse outcomes are common. There is an apparent trend of decline in the number of patients with RHD seen at referral hospitals.
Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococca... more Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococcal infection, is highly prevalent in Sudan. Echocardiographic (echo) screening has an established role in disease surveillance. This study aims to measure the echo prevalence of RHD using handheld echo (HHE) in West and North Darfur and Kassala states and initiate control programs. School children 10-18 years of age were selected from the three states and HHE screening was performed by trained paediatric residents supervised by cardiologists using a pretested protocol. Health worker training and public awareness sessions were carried out. The study was conducted between November 2020 and December 2021. In West Darfur, 1,547 children were screened, echo prevalence was found to be 17.4/1,000, and 22% had moderate to severe disease. In North Darfur, 800 children were screened and echo prevalence was 16.2/1,000, 23% had moderate to severe disease while in Kasala 2,225 children were screened a...
Rheumatic heart disease (RHD) is a completely preventable, life-threatening complication of a gro... more Rheumatic heart disease (RHD) is a completely preventable, life-threatening complication of a group A streptococcal pharyngitis and the commonest cause of acquired heart disease in children and young adults in low and middle income countries. Conventional control measures are faced with many obstacles including the difficulty of early diagnosis of bacterial pharyngitis and acute rheumatic fever (ARF) leading to late presentation with established RHD which is not curable. Recent evidence confirmed the role of echocardiography screening of asymptomatic children in early detection of "latent" RHD. Benzathine penicillin prophylaxis was shown to be effective in halting the progression of latent RHD. There is enough evidence to warrant implementation of control strategies that use lower thresholds for diagnosis of GAS and ARF and we believe that it is high time to introduce echocardiography screen-to- treat policy in endemic areas.
Rheumatic heart disease (RHD) is the commonest cause of cardiac morbidity and mortality in young ... more Rheumatic heart disease (RHD) is the commonest cause of cardiac morbidity and mortality in young people in Sudan. A control program was initiated based on a framework (SUR I CAAN), standing for SURveillance, Integration, Collaboration, Awareness, Advocacy and traiNing. It utilised research funds to initiate sentinel sites for RHD control in rural endemic areas. Handheld echocardiographic screening of 12,000 subjects in five regions revealed a wide disparity in RHD prevalence ranging from 0.3/1,000 in Khartoum to 61/1,000 in North Kordofan. Training of health personnel and public awareness campaigns were conducted. We believe that RHD control is achievable using small funds targeted to endemic areas.
Pediatric cardiology (PC) is a rapidly advancing specialty addressing a large population of child... more Pediatric cardiology (PC) is a rapidly advancing specialty addressing a large population of children as well as adults with congenital heart disease. It requires huge technical and financial resources; therefore, establishing, maintaining, and developing such services in limited resource settings are challenging. A PC program that includes clinical aspects, echocardiography, diagnostic and interventional cardiac catheterization and cardiac surgery, and rheumatic heart disease control was established in Sudan in 2004. There are currently three public centers with facilities to evaluate and treat children with heart disease: two in Khartoum and one in Wad Medani. Major obstacles include the shortage of trained personnel and operation rooms, the deficiency of intensive care facilities, and the financial burden of interventional procedures. This paper details the establishment and progress of the program, its challenges, potential solutions, and future perspectives for PC programs in Su...
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