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The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in five years follow-up in children with post-rheumatic valvulopathies in natural history in St. Elizabeth Catholic General hospital Shisong, cardiac centre. This retrospective analysis included 270 patients aged between 5 and 16 years old suffering from post-rheumatic valvulopathies who consulted in the cardiac centre from July 2008 through July 2013. Postrheumatic valvulopathies were diagnosed according to the World heart federation criteria. Data from patients' records, two-dimensional echocardiographic studies, and electrocardiograms were reviewed. Patients and their family were contacted every six months. The duration of the follow-up was 60months. Patients aged between 5 and 16 years old with a mean age of 12.4±4.5 years. Female gender was representing 63% (n=170) of the population. Surgery was indicated in 256 cases. Lesions of the valves needing prophylaxis with penicillin was diagnosed in 14 cases. In 95 patients surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 61.5%, n=164 patients; 38.5%, n=103 patients had aortic regurgitation. Mitral stenosis and mitral disease were also represented in 6%, n=16, and 8%, n= 21 patients respectively. Pulmonary hypertension was the common echocardiographic complication of the disease in=234, 87% of cases. Clinically, complications of the disease included congestive heart failure (n=229, 85%), growth retardation (n=162, 60%), sudden death (n=27, 10%). On presentation, n=210, 78% of cases were admitted. Mortality in two years was 35%, (p≤0.05, 95% CI=2.5-6.5), in five years was 65% (p≤ 0.05, 93% CI= 2.7-7.21). The challenges faced are patients' negligence and poor discipline, wrong beliefs, poverty. Post-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow up of patients is difficult.

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AIM: The purpose of the study was to assess the incidence and survival rate of patients with complete atrio-ventricular block in the cardiac centre of St Elizabeth Catholic General Hospital, Kumbo, Cameroon. METHODS: Between 2009 and 2011, 26 patients with complete atrio-ventricular block were diagnosed at our institution. Complete atrio-ventricular block was defined as complete heart block, diagnosed by echocardiographic or electrocardiographic documentation of the dissociation between electrical activity of the atria and ventricles. Hospital charts, electrocardiograms (ECG), echocardiography and chest radiography were reviewed. RESULTS: The triad of symptoms that pointed to the diagnosis of complete atrio-ventricular block was mainly fatigue, shortness of breath on mild physical exertion, and dizziness. The median age at diagnosis was 65 ± 15 years. The escape rhythm showed a narrow QRS complex in 35.2% of patients, whereas wide QRS complexes were seen in 64.8%. In only 15 patients were pacemakers implanted: dual-chamber in 10 and single-chamber in five cases, depending on the availability of the pacemakers. During the observational period, five non-implanted patients died, giving a mortality rate of 45%. We recorded no deaths in patients with pacemakers. CONCLUSION: In developing countries, natural selection is observed in patients with complete atrio-ventricular block. Lack of infrastructure and early detection, and financial limitations are the main problems faced in the follow up of these patients. Re-organisation of the public health system, new programmes for the prevention of cardiovascular diseases, and government subsidisation are needed in our milieu.

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UNLABELLED: The extent of congenital heart disease in Cameroon remains largely unknown. The aim of this study was to determine the occurrence and pattern of congenital heart diseases in the Cardiac Centre of St Elizabeth Catholic General Hospital, situated in a rural area of Cameroon. METHODS: Between November 2002 and November 2008, a population of 2 123 patients with suspected cardiac pathologies were consulted at St Elizabeth Catholic General Hospital referral cardiac centre. Of these patients, 292 subjects were recruited for the study, based on detection of (1) precordial murmurs and/or cardiomegaly on chest X-ray examination, or (2) congenital heart diseases on transthoracic Doppler echocardiography examination. RESULTS: Congenital heart diseases and inorganic murmurs were found in 95.5 and 4.5% of the patients, respectively. Congenital heart diseases included tetralogy of Fallot (26.1%), isolated ventricular septal defect (38.8%), atrioventricular cushion defect (7.3%), isolated atrial septal defect (2.8%), arterial duct cases (12.4%), common arterial trunk (1.3%), isolated stenosis of the pulmonary artery (2.6%), coarctation of the aorta (1.1%), congenital mitral valve regurgitation (1.2%), atresia of the triscupid valve (1.6%), double-outlet right ventricle (2.1%), anomalous pulmonary venous return (1.5%) and left isomerism (1.2%). CONCLUSION: Our data show that there is a high occurrence of congenital heart disease in this hospital in a rural zone of sub-Saharan Africa and that isolated ventricular septal defect is the predominant pathology. Post-surgical follow up remains very challenging as many parents cannot afford their children's medical treatment or are generally not well educated.

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UNLABELLED: The aim of the study was to investigate the occurrence, pattern and clinical aspects of congenital heart diseases and their management in Cameroon. In this multicentred retrospective study from January 2006 till November 2009, out of 51,636 consulting in three referral centres, 505 were recruited. All the patients presented with the following symptoms: cyanosis, clubbing, frequent respiratory tract infections, failure to thrive, growth retardation, precordial murmur and dyspnoea. Patients were sent for the screening of congenital heart disease. After the comprehensive Doppler echocardiography, the recruited patients were diagnosed with congenital (67.2%) and in few, acquired heart disease. Heart murmur, dyspnoea and growth retardation was the triad mostly encountered. The occurrence of congenital heart diseases in Cameroon is 9.87%. In Douala, isolated ventricular septal defect, interatrial septal defect and isolated pulmonary valve stenosis were more diagnosed than in Shisong (P <0.05) and Yaoundé (P <0.05). In Yaoundé, there were more cases of common arterial trunk, transposition of great arteries with ventricular septal defect and Ebstein disease than in Shisong (P <0.05) and Douala (P < 0.05). At Shisong, tetralogy of Fallot, arterial duct, coarctation of the aorta, congenital mitral valve regurgitation, atresia of the tricuspid valve, double outlet right ventricle, anomalous pulmonary venous return and left isomerism were more diagnosed than in Yaoundé (P <0.05) and in Douala (P <0.05). Thirty percent of the patients were operated abroad; 9% in the cardiac centre. CONCLUSION: Our data show that congenital heart diseases are represented in Cameroon as in the literature; isolated ventricular septal defect is the predominant pathology.

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UNLABELLED: Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, broadly as many as half of the 2.4 million children affected by RHD live on the continent. We report on the occurrence and pattern of valve involvement in RHD using echocardiography in our centre and post surgical follow-up. METHODS: In this retrospective study, transthoracic echocardiography (TTE) data collected from the Shisong cardiac centre over a period of 24 months (August 2005 to August 2007) were reviewed. Patients with a precordial murmur were selected. A total of 262 echocardiographic examinations were done in the centre over the two-year study period. The screening allowed us to see two categories of patients: 169 (64.5%), 79 male and 90 female, out of the 262 patients with abnormal results had an echocardiographic diagnosis of RHD, 80 (30.5%) patients had congenital heart disease. The 13 (5%) patients left had innocent murmur. Mitral valve regurgitation was the commonest echocardiographic diagnosis present in 101 patients (59.7%). Thirty-six (13.7%) patients had mixed mitral valve disease, 40 (23.7%) had mixed aortic and mitral valve disease, 42 (25%) had pure mitral stenosis and 26 (15.3%) had pure aortic regurgitation. The complications of RHD being observed included secondary pulmonary hypertension in 20 patients (11.8%) and functional tricuspid regurgitation was seen in 39 (21.9%). The congenital heart disease were: tetralogy of Fallot 29.1%, isolated ventricular septal defect 62.5%, isolated atrial septal defect 3.2%, atrioventricular canal 1.1%, patent ductus arteriosus 2.2%, common arterial trunk 1.9%. Our data showed that in children above 10-years-old in rural zone of Cameroon presenting with a precordial murmur RHD has to be suspected. Acute rheumatic fever primary and secondary prevention as well as rheumatic fever registers are important for the disease eradication in our countries. More surgical centres for a better management of the RHD complications are needed in sub-Saharan Africa. Due to poverty and illiteracy of parents, the post surgical follow up of patients is challenging.

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