An appraisal of rheumatic valvular disease in Western Samoa

Rheumatic valvular heart disease appears to be common in Western Samoa, although the exact incidence is unknown. The outcome in 170 known cases since 1974 is reviewed. Thirty-six patients underwent cardiac surgery overseas, with one operative and four late deaths and a further 32 patients died while on medical treatment. Advanced disease was present in the majority of the surviving medical patients. Mitral stenosis was the most common problem. Thromboembolism appeared to be uncommon despite the absence of anticoagulant therapy. Bacterial endocarditis was also seldom recognised, but was probably under-diagnosed. At present penicillin prophylaxis is often taken haphazardly and an unknown number of cases receive no treatment at all. A prophylactic programme centred on the screening of schoolchildren is suggested.