Maladies non transmissibles et comorbidités chez les séniors dans le service de medécine interne du CHU de Bouaké / Non-Communicable Diseases and Comorbidities in Seniors in the Internal Medicine Department of the University Hospital of Bouake

. Les maladies non transmissibles chez le sujet âgé sont négligées en Afrique car l'espérance de vie n'était aussi élevée qu'aujourd'hui. Quel en était donc le panorama, il y a 10 ans ? Objectif : Améliorer les connaissances des maladies non transmissibles et des comorbidités chez les sujets âgés. Méthodes. Il s'agissait d'une étude transversale, rétrospective à visée descriptive du 1er janvier 2009 au 31 décembre 2013 dans le service de Médecine Interne du Centre Hospitalier Universitaire de Bouaké (CHU). Elle portait sur 151 patients hypertendus âgés de 65 ans et plus. Résultats. L'âge moyen était de 75 ans avec des extrêmes de 65 ans et 93 ans. Le sex-ratio était de 1,07. Les comorbidités étaient marquées principalement par le diabète (47%). Les motifs d'hospitalisation étaient dominés par les signes neurologiques (70%). L'hypertension artérielle (HTA) systolique isolée représentait 48% et l'HTA de grade III 23%. Ses principales complications étaient les accidents vasculaires cérébraux (AVC) (62%) et les cardiopathies (32%). Ces AVC étaient surtout ischémiques (78%). L'HTA était associée à d'autres facteurs de risque cardiovasculaire (78%) notamment la pression pulsée (52%) et le diabète (47%). Les Inhibiteurs de l'enzyme de conversion (IEC) étaient les plus prescrits (64%). La mortalité était de 23%. Conclusion. Les facteurs de risque cardiovasculaire constituent depuis plus de 10 ans à Bouaké, la morbidité mais surtout la mortalité des séniors, du fait de la gravité de leurs complications.

Acute myocardial infarction at a district hospital in KwaZulu-natal ­ management and outcomes

Acute myocardial infarction (AMI) following ischaemic heart disease (IHD) is associated with increased morbidity and mortality. The condition remains a management challenge in resource-constrained environments. This study analysed the management and outcomes of patients presenting with AMI at a district hospital in KwaZulu-Natal. Methods: A descriptive study that assessed hospital records of all patients diagnosed with AMI over a 2-year period (01 August 2016 to 31 July 2018). Data extracted recorded patient demographics, risk factors, timing of care, therapeutic interventions, follow up with cardiology and mortality of patients. Results: Of the 140 patients who were admitted with AMI, 96 hospital records were analysed. The mean (standard deviation [s.d.]) age of patients was 55.8 (±12.7) years. Smoking (73.5%) and hypertension (63.3%) were the most prevalent risk factors for patients with ST elevation myocardial infarction (STEMI) in contrast to dyslipidaemia (70.2%) and hypertension (68.1%) in patients with non-ST elevation myocardial infarction (NSTEMI). Almost 49.5% of patients arrived at hospital more than 6 h after symptom onset. Three (12.5%) patients received thrombolytic therapy within the recommended 30-min time frame. The mean triage-to-needle time was 183 min ­ range (3; 550). Median time to cardiology appointment was 93 days. The in-hospital mortality of 12 deaths considering 140 admissions was 8.6%. Conclusion: In a resource-constrained environment with multiple systemic challenges, in-hospital mortality is comparable to that in private sector conditions in South Africa. This entrenches the role of the family physician. There is need for more coordinated systems of care for AMI between district hospitals and tertiary referral centres.

Causes de réhospitalisation pour insuffisance cardiaque dans le service de cardiologie du CHU de Brazzaville (République du Congo) / The causes of rehospitalization for heart failure in the department of cardiology at the university hospital of Brazzaville (Republic of the Congo)

But: Identifier les causes de réhospitalisation pour insuffisance cardiaque (IC) Patients et méthode: cette étude transversale a été menée entre avril 2014 et mars 2015 dans le service de cardiologie du centre hospitalier universitaire de Brazzaville (République du Congo). Ont été inclus, les patients ayant des antécédents d'hospitalisation pour IC. Résultats: Quatre-vingt-onze patients, 54 femmes (59,3%) ont été inclus. Le sexe-ratio était de 0,7. La fréquence de réhospitalisation pour IC était de 19%. L'âge moyen était de 62 ± 16 ans (extrêmes: 24-89 ans). Le nombre moyen de réadmissions était de 2 ± 0,8 (extrêmes: 1 à 5), les réhospitalisation fréquentes (supérieur à 3) étaient de 33 (36,2%). Les patients présentaient un statut socioéconomique faible dans 59 cas (64,8%), et une hypertension artérielle dans 40 cas (43,9%). L'examen physique a retrouvé : une insuffisance cardiaque globale 77 cas (84,6%), une insuffisance cardiaque droite exclusive 5 cas (5,5%). Les causes de l'insuffisance cardiaque étaient: la cardiopathie hypertensive 40 cas (43,9%), la cardiomyopathie dilatée 28 cas (30,8%) et les valvulopathies 9 cas (10%). Les principales causes de réhospitalisation étaient: les écarts du régime hyposodé 64 cas (70,3%), la mauvaise observance du traitement 56 cas (61,5%), la grippe 15 cas (16,5%), la fibrillation atriale 12 cas (13,2%), débit de filtration glomérulaire réduite 12 cas (13,2%). La durée moyenne d'hospitalisation était de 11 ± 6,4 jours (extrêmes: 2-29). Le décès a été enregistré dans 5 cas (5,5%). Conclusion: L'absence de respect pour un régime pauvre en sodium et une mauvaise adhésion au médicament ont été les principales causes de réhospitalisation pour IC à Brazzaville. À cet égard, il est nécessaire de promouvoir l'éducation thérapeutique et d'améliorer l'accès au traitement.

Background: to identify the causes of readmission for heart failure (HF) Methods: this cross-sectional study was conducted in April 2014 to march 2015 in the department of cardiology, University Hospital of Brazzaville (Republic of the Congo). We had included, the patients who had a history of hospitalization for HF. Results: Ninety-one patients, 54 women (59.3%) were included. Sex-ratio was 0.7. The frequency of readmission for HF was 19%. The mean age was 62±16 years (range: 24-89). The average number of readmission was 2±0.8 (range: 1-5), the history of readmission ≥ 3, were 33 (36.2%). The patients were low socio-economic status in 59 cases (64.8%). In examination, patients were in congestive HF (n=77, 84.6%), right-sided HF (n=5). The causes of HF were: hypertensive heart disease (n=40, 43.9%), dilated cardiomyopathy (n=28, 30.8%), and valvular heart disease (n=9). The main causes of readmission were: excessive salt intake (n=64, 70.3%), poor drug-adherence (n=56, 61.5%), influenza (n=15, 16.5%), atrial fibrillation (n=12, 13.2%), reduced estimate glomerular filtration rate (n=12, 13.2%). The average length of hospitalization was 11±6.4 days (range: 2-29). The death was recorded in 5 cases (5.5%). Conclusion: No respect of low sodium diet and poor drug adherence, were the most causes of readmission for HF at Brazzaville. In regard of this facts, promoting therapeutic education is needed, and increasing access to treatment

The effect of beta-blockers on foetal birth weight in pregnancies in women with structural heart disease: a prospective cohort study

Objective:To examine whether treatment with beta-blockers(BBs) in pregnant women with structural heart disease (SHD)resulted in a decrease in foetal birth weight (FBW) in a SouthAfrican cohort.Methods:This was a prospective cohort study conducted in a tertiary-level hospital in Cape Town from 2010 to 2016. Of the 178 pregnant women with SHD, 24.2% received BBs fora minimum of two weeks. Adverse foetal outcomes andmean FBW were compared between the BB groups and subgroups(congenital, valvular, cardiomyopathy and other). Adversefoetal outcome was defined as: low birth weight (LBW)<2 500 g, Apgar score<7, premature birth (<37 weeks) and small for gestational age (SGA).Results:BB exposure during pregnancy was found to be associated with a non-significant increased FBW (2 912 vs2 807 g,p=0.347). A significantdecrease(p=0.009) wasnoted in FBW for valvular SHD pregnancies using BBs,while a significant increase (p=0.049) was observed for thesame outcome in the cardiomyopathy subgroup using BBs.A significant increase was observed for SGA (p=0.010) andLBW (p=0.003) pregnancies within the valvular subgroupwhen exposed to BBConclusion:BB use in pregnant women with SHD in a South African cohort showed no association with a decrease in FBW or an increase in adverse foetal outcomes when compared to non-BB usage

Predictors of incident heart failure in a cohort of patients with ischemic heart disease

Introduction: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD. Methods: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded. Results: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol.Conclusion: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment

Heart failure in Ethiopian children: mirroring the unmet cardiac services

BACKGROUND: HeartFailure (HF) is a progressive clinical and pathophysiological syndrome caused by cardiovascular and noncardiovascular abnormalities. Childhood HF has not been well studied in Sub-Sharan Africa, particularly in Ethiopia. Hence, this study aimed at describing the pattern and outcome of pediatrics HF at a referral-teaching hospital. METHODS: Medical records of 216 HFchildren aged 2months to 14 years, and admitted between January 2014 and January 2016 were reviewed. Clinical information was collected, analyzed and presented in tables and pie charts. RESULTS: A total of 2000 children were admitted to Hawassa University Hospital during the study period. HF accounted for 10.8% (216) of pediatrics admissions, 51.9% males. The median age of the study subjects was 6years. Functionally, NYHA/Ross class III and IV consisted 65(30.1%) and 139(64.4%) of HF. Structural heart diseasewas the commonest cause of HF, 144(66.7%): Rheumatic heart disease (RHD),75(52%), and congenital heart disease (CHD),64(44.5%). Anemia and renal cases contributed to 50(23.1) and 12(5.6%) of HF.CHD was predominantly documented in <5years. Pneumonia 66(42.9%), and infective endocarditis 29(18.8%) were the common precipitating/comorbid conditions with HF.Thecase fatality rate of HF was 13.9 %( 30). CONCLUSION: In this study, HF accounted for a tenth of pediatrics admissions. Structural heart disease was the commonest cause of heart failure. CHD and RHD affected predominantly children of <5years of age and >5 years of age. Echocardiographic screening of HF cases for structural heart disease and optimal care for patients with underlying structural heart disease are recommended

Prise en charge des patients nécessitant une réintervention cardiaque valvulaire: Expérience du service de cardiologie du CHU d'Oran / Management of patients requiring a reintervention of the heart valve: Experience of the cardiology department of University Hospital Center of Oran

Introduction - Les cardiopathies valvulaires demeurent fréquentes malgré l'amélioration des conditions sanitaires qui ont permis la réduction de l'incidence du rhumatisme articulaire aigu (RAA). Les indications chirurgicales et interventionnelles se sont élargies et nous opérons aujourd'hui à des stades précoces voire asymptomatiques. Une réintervention chirurgicale valvulaire est nécessaire dans environ 15% des cas au cours de l'évolution d'une valvulopathie opérée. L'objectif de notre étude est de déterminer la fréquence des réinterventions valvulaires et d'identifier les principales indications de ces réinterventions. Méthodes - Il s'agit d'une étude rétrospective descriptive, portant sur 45 patients, admis au service de cardiologie du Centre Hospitalo-Universitaire (CHU) d'Oran, de janvier 2011 à juillet 2013, et présentant une valvulopathie déjà opérée nécessitant une autre réintervention chirurgicale valvulaire. Résultats - La moyenne d'âge est de 41 ans, 73% des patients sont des femmes et 27% des hommes (Sex ratio de 0,37). La plupart de nos patients sont symptomatiques (dyspnée stade II de la NYHA). Les réinterventions intéressent la valve mitrale dans 69% des cas, la valve aortique dans 37% des cas et la valve tricuspide dans 35%. Nous avons constaté l'importance des insuffisances aortiques et tricuspides négligées lors de la première intervention (31% et 62% respectivement). Le délai moyen entre les deux interventions, tout type confondu, est de 21 ans. Conclusion - Les réinterventions cardiaques peuvent survenir au cours de l'évolution d'une valvulopathie. Une bonne évaluation cardiaque initiale des valvulopathies lors d'une chirurgie portant sur la valve mitrale ou aortique est indispensable pour pallier au problème d'une réintervention pour des valvulopathies négligées.

Background - Valvular heart disease still common despite improved health conditions that have reduced the rheumatic fever incidence. Surgical and interventional indications have expanded and today we operate at early stages, sometimes even an asymptomatic stage. Valvular reoperation is required in 15% of cases during the evolution of an operated valve disease. The aim of our study is to determine the frequency of valvular reoperations and identify the main indications of these reinterventions. Methods - This is a retrospective study included 45 patients who were admitted to the cardiology department of University Hospital center of Oran, from January 2011 to July 2013 and who had previously operated valvular disease requiring another surgical valvular reoperation. Results - The mean age is 41 years. 73% of patients are women and 27% are men. 95% of patients are symptomatic (NYHA dyspnea stage II). Reinterventions affected the mitral valve in 69% of cases, the aortic valve in 37% cases and the tricuspid valve in 35%. We reporte the importance of neglected aortic and tricuspid regurgitation during the first intervention (31% and 62% respectively). The average time between the two interventions, all types combined, is 21 years. Conclusion - Cardiac reoperations may occur during the course of valvular heart disease. A good initial cardiac evaluation before surgery on the mitral or aortic valve is essential to overcome the problem of neglected valvular disease reoperation.

Patients risk factors as predictors of surgical wound infection following open heart surgery

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1­2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA.Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection

High prevalence of atrial fibrillation in stroke patients admitted to university of Gondar hospital, northwest Ethiopia

Purpose : Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke

Congenital Heart Disease in the Niger Delta region of Nigeria : a Four-Year Prospective Echocardiographic Analysis : Cardiovascular Topic

Introduction : Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease. No previous prospective studies have been done on the prevalence of congenital heart disease (CHD) in the Niger Delta area. This study was done to determine the frequency and pattern of congenital heart disease; using echocardiography as a diagnostic tool. Methods : All patients presenting to the Paediatric Cardiology clinics of two centres; the University of Port Harcourt Teaching Hospital and the Paediatric Care Hospital between April 2009 and March 2013; were recruited and all had echocardiography performed.Results : Prevalence of CHD in this study was 14.4 per 1 000 children; 277 (83.4) of the patients had acyanotic CHD and 55 (16.6) had cyanotic CHD. Ventricular septal defect and tetralogy of Fallot were the commonest acyanotic and cyanotic heart defects; respectively.Conclusion : The high prevalence of CHD in this study is the highest in the country and Africa; and may be attributable to the increased oil spillage and gas flaring from petroleum exploitation in this region

Childhood Acquired Heart Diseases in Jos; North Central Nigeria

The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country; and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period; including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84?4.5 years) and comprised 80 (45.7) males and 95 (54.3) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0) children; followed by dilated cardiomyopathy (33 cases; 18.9) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1); pericardial disease in 15 (8.6); infective endocarditis in 8 (4.6) and aortic aneurysms in 2 (1.1) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology; with RHD remaining the most frequent; particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country

Pattern of Congenital Heart Diseases in Delta State University Teaching Hospital; Oghara; Nigeria

BACKGROUND: Congenital heart diseases (CHD) when detected in primary or secondary health care levels are almost always referred to the tertiary hospitals where more competent diagnostic evaluation is carried out. The burden of the CHDs is enormous to the patient; parents and the health sector since the facilities for definitive surgical interventions are not readily available in Nigeria resulting in indefinite conservative palliative management for those who cannot afford such surgical interventions abroad. OBJECTIVE: The objective of this prospective study is to determine the pattern of the CHDs presenting to Delta State University Teaching Hospital (DELSUTH); Oghara; a major tertiary care referral centre for the entire Delta State of Nigeria. MATERIALS AND METHODS : Outpatient and inpatient cases of all CHDs at DELSUTH; OGHARA were determined and the pattern of presentation with respect to age; sex; type of CHD; as confirmed to echocardiography were analyzed from November 2010 to February 2012. RESULTS:A total of 18 cases were seen in DELSUTH; Oghara. Ages at presentation were from 3 months to 9 years; males were 10 (55.6) and Females 8 (44.4). Thirteen of the eighteen CHD patients (72) presented in complications that required immediate admission for in patient care

Looking for a More Useful Atherogenic Index for Nigerians

Researchers have divided opinion as to which lipid fraction or cholesterol ratio can effectively be used to predict the chances of an individual developing heart disease or can best describe the atherogenic index of an individual. In this study the atherogenic risk of Nigerian hypertensives and normotensives was examined by different parameters in an attempt to find out which one best separates the high risk individual from the one with low risk of atherogenicity. Lipid profile and lipid ratios were examined by standard methods in 330 untreated hypertensives and 110 age snd sex matched normotensives in Nigerian hypertensives and normotensives respectively in UBTH; Benin City; Nigeria. Statistical analysis was used to determine which lipid parameter(s) gave a better reflection of the atherogenic index. The mean of serum lipids and lipid ratios were significantly higher in the hypertensives than in the normotensives. The mean of the atherogenic index of plasma (AIP); log (Tg/HDL-C) was significantly positive for the hypertensives but significantly negative for the study population and for the normotensives; p

Children's Heart Disease in Sub-Saharan Africa: Challenging the Burden of Disease

Children with heart disease in Africa have little or no access to treatment of any kind; and cardiac surgical services are virtually absent outside a handful of centres in a few of the wealthier nations. There is little reliable data concerning the prevalence of congenital or acquired heart disease in African children; but there is sufficient information to indicate that the burden of cardiac disease is vast. This major non-communicable disease is largely hidden; overshadowed by the incidence of communicable diseases. There is as yet little evidence of the hoped-for epidemiological transition toward non-communicable diseases amongst children in Africa. The burden of congenital heart disease is only part of the problem; with rheumatic heart disease (RHD) remaining the commonest cardiac problem; related to poor socioeconomic conditions. RHD is the most preventable form of cardiac disease; yet there is little preventive work being done. The many obstacles to developing paediatric cardiac care are discussed; and some possible ways forward are proposed

QT Interval Prolongation in Patients with Hypertensive Heart Disease

Background: The study assessed the prevalence of QT interval prolongation and identified its associated factors Methods: The study was cross-sectional in design. Subjects confirmed on echocardiography to have HHD were recruited consecutively from 3 echocardiography laboratories in the Kano City; Nigeria; over 7 months. Prolonged QTc was defined as QTc 440 ms in males and 460 ms in females; or more than 500ms in both sexes in the presence of complete bundle branch block. A p-value of

Rheumatic Fever and Rheumatic Heart Disease: Where are we now in South Africa?

South Africa continues to face unacceptably high rates of rheumatic fever (RF) and rheumatic heart disease (RHD); despite readily available and inexpensive preventive measures. However; in the past several years; key players in South Africa's healthcare and political realms in addition to key players from many African nations have come together to acknowledge the persistent health burden attributable to RF/RHD and have agreed to a pledge of action to reduce it.The plan of action is a comprehensive RF/RHD prevention and treatment programme known as ASAP. The ASAP programme targets efforts to raise Awareness; establish surveillance systems; Advocate for increased resources for treatment; and to promote Prevention strategies. South Africa currently has a demonstration site where activities in all of these key areas are currently underway. Efforts in the area of surveillance include a RHD prevalence study that aims to screen 4 000 school-aged children through the use of a mobile echo-surveillance unit. In addition to local efforts; South Africa will join an international initiative to create a global RHD registry that will aid in all aspects of prevention and treatment to further reduce the burden of disease attributable to RF/RHD

La plastie mitrale sur valve rhumatismale chez l'enfant au Senegal : 100 observations

La chirurgie mitrale reconstructrice est une alternative de choix au remplacement valvulaire chez l'enfant. Cette chirurgie est adaptee aux pays en voie de developpement ou le cout des protheses cardiaques associees ou non a l'anti coagulation a vie est exorbitant. Le but de cette etude est d'evaluer les resultats a court et amoyen terme de la plastiemitrale chez l'enfant au Senegal. Il s'agit d'une etude retrospective sur 8 ans (1999-2007); concernant 100 patients porteurs d'atteintes valvulaires rhumatismales. L'age moyen etait de 12 +/- 5 ans (7-17 ans). La symptomatologie etait dominee par la dyspnee. Les lesions valvulaires etaient complexes; la fonction myocardique des patients etait conservee et le ventricule gauche dilate. Des gestes (transfert et raccourcissement) etaient effectues sur les cordages (73) completes par des commissurotomies (22) et des fermetures de fentes (17).Une annuloplastie etait realisee chez 84 malades. La mortalite hospitaliere etait de 2. La morbidite post operatoire etait caracterisee par 4 plasties fuyantes. Pour un suivi moyen de 5 ans; il n'y avait pas de mortalite tardive. Les resultats etaient satisfaisants avec 84 patients presentant des fuitesminimes oumoderees. La reduction du diametre du ventricule gauche etait statistiquement significative en systole (29;5+/-6;2 mm vs 33;1+/- 5;3 mm; p 0;05) et en diastole (47;1+/-8;6 mm vs 50;5+/-9;4 mm; p 0;05).Ainsi; la plastie mitrale permet une stabilisation de la fonction myocardique et un remodelage significatif du ventricule gauche; au prix d'une faible morbi mortalite post operatoire. Une analyse lesionnelle precise est determinante. Les resultats a moyen terme sont encourageants

Profil epidemiologique des cardiaques gestantes passees en reanimation

Objectif : Les auteurs rapportent le profil epidemiologique des femmes enceintes porteuses d'une cardiopathie rencontrees dans le service de reanimation de la Maternite Befelatanana du Centre Hospitalier Universitaire d'Antananarivo (Madagascar) Materiels et methodes : A travers une etude retrospective descriptive sur 2 ans; de Juin 2007 a Mai 2009; portant sur les dossiers des cardiaques gestantes; a l'exclusion des cardiopathies hypertensives hospitalisees dans ce service. Les parametres analyses ont ete la frequence; l'etat civil et la grossesse. Resultats : Trente sept patientes ont ete recrutees avec une incidence de 1 pour 600 accouchements. L'age moyen etait de 29;6 +/- 6;6 ans avec des extremes de 18 et de 41ans. Trente quatre patientes (92) avaient une parite inferieur ou egale a 3. Trente cinq patientes etaient des femmes mariees (94;6). Vingt patientes (54) residaient en zone urbaine; 11 (30) en zone rurale; et 6 (16) hors du district. Vingt six cas (70) etaient menageres et seules 11 cas (32) avaient un revenu mensuel superieur au Salaire Minimal d'Interet General (SMIG). Concernant la grossesse; l'age moyenne etaient de 33 +/- 8 semaines d'amenorrhee (SA) avec des extremes de 10 et 40 SA. Seules moins de 10de nos patientes avaient beneficie de plus de 5 consultations prenatales (CPN). Conclusion : Ce profil epidemiologique devrait attirer une attention particuliere a l'egard de la cardiopathie du peripartum; et exige l'amelioration du niveau de vie parmi les mesures preventives