[Determinants factors of hospital morbidity and mortality after reintervention of valve replacement]

Valve surgery involves valvular substitutes that expose to different types of complications that can lead to re subsequent interventions. was to identify the predictors factors of in-hospital morbidity and mortality of re interventions after valve replacement. Retrospective study of 73 consecutive patients who underwent a re valve replacement between 1985 and 2010 in the Cardiovascular Surgical department of La Rabta hospital. The average age at further surgery was 44 years [15-80 years] and sex ratio of 0.87. The average time between interventions was 10 years [3 days -33 years]. Different etiologies were found prosthesis thrombosis [36.9%]. The overall hospital mortality was 36.9%, 11 intraoperative deaths and 16 immediate postoperative deaths. The iterative intervention of valve replacement surgery is increasingly mastered by the surgical team. According to this study, the prognosis depends mainly on the patient preoperatively state, the cause of further surgery and its mode of occurrence

Natural history of atrial septal defect in the sixth decade: study of 5 cases

Atrial septal defect [ASD] is one of the most common causes of congenital heart disease manifested in adulthood. To describe clinical and likelihood picture of adults over 60 years born with an ASD type II. We performed a retrospective study of adult'sASD referred toourinstitutionfrom 1985 through 2010. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. On follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. Among forty ASD type II manifested in adulthood which were referred to our department of cardiology five cases of ASD manifested in the sixth decades [2 men and 3 women]. Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Slight anterior chest deformity was present in the older patient. Systolic murmur was found in the 3rd left intercostals space and the pulmonary second heart sound was accentuated in all patients. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. There was marked cardiomegaly in four patients. The pulmonary arteries were markedly enlarged and the peripheral vascular markings were increased. Echocardiographic data revealed large secundum ASD [mean 20 mm, ranged between 10 and 30mm], severe systolic pulmonary pressure in two cases [>5O mmhg]. MeanQP/QS was 2.2 and contrast revealed bidirectional shunt in one patient. All patients were studied by venous cardiac catheterization. They showed a significant increase in the oxygen content of right atrial blood. Three patients underwent surgical atrial septal defect closure under general anesthesia. There were no operative or peri operative deaths. At mean follow up of 50 +/- 75 months, there was one late death from heart failure in a patient with advanced preoperative heart failure. The oldest patient is in the medical group and he is 75years old. Most survival patients remain in good clinical condition. Some of them were symptomatic at the last follow up and complained of shortness of breath on effort and palpitations in two cases. Two patients were in chronic atrial fibrillation developed during follow up. However, chest RX showed reduction in cardiothoracic ratio postoperatively. Echocardiographic examination confirmed that there was no residual shunt in across the atrial septum in any patient. Systolic pulmonary pressure felled only in 2 patients in the surgery group. To our knowledge, thesepatients havealongue life span, although survivors with ASD described in the world. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60years. Given the higher risks of surgery in advanced age, the defect should be repaired as early as possible to prevent hemodynamic complications

Cardiac injury in traumatic subarachnoid hemorrhagea: prospective study in 35 patients

Various electrocardiographic abnormalities have been noted since 1954 in patients with head trauma complicated by subarachnoid hemorrhage [SAH]. However, very few studies have interested to these ECG modifications in the case of post traumatic SAH [t-SAH]. To assess the incidence of ECG abnormalities during the first five days after admission and the predictive value of these cardiac complications on the mortality in t-SAH. This prospective study included 35 patients out of 125 with traumatic SAH diagnosed in the emergency unit in Rabta's hospital [2001-2009]. Patients with cardio vascular history, thoracic trauma, non neurological coma and vascular-related neurological coma were excluded. An electrocardiogram monitoring was performed. A brain CT scan was performed in admission, 48 h after and case of neurological aggravation. Serum cardiac troponin 1C levels were determined on hospital admission and then on the third and fifth days of hospitalization. The statistical analysis was based on the non-parametric variance test of Kruskal-Wallis to compare the means; on the chi 2 and Fisher tests to compare percentage, with a significant result at 0.05 percentile and on the Odds ratio non-parametric factors for death. Association between 2 quantitative variables have been analyzed by Pearson coefficient of correlation. Mean age of the 35 patients was 39 +/- 17 years. Sex ratio was 4 in favor of men. The prevalence of electrocardiographic changes was of 57% [20 patients] Serum Troponin I level showed a peak on the 3rd day then it decreased. The majority of electrical abnormalities occurred during the third after admission and are associated to a markedly increased Troponin I plasma level and to the highest rate of mortality. Statistical analysis showed a significant correlation between T wave changes and the increase of serum Tn 1C level [p= 0; 0002]. The relative risk of mortality was higher than 7.2 times in cases with increase serum Tnlc level. We demonstrated that ECG changes were common in patients with t SAH and the major predictive factors of mortality were the increase of serum TnIC and T wave changes Subarachnoid hemorrhage [SAH] is a complication of head trauma inducing frequently cerebral vasospasm and even cerebral infarct. Various electrocardiographic abnormalities have been noted in patients with head trauma complicated by subarachnoid hemorrhage [1-5]. They are considered to be secondary to the massive catecholamine discharge in systemic circulation [6, -9]. Serum cardiac troponin I [Tnl] was considered a highly sensitive and specific marker of myocardial cell lesion and might be regularly performed in these patients to detect early myocardial ischemia. We carried out a prospective study in 35 patients with traumatic SAH [tSAH] in order to assess the incidence of coronary complications during the first five days after admission and to demonstrate the interest of troponin le blood assay in the diagnosis of coronary abnormalities

[Mitral stenosis a rare antology of diffuse pulmonary ossification]

Diffuse pulmonary ossification is a rare entity with unknown pathogenesis. It presents with the formation of mature bone within the pulmonary parenchyma. Pulmonary ossification can be idiopathic or associated with diffuse and chronic lung disease, system disorders or heart disease essentially mitral stenosis. We report a case of a 49 year-old woman with long standing mitral stenosis. The patient had undergone a valve replacement with a mechanical prosthesis. She complains from dyspnea on exertion and dry cough. Frontal chest radiograph shows bibasilar confluent calcific areas of increased opacity. Computed tomography scans confirmed the presence of ossified acinar clusters. Other aetiologies of diffuse pulmonary ossification were eliminated by different complementary exams. Diffuse pulmonary ossification is slowly progressive. Patients are generally asymptomatic or complain from mild symptoms. Most cases are of diffuse pulmonary ossification are diagnosed during autopsy. Establishing a prognosis is difficult as few living cases are diagnosed

[Lipoprotein [A] as a risk factor for coronary artery disease]

Lp[a] may represent a link between the fields of atherosclerosis and thrombosis. Elevated Lp[a] levels > 300 mg/l have been associated with the presence of atherosclerotic disease. This prospective study initiated in 1995 and, until June 1999 enrolled 218 subjects divided in two groups: Gl: subjects with / without angiographically proven coronary artery disease[CAD], n = 124 and Gll: controls, n-94 The objective of this study was to assess the influence of high Lp[a] serum levels on the CAD. Secondary end point was to demonstrate a correlation between the level sevum Lp[a] and the severity of angiographic coronary findings, we found that the cases had significantly [p = 0.004] higher Lp[a] levels than the controls and that correlation existel between the value of Lp[a] serum levels and severity of angiographic findings. However, we do recommend Lp[a] screening for patients with curly CA 1:] or a family history of CAD