[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

[Results of surgical treatment of intracardiac total anomalous pulmonary venous return]

Total anomalous pulmonary venous return [TAPVR] has a rather low incidence [1-3%] of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. To report our results and long-term follow-up of surgical management of intracardiac TAPVR. Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique

[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

Late reinterventions after repair of common arteriel trunk

The common arterial trunk is a heart disease in witch a unique arterial trunk, with a unique ventriculo-arterial valve, exits from the ventricular mass and supply directly the coronary, the aortic and also the pulmonary arterial circulations. Its anatomic repair is now possible but necessitates the use of conduit in pulmonary position. To evaluate the incidence and the causes of late reinterventions after repair of common arterial trunk. We retrospectively study the outcome of 17 patients who underwent repair of common arterial trunk between January 1983 and December 2006. The 15 early survivors were followed during a median period of 7 years [range 10 months and 13 years].: Nine reinterventions were necessary in 8 patients. Only one conduit reintervention was necessary in the 8 patients. Freedom from conduit reintervention was 73% at 5 years and 33% at 10 years. Three reinterventions were performed in 2 patients for severe truncal valve incompetence, including repair in 2 cases and replacement in one case. Freedom from truncal valve reintervention was 67% at 10 years. Late reinterventions are inevitable after repair of common arterial trunk. The most common reasons are conduit stenosis and truncal valve incompetence

[Q fever endocarditis: a case report]

Do we bring back the observation of a patient aged of 42 years having a mitro-aortic valvulopathy who present since 3 months a level III dyspnea, a fever to 39 degree C, a change of the general state and a splenomegaly. To the chest x-ray we note a pulmonary parenchymatous focus. Echocardiography puts in evidence a mitral illness to stenosis predominance and an aortic illness complicated of a graft bacterial with an abscess of the mitro-aortic trigone. Haemocultures were negative and the serology of the Rickettsia was positive. The diagnosis of infective endocarditis to Coxiella Burnetii is kept and is the patient put under Doxycycline 200mg/j, Hydroxychloroquine 2cp/j and Ofloxacine 400mg/j, Will the two first antibiotics be pursued to the 18th month. The patient benefited, after 20 days of three antibiotics therapy, of a duplicate aortic and mitral replacement with simple following

Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres

We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year [from March 2000 to February 2001]. Method: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender [OR=2.3, p<0.001], age [OR=l.02, p<0.01] and health insurance [OR=1.5, p<0.01]. 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularization of thrombolysis, 51% on men vs 31% on women [p <0.01]. The fatality rate was higher on women 14% vs 6.4% on men [p<0.01] at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age [RR=l.08, p < 0,001] and delay [2.56 p <0.001] and tobacco smoking [RR=2,83, p <0.0001]. this study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance

Prevention secondaire des maladies cardiovasculaires: Connaissances et pratiques des malades

The aim of our study is to assess the degree of awareness and practices of patients with cardiovascular disease. Method: During October 2002- February 2003, we conducted a CAP study [Knowledge, attitudes, behaviors] at some outpatient clinic visit of Tunis District. Using a standardized questionnaire, investigators have collected demographic and personal data, informations about risk factor levels, knowledge and attitudinal characteristics related to risk factors for patients who satisfied the inclusion criteria. 443 patients have been interviewed [68.4% are men]; 40% have more than 65 years old. Half of patients have never been schooled. Most of them have low socioeconomic level [38.8%] or middle one [56.0%]. 66.9% of men have quitted tobacco smoking and 19.5% still smoking 41.3% of patients have some difficulties to change their lifestyle, The difference is statically significant by educational and occupational levels. Almost 60% of them used to practice daily a moderate physical activity, which was more frequent among men then women [p<0.01]. During the last year, majority of patients has had checked their blood pressure [98%], glycaemia [94%] and cholesterolemia [94%]. However, about 57% to 67% of patients knew if they have hypertension, diabetes or hypercholesterolemia. Most of patients are aware that healthy lifestyle can be important in preventing heart attacks and stroke and that control of blood pressure, cholesterolemia and glycaemia reduce recurrence of these attacks once they happened. CVDs prevention and control is facing the crucial question on lifestyle change and enhancing patients responsibility in their own health promotion

Evaluation par echocardiographie doppler du profil hemodynamiques des protheses mitrales. A propos de 90 cas

From 1981 to 1999 mitral bileaflet prosthesis was implanted to 90 patients. Doppler echocardiography was performed for these patients between January and march 2002 with a mean deadline of 111 months after the intervention. 36 were women [40%] and 54 were men [60%]. The mean age was 41 years [20-70years]. The mitral bileaflet prosthesis was a saint jude in 65 cases jyros 8 cases, carbomedics 7 cases, sorin bicarbon 7 cases, Edwards duromedics 2 cases and an ON-X in one case. The maximal transprosthetic gradient was 15.7 mm Hg +/- 5.06 [6-25 mm Hg]. The mean transprosthetic gradient was 5.6 mm Hg +/- 1.07 [3-9.5 mm Hg]. The mean prosthesis functional area 2.37 cm2 +/- 0.44 [1.75 cm2 et 3.60cm2]. maximal gradient mean gradient and prosthesis functional area are independent from kind mitral bileaflet prosthesis and from the prosthesis size