Infectious endocarditis in congenital heart diseases

Infectious endocarditis [IE] is a serious complication of congenital heart diseases. The aim of this study is to evaluate local patient characteristics, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE and congenital heart disease. Over a three-year period, 14 patients with IE were retrospectively enrolled [median age 15.7 years, range 1-40 years] with a female predominance. IE on congenital heart disease occurs in 2.5% of cases. The underlying anomalies were ventricular septal defect [n=7], patent ductus arteriosus [n=3], cyanotic heart disease [n=3] and atrial septal defect [n=1]. Two patients underwent a previous heart surgery. Source of bacteremia was found in 5 cases with predominance of oral procedures. An aetiological diagnosis was made in 6 cases, with predominance of gram-negative bacteria. In 3 cases, we had 'culture-negative' IE. Transthoracic echocardiography visualised vegetations in 13 cases. Transesophageal echocardiography was performed in 3 cases and confirms the diagnosis of IE particularly in one case in which transthoracic echocardiography was negative. Complications were dominated by congestive heart failure [n=5]. All patients had medical treatment. Eight patients had been cured by medical treatment. Four patients required cardiovascular surgery later. There were two pre-operative deaths and no post-operative deaths. These results show that infectious endocarditis on congenital heart disease is still relatively frequent and severe, and emphasize the basic importance of the prophylactic treatment that consists on antibioprophylaxis and prevention of spontaneous bacteremia

[Kidney disease in high hypertension]

The relation between hypertension and kidney disease is difficult to distinguish if the kidney disease is the cause or the consequence of hypertension or there is an other factor responsible. The aim of this study is to analyse the different kidneys damage in a group of hypertensive outpatients. It's a prospective study including 185 patients. The OMS criteria were necessary to have a confirmation of hypertension. The check up contained "azotaemia, creatininaemia, kaliaemia, natriaemea, alburninuria ". All the patients had a kidney ultrasonography. This study included l46females and 39 males. The average age was 48 years. Most of the patients [43%] were aged from 50 to 60 years. Kidney damage was found in 56 cases. There are 2 types of kidney disease in hypertension. The malignant nephroangiosclerosis found in accelerated hypertension and glomerulo-sclerosis with slow evolution noted in moderated hyper-tension and diabetes. Even though a benign kidney disease may be found in a hypertension and patient, it may be a sign of more important vascular and kidney risk and justifies vigilant surveillance

[Dilated cardiomyopathy in appearance primitive. about children [23 cases]]

It's a retrospective study of 23 cases of dilated cardiomyopathy in the child collected in different services of pediatrics [Ibn Rochd CHU and Sid Soufi] and in the Cardiology service of the Ibn Rochd CHU on a period of 8 years [1981 -1988]. The analysis of thee observations showed that: - The CMD of the child is a relatively rare affection - The middle age is of 3,8 years. 82,4% are young children of less than 6 years old, - The sharing is homogenous between the two sexes. - The family inquiry is imperative during all CMD of primitive behaviour. - The clinic board is that of a cardiac insufficiency [95,6%], the most often dramatic In the infant. - The electrocardiogram is constantly disturbed, but without any specificity for the cardiomyopathy. - The echocardiography is apriviled ged technique for the study of the dilated cardiornyopathies. It allows to set the diagnosis, to follow the evolution and to value the prognostic. - The medical treatment is based on the association of a rest, a salt-free diet, diuretics and digitalics. - The evolution is marked by a strong precocious mortality with possibility of a total recovery in almost a the cases. The etiology remains unknown and the prognostic stays difficult to value

[Results of surgery in cyanogen congenital heart disease]

This study concerns 54 patients with cyanogen congenital heart disease operated by "Terre des Hommes" between 1976 and 1986. These cardiopathies are divided as following: tetralogy of Fallot [37 cases], trilogy of Fallot [5 cases], double outlet of ventriculus dexter cordis [5 cases], transposition of great vessels [2 cases], tricuspid atresia [2 cases], complex cardiopathy [2 cases], single ventricle [1 case]. The surgical treatment has been only palliative in 10 cases, curative after a palliative anastomosis in 3 cases, and curative directly in 4l cases. 13 patients have undergone a palliative intervention of Blalock-Taussig in 10 cases, Blalock-Hanlon with banding of pulmonary artery in 1 case and Brock in 2 cases. During the corrective reparation, we practiced an infundibulotomy in 40 cases, a wideness of the pulmonary tract by patch in 21 cases, a pulmonary valvular commissurotomy in 10 cases, a direct shutdown of the interventricular septal defect in 5 cases, a shutdown of the interventricular septal defect by patch in 34 cases, a direct sutura of the lnteratrial septal defect in 9 cases, a shutdown of the foramen ins cases, and a shutdown of the anastomosis of Blalock-Taussing in 3 cases. We noticed only one precocious death and two tardive deaths. The post-operative results after an average recoil of 5 years and a ha lf according to criteria of Hazan show: - a good result in 78% of the cases. - a mean result in 14% of the cases. - and a bad result in 8% of the cases

[Cardiothyrotoxicosis]

About a retrospective study of 20 cases of cardiothyreosis, collected at the cardiology department of University Hospital Ibn Rochd of Casablanca, during a period of7 years, we can pilot the following data: woman predominence is obvious [80%], the average is advanced [52 years old], the notion of preexistent cardio-vascular pathology is noted on 8 cases [40%], the goitre basedowing is the frequent aetiology of hyperthyreosis; the cardiac complications of hyperthyroidism are dominated by the disorders of rhythm [95%] and the heart failure [75%]. The treatment of cardiothyreosis is always double: the anti thyroidism therapy associate cardiac treatment where the beta blockers take an important place. On the evolutive level, the return to the euthyroidism is generally obtained, however it can persist the cardiovasculary disorders, in particular, the cardiac arrhythmia which is difficult to reduce

[Tuberculos pericarditis [about 220 cases]]

Between January 1977 and December 1989, 220 cases of tuberculosis pericarditis were diagnosed in the cardiology ward of the Medical School Ibn Rochd Hospital of Casablanca. They fell into three broad catergories: - acute pericarditis: 130 cases [59%] - sub-acute pericarditis: 40 cases [18%] - constrictive pericarditis: 50 cases [23%]. The average of the patients was 30 years, a majority being male [65%]. Forty-four cases of acute pericarditis were admitted with a tamponade. The cases of sub-acute pericarditis were distinguished by respiratory difficulties [95%] and signs of constriction [95%]. The cases of constrictive pericarditis were all characterized by the existence of Pick's syndrome [100%]. The diagnosis of tuberculosis was certain in 44 cases [20%], and was made with strong basis for assumption in the remaining 80%. We regret the 18 deaths that resulted during this study. Forty- three patients were seen again after an average delay of 47 months; development in 32 cases judged to be good, and stable in 7 other cases. Four later deaths were also recorded

Apparently primitive dilated cardiomyopathy. About 30 cases

This retrospective study was conducted in the Cardiology Unit of the University Hospital Ibn Rochd Casablanca. Thirty cases of primary cardiomyoparhy were recorded between 1980 and 1985. -Frequency of the disease [0.42%] was underestimated. - The mean age of the patients was 37.5 years; Most of them were males [73%]. - The clinical picture was a cardiac failure [96.6%] which was bilateral in 73.3%. - Electrocardiogram was always disturbed, but there was no specific sign. Q and QS waves of transmural fibrosis were frequently associated [33.3%]. -Echocardiography was a privileged technique for studying the dilated cardiomyopathy; it allows the diagnosis and the study of the ventricular function which is an important element in the prognosis evaluation. Treatment remains disappointing, based on the combination of rest, salt free diet associated which diuretics and digitalis. - Etiology is still unkown and the prognosis poor. - Death rate was 23.3%. Mean duration of survival was 12 months. - Two cases of this disease were of interest: a post-partum myocardiopathy and an alcoholic myocardiopathy

Chronic cor pulmonary resulting from tuberculosis

From 1977 to 1985, 78 patients with Chronic Cor Pulmonale resulting from antecedent tuberculosis have been treated in the cardiology department of Ibn Rochd Hospital, Casablanca, Morroco. The responsability of tuberculosis is predominant in the setting of the disease [30%]. Eight years was the mean time elapsed between the tuberculosis and the Cor Pulmonale. All patients were seen with right heart failure. The most frequent complications were acute respiratory failure [80%], supra-ventricular arrythmias [18%] and digestive tract bleeding [6.5%]. 42% died, most of them from acute respiratory failure. Survival rate was 52% nearly eight years after the onset of the cor pulmonale

Permanent cardiac stimulation

Our study covers twenty cases of "permanent electro-systolic pacers" used in the Cardiology Department of the Ibnou Rochd Hospital in Casablanca from 1976 to 1984. Our series have noted that: - The average relatively young age of our patients [48] with a predominance of complete congenital auriculo-ventricular blocks [BAV]. - The indications of stimulation have to be permanently watched because of the vital risk to our patients of repeated fainting and cardiac refractory insuffiency. - The almost exclusive adoption of endo-cavitory wey with the use of litium sentry batteries [QRS-] and monopolar probes. A conventional clinical, electrical and radiological supervision has been set up. - Immediately after the operation, where we have noted two displaced probes, which were put back in position on the ventricular right at the point level, and one infection of the casing put right by a change of batteries and probe. - The long term evolution after a period of 14 months is clear cut: - one case of worn sheath. - one case of displaced probe. - and two cases of worn out batteries. The reintervention in order to change the failed material has been practised in all cases

Can the amrinone struggle against myocardial depression induced by propanolol in narcotized dog

In the anesthetic dog, it has been researched if the amrinone, new positive inotropic agent, was able to face or to correct the depressor effect induced by propranolol. Used by simultanous perfusion to propranolol at the dose of 100 ug. Kg[-1], the amrinone increases significantly the LD 100 of propranolol from 33.4 +/- 2 mg. Kg[-1] to 44.14 +/- 4.21 mg. Kg[-1] and to 53.9 +/- 12.2 mg Kg[-1] at the dose of 300 ug. Kg[-1]. After the systolic arterial pressure reduction of 50 to 60% by the propranolol, perfusion of 25 or 50 ug. kg of amrinone correct quickly and completely the tensional decrease. The amrinone seems as a therapeutics not without interest in case of cardiovascular collapse induced by adrenergie betablocking agent

Pulmonary hypertension secondary to pulmonary asbestos. About 3 cases

After having during twenty years in a factory using asbestos cement, three morkmen have presented pulmonary fibrosis that manifested itself by a severe dyspnea, cough and expectoration, radiologically by diffuse pulmonary lesions with basal predominance and linear disposition, associated to a pleural calcification characteristic of the asbestosous origin. During the evolution, this pulmonary fibrosis has been complicated by chronic cor pulmonale: right ventricular hypertrophy and a pulmonary hypertension in those cases

Prinzmetal angina. About 2 cases

The authors report two characteristic cases of Prinzmetal angina and recall the main clinical, electric and angiographic features of this disease. The current therapeutic approach is also stated

[Operative results of open heart surgery to 47 cases of congenital cardiopathies-Second part: cyanogen heart diseases]

The second part of the surgical results of 47 congenital heart diseases deals with the cyanotic type. From 1970 to 1976, 18 patients were operated on [among them, 15 cases of Fallot's tetralogy]. The immediate and longer term results of this surgery are analysed