Severe Pulmonary Hypertension Secondary to Concomitant Mitral Stenosis with Veno-occlusive Disease in the Context of Systemic Sclerosis: Importance of Careful and Comprehensive Assessment

Pulmonary Arterial Hypertension (PAH) is a clinical syndrome consisting of physiologic/ hemodynamic criteria that are a consequence of several etiologies. Confirmation of pulmonary hypertension is based on right heart catheterization. Pulmonary hypertension is a devastating condition that can lead to considerable morbidity and premature mortality. In the last few decades, significant advancement in the pharmacotherapy of pulmonary hypertension has resulted from better understanding of the complex pathogenesis and pathophysiology of this dreaded disease. Despite these accomplishments, pharmacotherapy of pulmonary hypertension is still far from perfect, and the mortality in this modern treatment era is still unacceptably high. We report a complex clinical presentation characterized by severe pulmonary hypertension secondary to concomitant mitral stenosis with veno-occlusive disease in the context of systemic sclerosis. Our case highlights the importance of a systematic and comprehensive diagnostic approach to avoid missing an underlying pathology.

Left Ventricular Non-Compaction Cardiomyopathy: Case Report and Review of Literature

Non-compaction cardiomyopathy (NCC) is characterized by trabeculations in either one or both ventricles. Clinical presentation is highly variable: dyspnea, palpitation, thromboembolic events, arrhythmia, or sudden cardiac death. There are currently no universally-accepted criteria for classifying and diagnosing left ventricular non-compaction (LVNC) cardiomyopathy. Transthoracic echocardiography (TTE) is the diagnostic exam of choice. The diagnosis is often missed or delayed because of a lack of knowledge about this uncommon disease. Progression of LVNC is highly variable and prognosis is very difficult to predict. We report a case of a 50-year-old female patient with a history of total thyroidectomy under hormonal supplementation who consults for dyspnea and paroxysmal palpitations revealing an isolated LVNC. This case emphasizes the importance of imaging techniques, which are, TTE and cardiac magnetic resonance imaging (MRI) in early diagnosis, management, and follow-up.

Electrical, Echocardiographic and Coronary Artery Characteristics of Right Ventricular Infarction: Experience of the Cardiology Department of the CHU Mohammed VI Marrakech

Introduction: Coronary heart disease is the main cause of morbidity and mortality worldwide. Right ventricular (RV) infarction is often difficult to diagnose and has a poor prognosis due to rhythmic and hemodynamic complications. Objective: The study of electrical, ultrasonographic, and coronarographic features of the VD Infarction. Materials and Methods: Retrospective study of patients hospitalized in the Cardiology Department of the Mohammed VI University Hospital in Marrakech over a period of 24 months for MDI extended to the RV. Results: 120 patients were hospitalized during this period for MI with extension to the VD. Atypical clinical presentation was noted in 10% of cases. Clinical examination on admission revealed signs of right heart failure in 18% of cases, including 6% complicated by cardiogenic shock. Thrombolysis was performed in 10% of the patients, 67% of them successfully. The ECG found an isolated extension to the V3R leads in 76% of the cases and in association with a V4R overshoot in 45% of the cases, conduction disorders were noted in 28% of the cases, presented essentially by first degree auriculoventricular block. Echocardiography showed impaired LV function in 82% of cases, and longitudinal systolic dysfunction of the LV in 65%. Coronary angiography was performed in 91% of the cases, half of which underwent coronary angioplasty. The combination of both CD and IVA damage was found in 40% of the cases, and damage to the middle DC was the most common in almost half of the cases. The most frequent complications were rhythmic and conductive disorders in 38% of cases, and the evolution was fatal in 8% of cases. Conclusion: Involvement of the RV during MI is characterized by a very critical initial phase, once overcome, the overall prognosis becomes favorable in the long term.

Infective Endocarditis: Experience of the Cardiology Department of the Mohammed VI University Hospital

Introduction: Infective endocarditis (IE) is a rare but potentially serious disease. It causes a high mortality and a high level of morbidity and complications. Its epidemiological, clinical and microbiological characteristics have changed in recent years. The Aim of our Work: Is to study the epidemiological, clinical, bacteriological, ultrasonographic, therapeutic and evolutionary data of IE between January 2017 and October 2022 in the Mohammed VI University Hospital and to compare them to the global profile. Materials and Methods: Retrospective study including 110 patients hospitalized for a definite IE, according to the modified DUKE criteria, in the cardiology department of the Mohammed VI University Hospital over a period of 5 years and 10 months from January 2017 to October 2022. Results: The average age of our patients was 43 years with a male predominance. The bacterial graft was on native valve in 80% with predominance of rheumatic origin (69%), on cardiac prosthesis in 10% of patients, on healthy heart (4%) and congenital heart disease (6%). The most frequent portal of entry was dental (30%). Blood cultures were positive only in 33% of patients, isolating a staphylococcus (16%), a streptococcus (14%) and a GNB (3%). Transthoracic echocardiography (TTE) showed vegetation in 108 cases, valve perforation in 7 cases, cord rupture in 1 patient and perivalvular abscess in 10 cases. Seventy-seven percent of patients had surgical treatment with a mean delay of 29 days. The overall mortality was 24% with heart failure (p<0.001), renal failure (p=0.004) and neurological complications (p=0.002) as predictive factors of mortality. Conclusion: Infective endocarditis remains a real health problem with a consequent mortality and morbidity. The population is often young, revealing the IE by complications; its prevention is the best way to improve its prognosis.

Coronary Artery Connection Abnormality Revealed by Acute Coronary Syndrome: A Case Report and Review of the Literature

Coronary artery connection abnormalities are rare with an angiographic prevalence of approximately 1%. Their symptomatology is very varied, from incidental discovery to sudden death by myocardial ischemia, especially during exercise, hence the importance of early diagnosis and management. Angiographic diagnosis is generally easy, but it is sometimes difficult to specify the initial course of the ectopic vessel, hence the interest of non-invasive imaging, in particular the coronary CT scan. This latter represents the innovative imaging of choice for assessing the anatomical risk and selecting candidates for surgical treatment. We report a case of abnormal connection of the left coronary revealed by an acute coronary syndrome and we present a review of the literature on the different anatomical forms of the pathology and its management.