huge cardiac hydatid cyst: an unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography [CT] scan showed several hydatid cysts in the left lung, the liver, and in both breasts. After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic

Percutaneous closure of using Occlusion DeviceOstium Secundum Septal defect amplatzer occlusion device: Experience of cardiology department, Hedi Chaker Hospital, Sfax, Tunisia

To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects [OS ASDs] using Amplatzer septal occluder. It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic [TTE] and transoesophageal echocardiographic [TEE] monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure. From the 34 patients, 28 [82%] were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm. The final success rate of the procedure was 90.9% [30/33]. One patient was excluded from transcatheter occlusion and three patients [8,6%] had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients [11.7%] underwent surgery. No major complication [thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis] or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts. Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital

N-terminal pro-brain natriuretic peptide identifies patients at risk for occurence of postoperative atrial fibrillation in cardiac surgery with cardiopulmonary bypass.

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with cardiopulmonary bypass (CPB).The value of N-terminal (Nt)-pro brain natriuretic peptide (BNP) in predicting AF complicating cardiac surgery is not well studied. Our objective is to determine its predictive value in the occurrence of AF after cardiac surgery with CPB. In a prospective observational study, including patients scheduled for cardiac surgery with CPB, we collected blood samples for each patient: the first one immediately after the induction of anesthesia and before CPB. The subsequent samples were taken at the end of the CBP (H0), 4 hours later (H4), and every day during the first four days (H24, H48, H72 and H96). Nt-proBNP and cardiac troponin (cTnI) were measured in each sample. The levels of Nt-proBNP were significantly increased in patients who developed AF. The receiver operating characteristic curve (ROC) analysis of Nt-proBNP studied at different times showed that assays at the end of the CPB and at H4 had the maximum area under the curve (AUC). A threshold value of 353.5 pg/mL of Nt-proBNP at the end of the CPB showed a sensitivity of 71% and a specificity of 84% for the prediction of AF and an AUC of 0.711. The threshold value (307.5 pg/mL) of Nt- proBNP measured at H4 had the same sensitivity but a lower specificity (74%) and AUC = 0.709. We conclude that Nt-proBNP values of 353 and 307 pg/mL at 0 and 4 hour after CPB could predict occurrence of AF.