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

[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

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