[Differentiation between physiological left ventricular hypertrophy and hypertrophic cardiomyopathy of athletes, usefulness Doppler tissue imaging]

Athlete's heart is a cardiac adaptation to long-term, intensive training, wich includes physiological changes as increased ventricular cavity, wall thickness and mass. Maron highlighted a "gray zone" of wall thickness with difficult distinction between physiological left ventricular hypertrophy of athletes from hypertrophic cardiomyopathy [HCM]. The aim of the study is to analyse the data published about the diagnostic tools wich differentiate between physiological athlete's left ventricular hypertrophy and HCM. Even if the standard two-dimensional echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercice, the data currently available suggests the usefulness of Doppler tissue imaging [DTI] in the distinction between HCM and athlete's heart. The authors, will report the best DTI parameters recommended in this setting. The best DTI parameter to differentiate pathological hypertrophy of HCM from physiological hypertrophy of athletes was the gradient of diastolic velocity between the endocardium and the epicardium. On this ground, DTI may be taken into account in the Maron's diagnosis cascade

[Microalbuminuria and left ventricular geometry in essential arterial hypertension]

The association between left ventricular hypertrophy and microalbumiuria is actually admitted. Recent studies shown that patients with microalbuminuria have higher left ventricular mass index, worst systolic function and often concentric geometric kind of left ventricular hypertrophy. The efficiency of an adapted and early therapeutic on a potential relation sheep between reduction of microalbuminuria and improvement of target organ injury, principally heart and kidney, is still to evaluate. The aim of our study is to review geometric and hemodynamic aspect of left ventricular hypertrophy in hypertensive microalbuminuric patients

[Chronic constrictive pericarditis in a child]

The chronic constrictive pericarditis is a very rare disease in child. We report a case of chronic constrictive pericarditis with indeterminate etiology in an 8-year old girl. The child undergone pericardiectomy with well improvement. Through our case and review of the literature, we study the frequency of chronic constrictive pericarditis in child, its etiology and prognosis

Floating left atrial thrombus and dysfunction of mitral prosthetic. A case report

Echocardiographic evidence of parietal atrial thrombus is frequently and easily diagnosed in mitral valve diseases. In the opposite, mobile left atrial thrombus is rare; its diagnosis require special attention. Our case report is about a 52 years old lady, with prothetic mitral valve and atrial fibrillation who presented with ischemic cerebral stroke. Oral anticoagulation was inappropriately observed. Transthoracic and transesophageal echocardiography showed an organised intra left atrial appendage thrombus with two floating thrombus into the left atrial cavity. In spite of adequate intravenous anticoagulation, the patient died within 48 hours after a massive second ischemic cerebral stroke. This case report shows the therapeutic challenge of left atrial thrombus management in the acute phase of ischemic cerebral stroke

[Women's left main coronary artery stenosis, about three cases]

Coronary insufficiency represents the first mortality cause for men over 45 years old and women over 65 years old. In the left main coronary artery stenosis the prognosis is more reserved especially in the case of unstable angina. We report 3 cases of left main coronary artery stenosis. It concerns three women of 49, 55 and 69 years old. They were menopaused, having hyperlipaemia and hypertension. The 69 years old woman has also type II diabetes mellitus. They were admitted for an unstable angina with a normal cardiovascular exam and a normal percritic electrocardiogram. A coronarography was carried out on all three patients highlighting in the 69 years old woman's case an isolated left main coronary artery stenosis; in 49 years old woman's case a distal tight left main coronary artery stenosis with two tight stenosis of left descending artery; and in 55 years old woman's case two tight stenosis of distal left main coronary artery and medial left descending artery. All three patients had a successful bypass graft surgery. In conclusion women's left main coronary artery stenosis with unstable angina can evolve well if it is well taken care of and at an early stage

transition epidemiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie

We aim at analyzing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey [TNMMS]. In order to assess the CVDs [CHDs vs RHDs] trend, two representative samples of Cardiology Departments patients were compared one is selected from the TNMMS and the second from the hospitalizations recorded in 1992. Causes, stay duration, status at the end of the hospitalization, transfer to an other hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectively 58,8% and 38, 2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological. social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities

Evaluation par doppler des protheses de saint jude aortiques [gradient de pression et surface fonctionnelle]

The authors present the hemo dynamic performance of 31 prothesis aortic of saint- JUde by echo- doppler examination realised 48 months after this prothesis implantation. It was 6 prothesis N° 19, 12 prothesis N° 21 6 prothesis N° 6 and 7 prothesis N°25. Independenly of the size of the aortic Saint- Jude the maximal quickness trans prothetic is 2.59 +/- 0.35 m/s the maximal gradient is 26.95 +/- 2.3 mm hg. The transprothetic functional surface is 1.3 +/- 0.21 cm[2] and the indicative of permeability is 0.386 +/- 0.09. it was not a significative difference between the prothesis of small diameter and big diameter for the maximal quickness and the maximal gradient, the mitral surface is 1.2 +/- 0.2 cm[2] for the Saint- Jude n° = 19 and 1.53 +/- 0.3 cm[2] for the Saint jude n°25

Results of transluminal coronary angioplasty-about 42 cases

We present in this study the results of the coronary transluminal angioplasty realized in 42 patients between 1984 - 1991, the middle age is 54 years. 27 patients had a non stable angor and 15 cardiac infarction. The ventricular kimetic was not deteriorated in 75%. The interventricular was the arteria the most dilated [53%]. The dilatation of two arteria in the same session had been in 7 patients. The immediate result was a success in 46 cases, a reobstruction in 2 cases, and one death by necrosis myocardia