[Tricuspid dysfunction during the rheumatic disease]

Rheumatic tricuspid valve dysfunction is the rarest of all valvular disease and is often associated or secondary to left-sided valvular disease. She often realize tricuspid regurgitation. The surgical treatment is generally conservative but also it can be readical generally using bioprotheses. To assess the epidemiology of the rheumatic tricuspid dysfunction, the average diagnoses and its therapeutic. To evaluate the results of the surgical techniques, the factors of prognostis and to determine the therapeutic regarding an in front of important and symptomatic residual tricuspid regurgitation a long time after a valvular surgery first of the left heart. A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. The prevalence of the rheumatic tricuspid dysfunction was 8,42%. 70% of the patients had a tricuspid regurgitation. The average Age of our patients was 40 years. Our population consisted of 65,5% women. 21% of the patients had benefited at least from a percutaneous mitral dilation. 31% of the patients had antecedents of valvular cardiac surgery. 53% of the patients presented clinical signs of preoperative right cardiac failure and 58% of the patients were in permanent auricular fibrillation. The tricuspid regurgitation was major at 12% of the patients, severe at 88% of the patients, organics at 21% of the patients and functional at 31% of the patients. The average of the systolic pulmonary blood pressure was with 55 + - 16,8 mm Hg. All the patients had an associated left valvulopathy. The average of the ejection fraction of the left ventricle was 56 + 12,6%. The dilation of the right cavities was noted at 70% of the patients. The patients of our series were subdivided in two distinct groups. The first group gathers 30 patients who were operated of tricuspid in same operational time as the surgery of the left valves. The surgical gesture on the tricuspid was always conservative. 70% of the patients profited from a tricuspid annuloplasty. Hospital mortality is 10%. 26% of the patients presented a significant residual tricuspid regurgitation after 60 months. 26% of the patients presented late cardiac failure. Late mortality was from 30% to 5 years and 43% to 10 years. The second group is represented by 54 patients not operated on the tricuspid. 30 patients [81%] presented one or more episodes of late cardiac failure. 50% of the patients died during the late follow-up. Among operated patients of the tricuspid, the predictive factors of the residual tricuspid regurgitation post operational are the age <35 years and the mitral disease. The stage NYHA = 4 was the only predictive factor of hospital mortality the clinical signs of preoperative right heart failure and the antecedents of mitral replacement. The predictive factors of late right congestive heart failure postoperative 1 are the functional tricuspid regurgitation and stage 4 of the NYHA. The benefit of a systematic initial correction of a voluminous tricuspid regurgitation and even of average importance realized prematurely in same operation time that the left valvular gesture was largely shown. The late appearance of functional tricuspid regurgitation after mitral valve surgery in a prejorative marker in the evolution of these patients

Heart diseases in pregnant women

Diagnosis end treatment of heart diseases, physiopathologic changes in pregnancy. Pregnancy in woman with heart disease increases the risk of maternal and fetal complications. The aim of the study is to precise the physiopathologic, diagnostic, and therapeutic characteristics of heart diseases in pregnant woman extensive electronic search of the relevant literature was carried out using Medline. Key words used were: pregnancy, heart disease, maternal outcome, fetal outcome, cardiac complications. Rheumatic heart disease represent the most common cardiopathy found in pregnant woman in our country. Regurgitant valvular diseases are often well tolerated with medical therapy. Severe aortic stenosis is associated with poor prognosis. The use of percutaneous mitral balloon valvuloplasty has transformed treatment of mitral stenosis in symptomatic patients. In developed countries, congenital heart diseases are the most common cause of cardiopathy in pregnant women. Left-to-right shunts are generally well tolerated. Patients with Eisenmenger syndrome should be advised against pregnancy. Obstructive form of hypertrophic cardiomyopathy is associated frequently with hemodynamic deterioration in pregnancy. Dilated cardiomyopathy is usually considered as a contrindication of pregnancy. In the absence of underlying structural heart disease, cardiac arrythmias are uncommon in pregnancy and usually don't require pharmacological treatment. Drug therapy of arrythmias in pregnant woman is limited by side effects on the fetus. The prenatal counsel is based on the assessment of maternofetal risk. The management of pregnant woman requires a multidisciplinary team for optimal maternal and fetal outcomes

[Stress echocardiography and mitral stenosis: what interest?]

The stress echocardiography is used extensively as a diagnostic and prognostic tool and the assessment of ischemic cardiopathies. Its use in valvulopathies is more limited, but is increasing with time. The discrepancies between the functional symptoms and hemodynamics at rest is frequently met in patients with mitral stenosis. By assessing changes of pressures, gradients and surface stress echocardiography helps to identify the real hemodynamic conditions permitting to recommend a more aggressive approach in certain situations

[Introduction of the myocardal dopler tissue imaging]

Introduced in 1989, the myocardial doppler tissue imaging has now many clinical applications. The doppler tissue imaging explores the proper systolic and diastolic regional function of myocardial fibers. We can measure myocardial velocities by recording signals of low v‚locitiy and high magnitude, the strain and the strain rate are then derived from velocities. Specific softwares are therefore necessary. There are many ways of recording and representing myocardial doppler tissue parameters. Diagnostic and prognostic value of myocardial doppler tissue imaging is now proved and this method has many applications in ischemic cardiopathy and in cardiomyopathies. The development of powerful softwares is promising for the applications of the strain in the future

Contraced endocardial fibroelastosis in childhood: about one case

Endocardial fibroelastosis is un uncommon diseases and it has a very bad prognosis since fatal evolution is usual before 2 years old. We report the case of a 20 years old woman who is affected with the contracted form of this disease associated with atrial septal defect [ASD] and mitral regurgitation. This disease was discovered by endocardial biopsy when she was 4 years old and underwent surgical resection of endocardial fibrosis, a path on the ASD and mitral valve replacement. She was rehospitalised 15 years later with heart failure although continuous digitoxin therapy