Surgical Management and Outcomes of Cardiac and Great Vessels Echinococcosis: A 16-Year Experience.

BACKGROUND: Cardiac involvement is an uncommon presentation of hydatid disease. In this study, we aim to analyze the experience of surgical treatment of cardiac and great vessels echinococcosis in our cardiovascular and thoracic surgery department. METHODS: Through a 16-year period, from 2000 to 2015, 27 patients underwent surgery for cardiac and great vessels hydatid disease. The clinical, operative, and postoperative data were analyzed through this retrospective and descriptive study. RESULTS: Most of our patients came from a rural area. The most common symptom was chest pain. The diagnosis was mainly made by transthoracic echocardiography, which has shown the right ventricle as the most frequent location of the disease. All patients received surgical treatment under cardiopulmonary bypass, and only six surgeries were performed without cross-clamping the aorta. Inhospital mortality rate was 7.4%. CONCLUSIONS: Cardiac hydatidosis is a rare but potentially serious condition whose treatment is mainly surgical even for asymptomatic patients owing to its possible fatal complications. The surgery outcomes are usually satisfactory. Follow-up examinations are highly recommended to detect recurrences.

External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population.

OBJECTIVE: The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population to validate its use in our country. METHODS: This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the receiver operating characteristic (ROC) curve and analyzing its calibration using the Hosmer-Lemeshow statistics. RESULTS: The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve more than 0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining P values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). CONCLUSION: The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.

Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation.

Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient's hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.

[Acute pulmonic valve endocarditis]. / Endocardite aiguë isolée de la valve pulmonaire.

Right heart endocarditis mainly affects tricuspid valve, especially in drug users. Isolated pulmonary valve infection is rare. We here report the case of a 32-year old young woman whose diagnosis of community-acquired pulmonary valve endocarditis was confirmed. This study is even more interesting because pulmonary valve endocarditis has occurred in a patient without a history of drug addiction; nevertheless, it wasn't associated with restrictive interventricular communication. The patient underwent emergency surgery due to the visualization of large and mobile vegetation on transthoracic heart ultrasound. Surgery was carried out under extracorporeal circulation and pulmonary valve has been replaced with a bioprosthesis. Bloodcultures and valve culture showed methicillin-sensitive staphylococcus aureus. Postoperative evolution was favorable, with a follow-up of 06 months without recurring infections.

[Right ventricular myxoma in a child: an uncommon presentation]. / Myxome du ventricule droit chez un enfant: une présentation très rare.

The right ventricle is an uncommon location for cardiac myxoma. Its most common complications are pulmonary embolism and obstruction due to pulmonary valve tumor. We report the case of a 11-year old child with repetitive syncopes admitted to Cardiology ward. Echocardiography showed a right ventricular myxoma of 2cm obstructing the pulmonary orifice. Emergency surgical excision was performed under cardiopulmonary bypasss with favorable postoperative course. Anatomo-pathological examination of the surgical specimen confirmed the diagnosis of myxoma. At 18 months follow-up, there was no evidence of tumor recurrence.

Primitive cardiac sarcomas: about 2 cases.

BACKGROUND: the cardiac sarcomas, although very rare, represent the quasi-totality of the primitive sly tumors of the heart AIM: it is about a retrospective study of two cases of cardiac sarcomas operated in Sahloul university hospital of Sousse. CASES: it is about a woman and a man: The respective ages were 22 and 45 years. The clinical pattern of the patients was polymorphic and the diagnosis put by cardiac echography. Both patients had a surgical resection and a chemotherapy. Both patients died in 13 and 18 months after the diagnosis. CONCLUSION: because of the extreme rarity of the cardiac sarcomas, there is no precise therapeutic strategy. The only consensus concerns the surgery as soon as the diagnosis of cardiac tumor is put. The prognosis of these tumors is extremely redoubtable with a survival which does not exceed 2 years after the beginning of the symptomatology.

[Congenital abdominal infrarenal aortic aneurysm in infants: 2 case reports and literature review]. / Anevrysme congenital de l'aorte abdominale sous-renale chez le nourrisson: cas cliniques et revue de la littérature.

Abdominal aortic aneurysm is extremely rare in infant and is generally due to infection, umbilical artery catheterization, vasculitis, connective tissue diseases and tuberous sclerosis. At the absence of these evident causes, it is a congenital primary aortic aneurysm which is exceedingly rare and only a few cases have of which have been reported. Here we report two cases of aortic wall reconstruction done by a Gore tex patch. The immediate result is excellent with a reestablishment of the femoral pulse and an excellent Doppler control. The problem which we may face in the future is probably the aortic out come with this Gore tex patch a continaons follow up of these patients is necessary.

[Chronic aortic regurgitation with left ventricular dysfonction]. / Insuffisance aortique avec dysfonction ventriculaire gauche.

We studied fifty one patients (40 men and 11 women) under going valve replacement from 1990 to 2002 for aortic regurgitation and had left ventricular dysfunction. 45% patients were in class III or IV of New York Heart Association (NYHA). All patients were investigated by echocardiography (left ventricular ejection fraction [LVEF] < 50%) - Peroperative mortality was 5.8% due to myocardial failure. 81.4% of survivors were followed duering a mean period of 24 months (rangis from 3 to 67 months) after valve replacement.

[Cardio-pericardial hydatid cyst. Report of 19 cases]. / Les kystes hydatiques cardio-pericardiques. A propos de 19 observations.

From May 1991 to July 2003, 19 patients (9 men and 10 women), of 30 years average age were operated in our department service for surgical cure of cardio-pericardial hydatid cysts. The TEE constitutes the examination of choice in the cardio-pericardial diagnosis of hydatid cyst. The surgery under CPB is the technique of choice, we practiced used 15 times. The left ventricular localization is most frequent. We deplore only death into post-operative immediate. The post-operative was course simple at the majority of our patients. 17 patients could be controlled remotely of the intervention with 35.5 months an average passing. We deplore 2 late deaths. No relapse was observed.