Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy.

BACKGROUND: The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). METHODS: We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. RESULTS: Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87-1, p < 0.001), with a cut off value of < 40% (sensitivity = 93% and specificity = 87%). Concerning fetal outcomes, baseline LVEF had the best area under the curve (AUC) to predict abortion or prematurity among all variables (AUC = 0.75; 95% CI 0.58-092, p = 0.003), with a cut-off value of < 50% (sensitivity = 79%, specificity = 67%). CONCLUSIONS: SSP outcomes are still severe in our practice. Maternal mortality remains high and is linked to ventricular systolic function at admission (due to pregnancy), while fetal outcomes are linked to baseline LVEF before pregnancy.

Epidemiological and clinical features, ultrasound findings and prognosis of right-sided infective endocarditis in a teaching hospital in Ouagadougou.

INTRODUCTION: Right-sided infective endocarditis is rare. It accounts about 5 to 10% of all infective endocarditis cases and is prevalent in patients with congenital heart disease, intravascular devices and drug addiction. Our study aimed to describe the epidemiological, clinical and echocardiographic characteristics of right-sided endocarditis and evaluate the prognosis after treatment. METHODS: From January 2010 to December 2011 we recruited all patients admitted to Yalgado Ouedraogo Teaching Hospital for infective endocarditis, and selected those who had a right-sided location. The Duke criteria were used for diagnosis. We analysed entry points and underlying heart disease. The causative organisms were tracked using blood sample cultures. Ultrasound characteristics were described, and treatment and prognosis were evaluated. Patients' follow up was conducted from recruitment to 30 June 2012. RESULTS: In the two-year period, 14 cases of right-sided infective endocarditis were recorded, including seven cases in children. They accounted for 29.1% of all infective endocarditis cases. The mean age was 25.5 ± 12.5 years (range 9-80 years). The venous route was implicated in 12 cases (85.7%). Blood cultures were positive in 11 patients. The bacteria isolated were Streptococcus pneumonia in six cases, Staphylococcus aureus in three and Hemophilus influenza in two cases. HIV status was positive in three patients. Underlying heart diseases were dominated by congenital heart disease in six cases and peripartal cardiomyopathy in four others. Vegetations were located in the right heart in only 11 cases. With antibiotic treatment, a lowering of temperature was shown within an average of 10 days of follow up. Two fatalities were reported. CONCLUSION: This study showed that right-sided endocarditis is common in our clinical practice. This infection was prevalent in patients with congenital heart disease or peripartal cardiomyopathy in our context, and the venous route seemed to be the main entry point.

[Acute myocardial infarction complicated by acute pulmonary oedema and cardiogenic collapse during dobutamine stress echocardiography]. / Acute myocardial infarction complicated by acute pulmonary oedema and cardiogenic collapse during dobutamine stress echocardiography

Acute myocardial infarction is a rare complication of dobutamine stress echocardiography. We describe the case of a diabetic patient who presented with an anterior myocardial infarction complicated by an acute pulmonary oedema and cardiogenic collapse during dobutamine stress echocardiography, requiring five days' hospitalisation. Coronarography could not be performed because of inadequate medical facilities.