[Chronic atrial fibrillation in adults: direct current cardioversion or medical cardioversion]. / La fibrillation auriculaire chronique de l'adulte : cardioversion electrique ou medicamenteuse.

To study cardioversion modalities of atrial fibrillation, we had a look to 100 cases hospitalized in Mongi slim cardiologic department during the period lasting from January 1993 to July 2001. Medical cardioversion (with amiodarone) was performed in 47 patients and electrical cardioversion in 53 patients. Atrial fibrillation was 17 months old. Vavular heart disease was the main etiology (65%). The primary success rate of medical cardioversion (73%) was equivalent to electrical cardioversion (70%). Oldness of atrial fibrillation was the only predictive factor of failure of cardioversion.

[Echocardiography under perfusion with dobutamine. Experience of Tunisian cardiologic service. About 70 cases]. / Echocardiographie sous perfusion de dobutamine. Experience d'un service de cardiologie Tunisienne: a propos de 70 cas.

We report a prospective study which began on February 1st, 1999. 70 consecutive and non selected patients got dobutamine stress echocardiography. The major indication, in 53% of cases, was detection of coronary disease in patients suffering from chest pain but whose stress testing were not conclusive. Dobutamine was continuously and intravenously administered at doses ranging from 5 to 40 microg. Maximal dose was obtained in 73% of cases. The most frequent reason that led us to stop the test was the reach of the target cardiac frequency (85 of FMT). We observed 7 severe rhythmic complications (2 auricular fibrillation, 1 flutter, 2 episodes of frequent and polymorphic ESV, 2 TVNS). One patient presented a myocardial infarction during dobutamine echography whereas the basic kinetics was normal. 26 patients got a coronarography within 3 days following echography. Stress echography detected a significant coronary stenosis (> or = 50%), with a sensitivity of 86%, a specificity of 83% and a precision in the diagnosis of 84%.

[Left main coronary stenosis: clinical and paraclinical aspects]. / Stenose du tronc commun gauche: aspects cliniques et paracliniques.

The authors report a retrospective study about 20 cases of left main coronary disease admitted during 7 years. The mean age is 60 years with a large predilection for men (65% cases). The left main coronary stenosis generally presented as instable angina in 45% cases, myocardial infarct in 40% cases and left ventricular dysfunction in 10% cases. The left main coronary disease was associated with three vessel disease in 45% cases, two vessel disease in 20% cases and one vessel disease in 15% cases. The left main stenosis is frequently distal (60% cases), severe left myocardial dysfunction (EF < 40%) is found in 25% cases. 13 patients had coronary artery by pass graft with favourables outcome in all patients. The mortality was evaluated at 20% cases, only in medical group.

[Mitral valve repair using Alfieri technique: necessary indication in a case]. / Plastie mitrale selon la technique d'Alfieri: indication de nécessité dans un cas.

Carpentier techniques for valve repair remain our first choice to deal with mitral insufficiency. This case is of a 65 years old woman scheduled for mitral valvuloplasty. Using conventional procedure was prevented by unfavourable anatomic conditions (lack of papillary muscles with chordaes supported by several tiny trabeculations). As an alternative to valve replacement (required in these instances), we performed mitral valvuloplasty according to Alfieri technique. Postoperative outcome was uneventful. Ultrasonographic assessment at 2 months showed competent mitral valve with no residual stenosis. Unless its late results are well defined, this new technique shall be used only in particular cases.