[Long term results of patients implanted with CRT-D: Results of a monocentric study]. / Devenir à long terme des patients implantés d'un défibrillateur triple chambre: résultats d'une série monocentrique en centre hospitalier.

Implantable cardiac defibrillators and resynchronization devices (CRT-D) are frequently used for heart failure patients. This is a retrospective study which included 50 patients with a CRT-D. The objective was to evaluate the prevalence of cardiac events (death, hospitalization for acute heart failure, ventricular arrhythmias). During 30-month follow-up, 4 patients (8%) died, 10 patients were hospitalized for acute decompensated heart failure (20%) and 5 patients (10%) presented an appropriate choc for a ventricular arrhythmia. In total, 19 patients presented at least one cardiac event (38%). An improvement in dyspnea was reported in 84% of patients. An improvement of left ventricular ejection fraction (LVEF) was reported in 74% of patients and 12% of them have normalized LVEF. In this study, the majority of patients implanted with a CRT-D presented an improvement of their symptoms. However, residual cardiac events were reported and remain unpredictable.

[Immediate results of repeat percutaneous mitral valvuloplasty]. / Résultats immédiats de la redilatation mitrale percutanée.

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy. However, this technique is costly, is not devoid of complication and success is not guaranteed. Indications of an attempted redo percutaneous mitral valvuloplasty (redo-PMV) are not well established. Hence the idea to study the immediate results of (re-PMV). PURPOSE OF WORK: The purpose of this study is to evaluate the immediate results of the re-PMV in patients with mitral restenosis and analyze the different clinical and laboratory findings to determine predictors of success of re-PMV to better selection of candidates for a new attempt PMV. METHODS: Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon succeeding a successful initial procedure, collected in the cardiology department of Habib Thameur hospital of Tunis between 1996 and 2011, in which we identified the data of clinical and paraclinical examinations. RESULTS: The mean age of patients was 43 ± 11 years [23; 63]. Of the population, 87.5% were female (five men and 35 women). The average time between the two procedures was 8 ± 4 years [1; 15]. The immediate procedural success defined by a mitral valve area greater or equal to 1.5 cm(2) and a grade less than or equal to 2 mitral regurgitation was obtained in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in three patients (7.5%). A cerebrovascular stroke occurred in one patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and an overall score of Padial greater than 10 were retained as predictors of failure. More the overall score of Wilkins is high (>8), more it is predictive of failure. The two components of the Wilkins score: valvular mobility and subvalvular apparatus (SVA) and the parameter of the redesign of the SVA score of Padial considered separately are also predictive of failure. Only a left atrial area less than or equal to 25 cm(2) was linked to high risk of severe MR. CONCLUSION: Redo percutaneous mitral valvuloplasty is a therapeutic alternative to surgery that is effective and promising interesting immediate results. Analysis of clinical and mainly echographic parameters is useful for predicting the success of the gesture, which will allow a better selection of candidates for re-PMV.