[Rheumatic heart disease in schoolchildren in Brazzaville]. / Les Cardiopathies rhumatismales en milieu scolaire à Brazzaville.

The purpose of this study is to screen for rheumatic heart disease as a basis for treatment of the disease and determination of its prevalence in schoolchildren in Brazzaville, Congo. Surveying was conducted in 4 schools located in suburban districts of Brazzaville from May to June 2005. A cohort of 2250 school children was enrolled by random sampling at 3 levels. Age ranged from 5 to 17 years. The variables recorded were age, sex, socioeconomic status, clinical features, and laboratory findings. Clinical selection was based on cardiac auscultation. Data analysis was performed using the Epi Data 3.1 and Stata 8.2 software packages (differences being considered as significant at p< 0.05). A total of 2232 children underwent testing including 1900 from public schools (boys, 47.5%; girls, 52.5%) and 332 from private schools (boys, 47.3%; girls, 52.7%) (p>0.05). The prevalence of rheumatic heart disease was 3,5 per thousand overall, 3.6 per thousand in children in the low socioeconomic status group, and 3 per thousand in the high socioeconomic status group (p<0.05). The ages of children presenting valvular cardiopathy ranged from 7 and 16-years-old and 75% lived in overcrowded dwellings. One or more previous episodes of strep throat were noted in all cases and had not been treated in 7 out of 8 cases. Valvular disease was significantly correlated with history of strep throat, overcrowded living conditions, and low socioeconomic status (p<0,01). Compliance with prophylactic treatment using benzathyn penicillin was 75% after one month of follow-up and 37.5% after three months.

Les cardiopathies rhumatismales en milieu scolaire a Brazzaville

L'objectif de l'etude est de determiner la prevalence des cardiopathies rhumatismales en milieu scolaire a Brazzaville; Congo; et traiter les cas ainsi depistes. Une enquete de prevalence a ete realisee dans 4 ecoles des quartiers suburbains de Brazzaville. L'etude s'est deroulee aux mois de mai et juin de l'annee 2005. Le sondage etait aleatoire a trois niveaux aupres d'un echantillon de 2250 ecoliers. L'age etait compris entre 5 et 17 ans. Les variables etudiees etaient : l'age; le sexe; le statut socio-economique; les aspects cliniques et para cliniques. La selection clinique etait basee sur l'auscultation cardiaque. Les logiciels Epi Data 3.1 et Stata 8.2; ont permis la saisie et l'analyse des donnees (difference significative pour p0;05). Le nombre d'enquetes etait de 2232. Il y avait 1900 enfants issus des ecoles publiques (47;5de garcons; 52;5de filles); 332 issus de l'ecole privee (47;3de garcons; 52;7de filles) p0; 05. La prevalence clinique des cardiopathies rhumatismales etait de 3;5(3;6chez les ecoliers de classe sociale basse et 3chez ceux de haut statut socio-economique; p0;05). L'age des enfants presentant des cardiopathies valvulaires etait compris entre 7 et 16 ans; 75d'entre eux vivaient dans des habitations surpeuplees. Un ou plusieurs antecedents d'angines etaient retrouves dans tous les cas; non traitees dans 7 cas sur 8. Il y avait une relation entre les antecedents d'angines; la promiscuite; et le statut socio-economique (p0;01). La compliance au traitement prophylactique par la benzathine penicilline etait de 75au 1er mois du suivi; et seulement de 37;5au 3e

[Aortic dissection among blacks. Report of 6 Congolese cases]. / La dissection aortique chez les Noirs. A propos de six cas congolais.

INTRODUCTION: The authors report on six cases of aortic dissection (AD). The work intended to bring out AD characteristics and attempt to define a profile of African patients who manifested this disease. The diagnosis of AD was determined on the basis of: clinical and radiological criteria (six cases); echocardiographic data (five cases); aortographic and surgical informations (two cases). PATIENTS AND METHODS: There were three males and three females with an average age of 40.2 years, with a variation of +/- 10.6 years (from 17 to 49). The frequency of AD was estimated at 1.8/10,000 admissions considering all causes and 5.4/10,000 for cardiovascular disease. Strain was the only triggering factor--noted in two cases (Observations 2 and 3). All patients suffered from severe arterial hypertension (AHT) of which there was one case of renovascular AHT based on the Takayasu arteritis. All symptoms and physical findings were the same described in literature. Operations were successful on two patients. The four unoperated patients died (tamponade: two cases, undetermined cause: two cases). CONCLUSION: The authors conclude as to the similarity of the AD charts described in the literature. However they stress the almost exclusive role of AHT in African studies series as well as that, in rare cases, of Takayasu's disease. They recommend preventing AD through the sustained and effective treatment of AHT.

[Endomyocardial fibrosis: report of 22 Congolese cases]. / La fibrose endomyocardique: à propos de 22 cas congolais.

A study has been made of 22 cases of endomyocardial fibrosis (EMF) observed over a 12-year period. The epidemiological characteristics have been described, and the importance of the echocardiographic findings in the diagnosis of the disease has been emphasized. EMF constitutes 0.3% of the total admissions in the department, 0.9% of the cases of cardiac failure, and 3% of the cases involving subjects under 40 years old. The patient population consisted of 13 men and 9 women with an average age of 35.6 +/- 16.4 years (age range: 8.5-77 years). The diagnosis of EMF was based on clinical, radiological, electrocardiographic, and echocardiographic findings (22 cases), and surgical examination (1 case). In 8 cases, parasitosis (filariasis: the patients came from a known endemic area) with hypereosinophilia was observed. Three of these patients had associated high blood pressure. In 13 subjects, a severe right adiastolic syndrome was noted. Two patients presented with tachycardia, 2 others had signs of overall cardiac failure, and 5 subjects suffered from palpitations connected with arrhythmia. Thoracic X-ray showed cardiomegaly in all cases, lung involvement in 15 cases, normal lungs in 5 cases, and bilateral hilar stasis in 2 cases. Electrocardiography mainly showed endomyocardial fibrosis (15 cases), supraventricular arrhythmia, notably auricular fibrillation (13 cases), and conductive disorders (12 cases), which were frequently associated. Echocardiography showed the presence of EMF in 21 cases (95.5%). Doppler (n = 9 cases) detected tricuspid failure in 9 subjects, and mitral failure in 1 subjects. EMF was exclusively located on the right side in 19 cases, bilateral in 2 cases, and on the left in 1 case, which required surgery. Four patients died (i.e., 1 case of sudden death, 1 case of pulmonary embolism, 1 case of neurological coma, and 1 case of cardiac arrhythmia). The authors, like many others, note the clinical polymorphism of EMF, the predisposition to the disease caused by the presence of helminthiasis, which should be eradicated, the diagnostic value of echocardiography-Doppler, and the efficiency of surgery in the treatment of this condition.

[The heart and AIDS]. / Le coeur et le Sida.

PIP: Records of 133 AIDS patients treated at the Internal Medicine and Cardiology Service of the University Hospital in Brazzaville between January 1986 and December 1995 were analyzed. During the 10 years, 342 patients with AIDS were admitted, of whom 133 (38.9%) had recently developed cardiopathies. Patient ages ranged from 17 to 78 years (average, 35 years). 75 were male and 58 female. Clinical manifestations were often minor or even absent, but patient histories revealed functional symptoms. The patients were generally in an advanced stage of HIV infection. Clinical examination showed myocarditis to be the most frequent condition, with 81 cases (61%). Isolated liquid pericarditis was observed in 47 cases, including 15 with blockage. 25 patients showed mitral insufficiency, 16 tricuspid insufficiency, 2 aortic insufficiency due to infectious endocarditis, and 2 myocardial infarct. In 17 cases the onset was abrupt, with influenza-like symptoms. Standard cardiac radiography demonstrated cardiomegaly in all cases. Only 23 of the 133 electrocardiograms were considered normal. The other 110 showed various anomalies, of which the most frequent and significant was diffuse and concordant inversion of the T waves. Cardiac ultrasound in the 90 patients examined allowed diagnosis of 58 cases of myocarditis, 27 of liquid pericarditis not associated with myocarditis, and 5 of infectious endocarditis. 20 deaths were observed. The condition was stabilized in 85%. The fatality rate for AIDS-related cardiopathy is relatively low, on the order of 15-20%. Early diagnosis allows initiation of treatment, which often reduces patient discomfort.^ieng

[Idiopathic subvalvular aneurysm of the left ventricle. Anatomical, clinical and developmental characteristics. Apropos of 13 cases]. / Anévrismes sous-annulaires idiopathiques du ventricule gauche. Caractères anatomiques, cliniques et évolutifs. A propos de 13 cas.

The authors report 13 cases of idiopathic subvalvular left ventricular aneurysm (ISVLVA), observed over a 7-year period in a total of 29,617 patients (0.04%). They describe the clinical features, results of complementary investigations and clinical course of this disease. The diagnosis was based on angiographic and anatomical findings in 4 cases and on echocardiographic findings in 10 cases. This series consisted of 10 females and 3 males with a mean age of 37.3 +/- 2.1 years (range: 9 to 72 years). Clinical signs consisted of palpitations in 2 cases, angina pectoris in 4 cases, heart failure in 9 cases, and systolic murmur of mitral incompetence in 13 cases. Chest x-rays showed vaulting of the left ventricle in 8 cases (61.5%). ECG showed sinus rhythm in 11 cases, atrial fibrillation in 2 cases, ventricular tachycardia in 1 case and junctional tachycardia in 1 case. The erythrocyte sedimentation rate was raised in 10 cases (76.9%). Complementary examinations revealed ISVLVA, which was often very large, calcified (7 cases), thrombosed (6 cases), situated on the posterolateral surface of the left ventricle, in a mitral subvalvular position (13 cases) and responsible for mitral incompetence (13 cases). The coronary arteries were normal in the 5 cases in which they were studied. No aetiology was found. Complications included death (1 case), heart failure (9 cases) and arrhythmias (3 cases). No systemic embolism was observed. Medical treatment (digoxin, furosemide, antiarrhythmics) was considered to be fairly effective, but insufficient to prevent episodes of heart failure and arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

Arythmies supraventriculaires : frequence et aspects etiologiques : a propos de 196 cas

A partir de 196 cas d'arythmies supraventriculaires colliges en 5 ans parmi 4269 malades hospitalises; les auteurs ont determine leur frequence et ont analyse les etiologies. La fibrillation auriculaire etait l'arythmie supraventriculaire la plus frequente (156 cas: 79;6 pour cent); suivie du flutter auriculaire (17 cas: 8;7 pour cent); la tachysystolie auriculaire (13 cas: 6;6 pour cent); et la tachycardie jonctionnelle (10 cas: 5;1 pour cent). Dans 188 cas (95;7 pour cent); une cause organique cardiaque a ete identifiee. Il s'agissait d'une cardiopathie arterielle (81 cas); d'une valvulopathie (68 cas); d'une myocardiopathie (22 cas); de cardiopathies diverses (15 cas); de cardiothyreose (2 cas). Dans 3 cas il s'agissait d'une cause extracardiaque et dans 5 cas d'arythmies supraventriculaires idiopathiques. Devant une arythmie supraventriculaire; il parait primordial de rechercher une cardiopathie sous-jacente de facon a traiter l'une et l'autre. Les auteurs soulignent l'interet d'un equipement en moyens adequats de diagnostic et de surveillance rythmologique

[Tricuspid infectious endocarditis in Brazzaville. Apropos of 12 cases]. / Endocardites infectieuses tricuspidiennes à Brazzaville. A propos de douze cas.

The authors report their experience of the clinical and echocardiographic aspects and course of tricuspid infectious endocarditis, based upon 12 cases collected between September 1985 and December 1992. The diagnosis was confirmed on the basis of the association of signs of septicemia (12 cases), at least two positive blood cultures for the same organism (9 cases) and well-defined vegetations seen by trans-thoracic echocardiography (12 cases). All patients were young women: mean age = 21.8 +/- 4.7. None were heroin addicts but one was positive for human immune deficiency virus. Tricuspid infectious endocarditis was most often acute (9 cases), primary (10 cases, post-abortum (11 cases), due to Staphylococcus aureus (5 cases), and complicated by cardiac failure (12 cases) and lung abscess (4 cases). Four patients died of septicemia (2 cases), of cardiac failure and lung abscess (2 cases). One had severe tricuspid incompetence requiring surgery. It has not yet been possible to operate on this patient because of the lack of cardiac surgery facilities in Congo. The prevention of tricuspid infectious endocarditis depends above all on the fight against clandestine abortions and against the development of intravenous drug abuse.

[Infectious endocarditis of gyneco-obstetric origin. Apropos of 15 cases]. / Endocardite infectieuse à porte d'entrée gynéco-obstétricale. A propos de 15 cas.

With the object of analyzing current characteristics of post-partum and post-abortum infective endocarditis (IE), authors carried out a retrospective study of 15 cases between september 1985 and may 1992. Mean age was 22.2 +/- 4.0 years. Origin of sepsis was delivery (1 case), abortion (14 cases). There was no underlying cardiac lesion in 9 cases, rheumatic heart disease in 6 cases. Infecting organisms were Staphylococcus aureus (n = 6), streptococcus D (n = 3), Clostridium perfringens (n = 2). There were 10 acute and 5 subacute IE, 7 right-sided, 7 left-sided, and 1 right and left-sided IE. Vegetations were determined by transthoracic echocardiography in 12 cases (80%). The main complications were heart failure (15 cases), and pulmonary or arterial embolism (7 cases). Lethality was 53.3% and was not different in tricuspid acute IE and left-sided IE. Treatment was the more difficult as cardiac surgery is expensive or even inaccessible. Accordingly, prevention is primordial. It consist of antibiotic prophylaxis and fight against illicit abortion.

[Infectious endocarditis. Experience of a service in Brazzaville. 47 cases]. / Endocardite infectieuse. Expérience d'un Service Brazzavillois. A propos de 47 cas.

The aim of this study was to report the authors' experience of infective endocarditis (IE) from 47 cases collected between 1976 to 1991. Infective endocarditis (IE) was documented with surgical (n = 9), microbiological (n = 26), and echocardiographic (n = 30) criteria. There were 11 male, 36 female: mean age, 26.2 +/- 10.3 years (extremes: 17 and 47). The authors noted a great importance of gynecological portal entry (13 cases), acute infective endocarditis (23 cases i.e. 48.9%), heart failure (39 cases i.e. 82.9%), and pulmonary (4 cases i.e. 8.5%) and systemic (8 cases i.e. 17.0% embolism. Surgical treatment was impossible in Brazzaville. Trans-thoracic echocardiography was performed in 38 cases and revealed vegetations in 30 cases i.e. 78.9%. Twenty patients died (42.5%) because heart failure. There was no significant difference in letality between infective endocarditis treated surgically or no, between native valve or prosthetic valve infective endocarditis, between culture negative or culture positive infective endocarditis (IE). This study corroborate that infective endocarditis is a heavy illness, characterized by high frequency of heart failure. The authors insist upon the prevention of infective endocarditis.

[Infectious endocarditis in the University Hospital Center of Brazzaville. A study of 32 cases]. / Les endocardites infectieuses au Centre hospitalier et universitaire de Brazzaville. Etude à partir de 32 cas.

Thirty-eight cases of infective endocarditis (IE) were observed between 1976 and 1989 (1.3% of all cardiac disease). Thirty two cases were retained for study based on Von Reyn's criteria: 28 native valve endocarditis (27 left and 1 right heart valves) of which 18 occurred on previously undiseased valves (56.3%); 4 cases of left heart prosthetic valve endocarditis. The average age of the patients was 27.5 +/- 14 years and the group comprised 24 women and 8 men (p less than 0.001). Blood cultures were negative in 13 cases, revealed a Gram negative pathogen in 8 cases, a streptoccocus in 3 cases. Blood cultures were not performed in 2 cases. The IE was acute in 18 cases (56.7%) and subacute in 14 cases (43.7%). The dominant clinical signs were of massive and sometimes acute valvular regurgitation (mitral: 21 cases; aortic: 10 cases; mitral and aortic: 3 cases; tricuspid: 1 case). Twenty-six patients had cardiac failure (81.2%): LVF: 15 cases, congestive cardiac failure: 10 cases, RVF: 1 case. The other complications were embolic: cerebral (3 cases), mesenteric (1 case), pulmonary (4 cases). Antibiotic therapy was prescribed in all patients; surgery was required in 9 cases. There were 12 fatalities (37.5%), 10 in the medically treated group and 2 in the surgical group (p less than 0.05). The results show that the prognosis of IE in underdeveloped regions remains poor. Effective strategies of early diagnosis and treatment are urgently required to reduce the high mortality. Prophylaxis of IE should commence with measures to counter the portals of entry of the pathogens and the valvular sequellae of acute rhumatic fever.

Black-white differences in serum Lp(a) lipoprotein levels.

Serum Lp(a) lipoprotein was determined in 81 black and 81 white healthy men and women matched for sex and age. The results show a highly significant increase of Lp(a) concentrations in blacks as compared to whites, and confirm the notion that Lp(a) lipoprotein levels are race-dependent. Whether high values of Lp(a) play an atherogenic role in blacks remains to be established in further studies.

[Clinical and biological consequences of human immunodeficiency virus (LAV) infection in 15 Congolese subjects]. / Conséquences cliniques et biologiques de l'infection à human immunodeficiency virus (HIV) chez 15 sujets congolais.

We report 15 cases of symptomatic HIV infection seen in Paris between June 1983 and June 1985 in Congolese patients. The first signs were diarrhea, weight loss, fever, pruritus. Disseminated lymphadenopathy was frequent. Twelve patients had AIDS, and the opportunistic infections were: isosporosis, oesophageal candidiasis, cerebral toxoplasmosis, Kaposi's sarcoma, CNS' cryptococcosis, cutaneo-mucosal.

[Hepatic amebiasis: various aspects in Brazzaville]. / L'amibiase hépatique: les différents aspects à Brazzaville.

The authors present the results of a study of 27 cases of hepatic amoebiasis observed in the general hospital of Brazzaville from the 1st January to the 30th June 1982; then they precise the various aspects of this frequent infection in Congo.

[Mitral insufficiency complicating idiopathic subvalvular aneurysm of the left ventricle. Apropos of 5 surgical cases]. / L'insuffisance mitrale compliquant les anévrysmes idiopathiques sous-valvulaires du ventricule gauche. A propos de 5 cas opérés.

The surgical team of Pr Ch. Dubost operated 5 cases of idiopathic subvalvular left ventricular aneurysm with associated mitral incompetence over a 6 year period (from 1976 to 1981). These 5 cases closely resemble Abraham's et al's classical description of "annular subvalvular left ventricular aneurysms". They occur in black Africans, often young adults (mean age of our five cases 31,8 years) in the absence of coronary artery disease. The common feature is the peculiar anatomical localisation of the aneurysm on the posterior or lateral wall of the left ventricle, which explains the common finding of mitral regurgitation. They are often calcified and thrombosed, the thrombosis tending to extend into the left heart chambers. This was the case in 3 of the reported cases. Mitral regurgitation was controlled in one case by closure of a fistula into the left atrium with a very good result, and in 2 cases by simple section-suture of the neck of the aneurysm with good results and a small residual mitral leak. In a fourth case (Case n degree 1) the mitral valve was normal, regurgitation being the result of an extensive thrombosis. The valve was replaced but, in the light of the following cases, it is possible that the valve might have been unnecessarily sacrificed. Despite their sometime vast size and the association with mitral regurgitation, these subvalvular idiopathic left ventricular aneurysms are reasonable surgical indications for the following three reasons: the neck is often narrow, enabling closure under satisfactory surgical conditions; the structure of the valve is normal which, in the majority of cases, means that it can be respected at surgery; the absence of coronary artery disease.

[Aortopulmonary fistula with interventricular defect and pulmonary valve stenosis in a 15-year-old girl. Surgical correction]. / Fistule aorto-pulmonaire avec communication interventriculaire et rétrécissement orificiel pulmonaire chez une jeune fille de 15 ans. Correction chirurgicale

A young girl of 15 with an aorto-pulmonary fistula was treated surgically, with a successful outcome. The clinical diagnosis could only be established at right-sided catheterisation, and especially at retrograde per-arterial aortography. The small size of the fistula explains the low level of the pulmonary arterial hypertension, and the way in which the condition was well-tolerated for some time. The association of this lesion with ventricular septal defect and pulmonary stenosis is extremely rare.

[Functional aortic systolic murmurs in the elderly]. / Souffles systoliques en écharpe "innocents" des sujets âgés

The authors report a clinical and phonocardiographic study of functional aortic systolic murmurs in 26 elderly patients, in 19 of which the lesion was confirmed pathologically. Systolic murmurs radiating across the chest in elderly have the same clinical characteristics as aortic stenosis from which they may, however, be distinguished owing to the: absence of a thrill during systole. The brief duration and the proto-meso-systolic position of the murmur with early inscription of maximal oscillations on the phonocardiogram. Conversion of the second aortic sound. Almost constant absence of a diastolic murmur. Normal carotid arteriogram, including normal ejection time after correction and time of half rise. "Innocent" systolic murmurs are due to calcification of the aortic valve without stenosis, and/or dilatation of the ascending aorta. There is no systolic pressure gradient between the left ventricle and the aorta during cardiac catheterisation. No lesions were found in the mitral valve suggesting mitral incompetence, therefore, we consider the term mitro-aortic murmur used by Huchard should be dropped; Radiation of the murmur from the apex of the heart up into the neck may be explained by the simultaneous occurrence of anatomical changes due to age and/or hypertension and by the vibratory nature of the murmurs which become propagated above and below their origin, as shown by the intracardiac recordings.

[Various etiologies of systolic murmurs radiating from the apex of the heart to the neck]. / Les variétés étiologiques des souffles systoliques en écharpe

The authors studied systolic murmurs in 89 cases, 50 of aortic stenosis, 14 cases of obstructive cardiomyopathy and 20 cases of mitral incompetence. This systolic murmur is characterised by its exceptional intensity, its raspy character at the base, becoming softer at the apex and in the axilla, the presence of a thrill and irradiation into the neck in 50 to 75% of cases. The etiological diagnosis was ensured precisely by 1) pharmaco-dynamic tests: amyl nitrite accentuates the systolic ejection murmurs and attenuates murmurs due to mitral regurgitation. 2) careful analysis of diastole: a systolic murmur extending into early diastole, a third sound or an opening snap and a low-pitched diastolic murmur, suggest mitral incompetence. A high-pitched diastolic murmur is in favour of aortic stenosis. 3) the carotid arteriogram and catheterisation show the characteristic abnormalities of the carotid arteriogram found in aortic valve disease and the existence of a trans-aortic or intra-ventricular pressure gradient, when there is an obstruction to left ventricular jection. The F wave of the apex cardiogram or left atrial reflux of the contrast medium during cineangiocardiography, confirm mitral incompetence. The main phono-hemodynamic and phono-anatomical correlations have been emphasized: 1. The intensity of the systolic murmur is directly proportional to the degree of obstructive cardiomyopathy or mitral incompetence, but does not parallel the degree of the sub-valvular apparatus. 3. The maximum intensity of the murmur occurs all the later when the stenosis is tight, whilst it is earlier in severe obstructive cardio-myopathy. 4. The lozange shape of the murmur of mitral incompetence on phono-cardiography is, above all, due to those cases with lesions of the sub-valvular apparatus. Finally, a study of the sound recorded by the Allard-Laurens micromanometer permitted us to determine the mechanism of this irradiating systolic murmur.