[Monocentric retrospective study on the prevalence and significance of incomplete right bundle branch block in young competitive athletes in Tunisia]. / Étude rétrospective monocentrique sur la prévalence et la signification du bloc de branche droit incomplet chez les jeunes sportifs de compétition en Tunisie.

AIMS: Few studies have assessed the prevalence and significance of right bundle branch block in athletes. Aims of this study were to evaluate the prevalence of incomplete right bundle branch block and its correlation with the nature of sports practice and to compare the athlete with right bundle branch block and the one with a normal electrocardiogram. METHODS: It was a retrospective study of the electrocardiogram and echocardiography of competitive athletes recruited in the medical-sports center of Sousse RESULTS: A total of 554 athletes were included. Mean age was 16.1 ± 2.9 years and 69 % were male. The mean training duration was 5.8 hours per week. The prevalence of incomplete right bundle branch block was 13.9 % (77 cases). Endurance sports were practiced in 71.4 % of cases among subjects with right bundle branch block versus 55.4 % in the rest of the population (p < 0.001). The basal diameter of the right ventricle was larger in athletes with right bundle branch block compared to athletes without right bundle branch block: 28 ± 3.6 mm versus 24 ± 2.4 mm (p < 0.001). CONCLUSIONS: The results of this study suggest that right bundle branch block is a marker of incomplete right ventricular remodeling. This remodeling represents a form of adaptation to sustained elevation of volumetric load observed mainly in endurance sports.

A retrospective study from a single center to compare outcomes in 79 patients with in-stent restenosis treated with paclitaxel-coated balloon angioplasty or drug-eluting stent implantation.

BACKGROUND: Despite the recent progress made in drug-eluting stents (DESs), in-stent restenosis (ISR) is still a common complication of percutaneous coronary interventions. This retrospective study from a single center aimed to compare outcomes in 79 patients with ISR treated with paclitaxel-coated balloon (PCB) angioplasty or DES implantation. RESULTS: From January 2017 to December 2021, 83 ISR lesions from 79 patients were included. Thirty-two were treated with PCB and 51 treated with available DES in the catheterization laboratory. Baseline characteristics were similar in both groups. Mean time between index angioplasty and restenosis was 27 months with a minimum of 4 months and a maximum of 70 months. Concerning Mehran ISR angiographic classification, classes II and III were more likely treated with DES. Stenosis diameter and minimal lumen diameter (MLD) were similar in both groups. PCB used was significantly shorter than DES: Mean length was 19.75 ± 5.7 versus 22.1 ± 16.5 (p < 0.001), respectively. Angiographic results immediately after intervention were similar in both groups: In-segment MLD after the procedure was 2.5 ± 0.4 in the DES group and 2.26 ± 0.55 in the PCB group. A median follow-up of 20 months was achieved for 68 patients, and 11 were lost to follow-up. There was also no difference in both groups regarding free from events survival. CONCLUSIONS: The findings from this study support recent international studies that have shown no significant differences between DES and PCB and in-stent restenosis. This suggests that PCB use is an option to consider in our local daily practice.

Delay of Fibrinolysis in ST- Elevation Myocardial Infarction: Results of an Investigation Conducted in a Single Center in Sousse Tunisia.

BACKGROUND: The aim of our study was to assess the delay of fibrinolysis in ST elevation myocardial infarction (STEMI) in our region and to identify characteristics associated with prolonged delay. PATIENTS AND METHODS: We analyzed clinical characteristics of a prospective cohort of unselected patients admitted for (STEMI). The study was conducted over three years 2007-2009 and 250 patients were included in a single center without capability of percutaneous coronary intervention. RESULTS: The mean age of our patients was 58±13, 7 years. Ninety percent of our patients consult directly the emergency department and 61, (5%) of them were admitted within first 6 hours of onset of symptoms. Median time to reperfusion was 46 min. Predictor of this long delay to initiate fibrinolysis were inter-department decision OR 6; 95% CI 3,48-10,34, diabetes OR 2,25; 95% CI 1,28-3,96 age >58,4 years OR 1,97; 95% CI 1,19-3,25 and transfer from regional hospital to our center OR 1,78; 95% 1,03-3.07. CONCLUSION: These results suggest that improvement in organization health care system can shorten delay to fibrinolysis in a center without percutaneous coronary intervention capability.

[Permanent cardiac pacing: about 234 patients]. / La stimulation cardiaque permanente : à propos de 234 patients.

BACKGROUND: Permanent cardiac pacing remains the only effective treatment for chronic, symptomatic bradycardia. In recent years, the role of implantable pacing devices has expanded substantially. AIM: To compare the situation of patients with critical brady arrhythmias before and after pacing focusing on indication for pacemaker implantation, frequency of re intervention and early and late complications. METHODS: Retrospective study performed over 24 years between 1984 and 2007 at the department of cardiology of Farhat Hached hospital. A total of 234 patients were included, and the database was formed by the patients' files and the protocols of implantation. RESULTS: The mean age of patients was 69.5 years. The most frequently reported signs and symptoms before implantation of pace maker were dizzy spells and syncope respectively in 53% and 29.1% of patients. Among the electrocardiographic alterations leading to an indication of pacemaker implantation, atrio-ventricular blocks were the most numerous at 74.4% followed by sinus node disease at 17.1%. Early complications were represented essentially by haematoma and infection of the pocket of pacemaker respectively at 2.9% for each one. After a mean follow up of 6.8 years, 88 patients (45.3%) still free of symptoms. Late complications include lead dislodgement and pacemaker syndrome at 2% for each one. CONCLUSION: The results of our study demonstrates that even the rate of complications following pacemaker implantation is not high, the follow-up of patients should be fast, complete, safe, and clear, and should include sufficient documentation.

[Epidemiologic features of myocardial infarction in young patients]. / Caractéristiques épidémiologiques de l'infarctus chez le sujet jeune.

Acute myocardial infarction (AMI) in persons under the age of 45 years is uncommon. To determine the clinical features in young patients presenting with AMI, we include 38 patients with mean age 35 years who survive from myocardial infarction. This disease is almost associated with cardiovascular risk factors, the most common of which are tobacco abuse (90%) and diabetes (20%). The coronary arteries are most often normal (40%) or single vessel (33%). In hospital complications are the same as in the older adult but the prognosis seems to be better.

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis.

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.

[Right atrium angiosarcoma disclosed by alveolar hemorrhage]. / Angiosarcome de l'oreillette droite révélé par une hemorragie alvéolaire.

UNLABELLED: Cardiac angiosarcoma represents a primary cardiac malignancy tumor whose early diagnosis is difficult because of its non specific clinical presentation. We present the case of a 57 years old patient with medium abundance hemoptysis. The chest X ray film and CT scan showed bilateral pulmonary infiltrate without cardiac anomaly. Abdominal echography showed disseminated hepatic tumoral lesions. A transthoracic echocardiography made after apparition of heart failure symptoms found a right atrium cardiac tumor. The hepatic lesion biopsy showed angiosarcoma. CONCLUSION: In presence of uncommon systemic symptoms like diffuse pulmonary lesions associated with cardiac anomaly, the diagnosis of angiosarcoma should be included.

[Feasibility of transesophageal echocardiography during balloon mitral valvulotomy]. / Echographie transoesophagienne multiplan durant la dilatation mitrale percutanée.

The purpose of this study was to demonstrate the utility and feasibility of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). 40 patients were included with symptomatic rheumatic mitral valve stenosis with mean age of 31 years. Transoesophageal echocardiographic monitoring allowed an immediate detection of mitral insufficiency in 10 patients. This latter was moderate in eight cases and severe in two cases indicating to stop the procedure. The addition of on-line TEE during PBMV facilitate and confirm the success of the procedure and detect complications.

[Cardiac tamponade revealing systemic scleroderma]. / Une tamponnade cardiaque révélatrice d'une sclérodermie systémique.

The frequency of pericardial involvement in Systemic Sclerosis (SSc) is high but usually was asymptomatic and cardiac tamponnade was exceptional. We report a case of systemic sclerosis (scleroderma) revealed by cardiac tamponnade. This case illustrate the value of transthoracic echocardiography in the diagnosis of cardiac tamponnade in systémic sclerosis.

[Cardiopericardial echinococcosis]. / Echinococcose cardiopéricardique.

UNLABELLED: Cardiac hydatid cysts are rare and represent 0.5 to 2% off all hydatid cyst in human. We describe clinical and echographic features in 12 patients with cardiac echinococcosis, admitted between 1992 and 2001. Average age was 40 years (16-60 years). The cysts were located in the left ventricle wall (3 patients), right ventricle wall (3 patients) right atrium (3 patients) and pericardial cavity (3 patients). Cardiac Hydatid cyst diagnosis was established by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in all cases. Computed tomography and magnetic resonance imaging confirmed echographic finding. All patients were operated. The operation finding confirmed the imaging data. Only one patient died in the post operative period. No recurrence or associated complication were reported in the late follow up. CONCLUSION: In presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst the diagnosis of cardiac echinococcosis is possible. TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcosis diseases in other intra or extrathoracic location.

[Cardiovascular manifestations of Kawasaki syndrome. Value of echocardiography in diagnosis and progression]. / Manifestations cardiovasculaires du syndrome de Kawasaki. Apport de l'échocardiographie dans le diagnostic et l'évolution.

Seven children with suspected Kawasaki disease were studied by echocardiogram. Coronary abnormalities occurred in all patients, associated with: thrombosis (2 patients) small pericardial effusion (2 patients) poor ventricular function (2 patients), moderate mitral regurgitation (2 patients). Patients received treatment with intravenous gamma globulin, aspirin, and anticoagulant. Echocardiogram abnormalities disappeared between 1 and 26 months after the onset of the disease; only persist coronary hyperechogenecity in 6 patients.

[Candida albicans prosthetic valve endocarditis. Two cases]. / Endocardite infectieuse à Candida albicans sur prothèse. A propos de deux cas.

TWO CASES: Candida albicans prosthetic valve endocarditis (PVE) is a rare entity with serious complications. We report two cases of Candida albicans PVE, confirmed by culture of the prosthetic valve. The first patient died twenty days after surgery with cerebral bleeding secondary to multiple mycotic aneurysms, the second patient was still alive eight months following a Saint-Jude aortic valve replacement and prolonged antifungal therapy. The difficulty of diagnosis and management are discussed.

[Value of early systematic transoesophageal ultrasonography after mitral valve replacement by Saint-Jude prosthesis]. / L'apport de l'échographie transoesophagienne précoce systématique après remplacement valvulaire mitral par une prothese Saint-Jude-Médical.

The aim of this study was to assess the value of the routine multiplane transoesophageal echocardiography (TEE) in the early postoperative period after mitral valve replacement with a Saint Jude Médical (SJM) mechanical prosthesis. This prospective work enrolled 56 patients who have been operated between September 1999 and September 2001, all these patients had a multiplan TEE after 14.7 days (8-29 days) of post-operative. The effect of peri-prosthetic leaks was 59%. They were always minimal and asymptomatic. 68% of them disappeared at the late exam. An asymptomatic intermittent blockage of an leaflet had been noted in one patient. It appears to us today indispensable to achieve a systematic TEE in the early post operative period after mitral valve replacement. This exam remains little aggressive and comfortably supportable by the patient in look of information brought.