Anevrisme du ventricule gauche associe a une infection par le VIH chez un enfant de 13 ans

Contexte. Les anevrismes ventriculaires sont rares chez les enfants; et les theories concernant les facteurs etiologiques varient. Les objectifs. etaient de decrire l'experience d'un cas clinique et discuter les particularites de cette pathologie diagnostiquee chez un enfant infecte par le VIh. Patient et Methode. Il s'agit d'une etude prospective d'un anevrisme du ventricule gauche associe a une infection par le VIh1 chez un enfant de 13 ans a l'institut de cardiologie d'Abidjan. Resultats. Il s'agissait d'un enfant de 13 ans; de sexe masculin qui consultait pour une douleur thoracique associee a des palpitations puis une dyspnee d'effort. Le tableau clinique etait celui d'une douleur precordiale. L'electrocardiogramme a objective une hypertrophie ventriculaire gauche. L'echocardiographie Doppler objectivait un large anevrisme du ventricule gauche. L'indication d'une cure chirurgicale a ete retenue. Le bilan biologique preoperatoire a objective une serologie retrovirale positive pour le VIh 1. Ce patient n'a pas encore ete opere du fait de l'absence de couverture sociale. Il a ete traite avec de l'aspirine. Conclusion. Cette association; anevrisme du ventricule gauche et infection a VIh; est certes rare chez l'enfant mais avec la persistance de l'endemie VIh/SIDA dans notre milieu ; on pourrait en decouvrir d'avantage si les explorations en cardiologie sont vulgarisees

[Infective endocarditis complicating patent ductus arteriosus: emergency surgical treatment of two cases]. / Endocardite infectieuse compliquant une persistance du canal artériel et opérée en urgence : à propos de deux observations.

Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience.

Association of the HLA antigens with early atheromatosis in subjects with type 2 diabetes mellitus.

BACKGROUND: Inflammation plays an important role in the pathogenesis of atherosclerosis. The major histocompatibility complex, as expressed by the human leukocyte antigens (HLA) is considered to regulate the immune response. The aim of this study was to investigate the association of the HLA antigens with vascular remodeling estimated by the carotid intima-media thickness (IMT) in subjects with type 2 diabetes mellitus (DM). METHODS: We evaluated 197 patients with type 2 DM, 80 males and 117 females, mean age 61.8+/-7.8 years, with no history of cardiovascular events. The presence of other major cardiovascular risk factors was recorded. The currently identified HLA class I (-A, -B, -Cw) and class II (DR, -DQ) antigens were studied by a classical 2 step microlymphocytotoxic technique in peripheral blood T and B lymphocytes. Measurements of the IMT were performed in the right and left common carotid arteries, 15-20 mm proximal to the dilatation of the carotid bulb in an end-diastolic "frozen" and magnified B-mode ultrasonographic image. Glycosylated hemoglobin A1c (HbA1c) and C-reactive protein (CRP) were also measured. The results are presented as mean +/-1 standard deviation. RESULTS: Regarding the HLA phenotypes in the final analysis we tested a total of 24 HLA antigens that exhibited a frequency of at least 5% in our diabetic population. Only HLA A3 was found to be significantly associated with the carotid IMT. Forty-nine (24.9%) diabetics were HLA A3 positive (group A), while 148 (75.1%) were HLA A3 negative (group B) and had mean IMT of 0.89+/-0.16 mm and 0.98+/-0.21 mm, respectively (p<0.01). Also the two groups differed significantly in respect to CRP, with group A exhibiting lower serum levels (1.1+/-0.4 mg/dl vs 2.6+/-0.7 mg/dl for group A and B, respectively, p<0.05). However, no differences were observed between the two groups as far as blood glucose control, arterial hypertension and dyslipidaemia were concerned. CONCLUSIONS: Human leukocyte antigen A3 is associated with less vascular damage, as expressed by carotid wall thickness, in subjects with type 2 DM. These subjects may be characterized by a milder inflammatory response, as shown by the lower serum levels of CRP.

Distribution of different HLA antigens in Greek hypertensives according to the angiotensin-converting enzyme genotype.

The angiotensin-converting enzyme (ACE) insertion/deletion polymorphism is an independent risk factor for cardiovascular disease. It has also been suggested that some HLA genes may contribute to the genetic susceptibility to essential hypertension. So far, an association between ACE polymorphism and HLA antigens in arterial hypertension has not been reported. We have studied 94 subjects with newly diagnosed essential hypertension, 49 men and 45 women (mean age, 52.3 +/- 11.3 years), as well as 104 randomly selected, age- and gender-matched normotensive individuals (54 men and 50 women, mean age 48.7 +/- 10.8 years). Both cohorts originated from the Greek population and lived in the greater Athens area. The ACE genotype was analyzed by polymerase chain reaction. HLA class I and II antigens were studied by serologic and molecular techniques. The prevalence of the ACE genotypes did not differ significantly between hypertensives and normal individuals. The casual blood pressure levels and the average ambulatory blood pressure levels were similar among the three ACE genotypes. Hypertensives with the ACE-DD genotype were characterized by an increased prevalence of the HLA-A2 antigen (50% v 31.4%, P < .005) and DR6 (16.7% v 11.4%, P < .01) in comparison to the normotensive subjects with the ACE-DD genotype. HLA-A24 was found more frequently among the hypertensives with the ACE-ID genotype than in the normal controls with the same genotype (35.5% v 26.4%, P < .05). ACE-DD genotype is associated with a high prevalence of specific HLA antigens. The coexistence of the ACE-DD genotype with certain HLA phenotypes could reveal a distinct hypertensive population with increased risk for cardiovascular events.

Les arythmies dans l'endocardite parietale chronique : a propos de 160 cas

Dans cet article; il s'agit d'une etude dont le travail avait pour but d'evaluer la nature et la prevalence des arythmies au cours de l'endocardite parietale chronique (EPC) ou fibrose endomyocardique (FEM) et de determiner le role de certains facteurs tels que l'age; la taille des cavites; le niveau des pressions telediastoliques dans la survenue de ces arythmies. Cette etude retrospective portait sur 160 patients hospitalises a l'Institut de Cardiologie d'Abidjan du 1er janvier 1977 au 31 decembre 1989. Le diagnostic de EPC a ete porte soit par l'angiocardiographie soit par l'autopsie. Les explorations cardiologiques habituelles ont ete realisees et l'electrocardiogramme a ete systematiquement analyse pendant l'hospitalisation et a chaque consulltation.On y trouve des troubles du rythme les plus frequemment rencontrees. D'autres arythmies sont plus frequentes chez les enfants que chez les adultes. Les donnees quelque peu contradictoires conduisent a evoquer l'intervention d'autres facteurs dans le determinisme des arythmies; notamment supraventriculaires; rencontrees au cours de l'EPC