Pulmonary and aortic endarteritis revealing a patent ductus arteriosus in an adult.

The ductus arteriosus, an essential fetal structure, normally closes spontaneously soon after birth. Its persistence into late adulthood is considered to be rare; infective endarteritis (IE) complicating a patent ductus arteriosus (PDA) is an even rarer event. The clinical picture of an infected PDA could be subtle, and the diagnosis is frequently delayed. We present the case of a young woman who presented with prolonged fever for whom we made the diagnosis of a PDA complicated by IE, with vegetations in both pulmonary and aortic walls with mycotic aneurysms of the descending aorta. She underwent surgery and the post-operative course was uneventful. To our knowledge, this is the first reported case of a PDA complicated with both pulmonary and aortic endarteritis.

Incidental finding of multiple pulmonary and cardiac hydatid cysts.

BACKGROUND: Cardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important, however, it may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. CASE PRESENTATION: We report a case of a young asymptomatic boy, who underwent a routine chest x ray in a pre employment check up in whom we discovered a multiple pulmonary lesions and a right ventricle hydatid cyst. He then underwent a successful treatment CONCLUSION: Due to the high risk of associated complications, cardiac hydatid cysts should be removed surgically, even in asymptomatic patients.

[Cardiac hydatid cyst about 17 operated cases]. / Les kystes hydatiques cardiaques à propos de 17 cas opérés.

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period. METHODS: Between May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25±13years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest. RESULTS: Our study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n=2). Morbidity was marked by conduction abnormalities (n=2), bleeding and hematoma of the residual cavity that required surgical treatment (n=3). Eleven patients were followed with a mean period of 40.5±19.4 months. At follow-up, neither late deaths nor recurrence have occurred. CONCLUSION: Cardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.

[Conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis. Report of 21 cases]. / La chirurgie conservatrice mitrale dans le traitement de l'insuffisance mitrale infectieuse. A propos de 21 cas.

BACKGROUND: To evaluate the feasibility of mitral valve repair in patients with infective endocarditis (IE). METHODS AND RESULTS: Forty-seven patients operated for mitral endocarditis between 1995 and 2005; 21 underwent mitral valve repair. The repair was performed for acute endocarditis in seven patients at a median of 14 days after the onset of treatment and 14 patients for healed endocarditis after a median of six months. RESULTS: Mitral valve repair was feasible in 21 patients (45%). This repair involved mitral annuloplasty in 16 patients (76%), shortening or transposition of chordae in 10 patients (48%), a pericardial patch in five patients (24%), and suture of perforation in two patients (9%). Associated procedures were aortic valve replacement in seven patients and tricuspid annuloplasty in two. There were no operative deaths. The mean follow up was five years (one to 11). One patient was reoperated for severe mitral regurgitation and another had a stroke due to cerebrovascular embolism in the first postoperative years. No recurrence of infectious endocarditis occurred. CONCLUSIONS: Mitral valve repair in IE gives satisfactory results in terms of survival and symptomatic improvement with a low operative risk. With antibiotic therapy, it provides a cure of mitral lesions even when carried out in the acute phase of endocarditis. Finally, it feasible in several cases with excellent results.

[Results of the surgical closure of ventricular septal defects of various ages: report of 30 cases]. / Résultats de la fermeture chirurgicale des communications interventriculaires à tous les âges. A propos de 30 cas.

OBJECTIVE: To appreciate short and midterm results of patients after surgical closure of the ventricular septal defect. MATERIAL AND METHODS: The study is retrospective and took place in the department of cardiovascular surgery "B", Ibn-Sina hospital, Rabat, Morocco. Between 1995 and 2005, 30 patients underwent a surgical closure of ventricular septal defect. Eighteen patients (60%) were males and twelve (40%) were females with a mean age of 10 years (18 months-36 years). Seven patients (23%) were older than 16 years. All of ventricular septal defects were type 2, unique and most of them perimembranous (70%). Four patients (13%), were older than 16 years, had a significant aortic insufficiency that has dictated the aortotomy for ventricular septal defect repair. The surgical approach through the right atriotomy was sufficient for complete repair in 22 patients (73%). Closure of the defect has been done using a pericardial autologous patch in 28 patients (93%). RESULTS: No operative mortality was observed. The mean follow-up was five years. Eight patients (26%) had a residual ventricular septal defect that progressed to spontaneous closure. Two patients (6%) had a residual pulmonary hypertension and two others a moderate aortic regurgitation. The four patients were older than 16 years. Echocardiography showed a significant reduction in left ventricular dimension and systolic pulmonary artery pressure. At last follow-up, 87% of the patients were in NYHA class 1. CONCLUSION: This study demonstrates that surgical closure of ventricular septal defect ensures a good outcome in short and midterm. Nevertheless, the risk of delayed complications justifies long-term and regular follow-up.

[Q fever: a rare cause of endocarditis]. / Fièvre Q: une cause rare d'endocardite A propos d'un cas.

Coxiella Burnetii endocarditis is very rare. It is the main complication of the chronic form of Q fever. Blood cultures are negative and clinical presentation very variable and diagnosis is essentially based on indirect immunofluorescence serum analysis. The authors report the case of a 19 year old patient with a history of rheumatic aortic regurgitation admitted for an episode of left ventricular failure in a context of long-term pyrexia without valvular vegetations or mutilation. The antiphase I Ig G antibody levels were significant. Treatment with doxycycline and fluoroquinolone was initiated. The clinical improvement was spectacular. Three months later, the patient underwent aortic valve replacement and histological examination of the valve showed subacute endocarditis on chronically fibrotic valvular disease. This is an interesting case by its rarity and its diagnostic and therapeutic problems.

[Haemangioma of the right atrium revealed by cardiogenic shock]. / Hémangiome de l'oreillette droite révélé par un choc cardiogénique.

Intracardiac haemangioma is a very rare primary benign tumour. A 20 year old female patient, with no significant previous medical history, presented to the emergency department with cardiovascular collapse and vague abdominal pains, with no peripheral signs of cardiac failure. The electrocardiogram showed sinus rhythm with diffuse reploarisation disturbances. Chest radiography revealed cardiomegaly (cardiothoracic index of 0.67) with a right paracardial opacity. Abdominal ultrasound showed a moderate peritoneal effusion and transthoracic ultrasound showed a tumour occupying the right atrial cavity but sparing the interatrial septum. The patient underwent emergency open heart surgery for tumour resection and right atrial wall repair with autologous pericardium. Histology confirmed a haemangioma. Follow-up at one month was uneventful. The clinical, diagnostic and therapeutic features of this case are underlined.