The implantable cardioverter defibrillator: Indications and follow-up.

INTRODUCTION: Sudden cardiac death (SCD) is a public health problem. In most cases, it is the consequence of ventricular arrhythmias. The only treatment of proven effectiveness is the implantable cardioverter defibrillator (ICD). AIM: To describe indications for ICD implantation according to the underlying heart disease and report it's short and long-term results. METHODS: We report a retrospective and descriptive study involving 90 patients implanted with an ICD in our facility collected between January 2003 and December 2014. RESULTS: The average age of our population was 49 ± 15 years (14-76). A male predominance was noted (sex ratio: 6). Ischemic heart disease was the most common underlying heart disease found in 37% of cases. The average left ventricular ejection fraction was 43.5 ± 17.7%. A slight predominance of primary prevention was noted in our series (52%). Single, dual and triple chamber ICD were used in respectively 34%, 36% and 30% of cases. The use of triple chamber ICD was more frequent in cardiomyopathies and ischemic heart disease. Early complications were observed in 9 patients (10%). No deaths directly related to the ICD implantation procedure was observed in our series. The mean follow-up was 39.7 months (3-136). We recorded 14 deaths. The main cause of death was refractory heart failure. During follow-up, 16 patients (18%) received appropriate ICD shocks. The only predictor of appropriate therapies was the indication of ICD for secondary prevention (p=0,002). Twenty one patients (23%) had complications inherent to the implantation of ICD. The main complication was inappropriate shocks found in 11 patients (12%). The main cause of these shocks was supraventricular arrhythmias 68%). Ischemic heart disease (p = 0.001) and secondary prevention (p = 0.048) were significantly associated with the occurrence of inappropriate ICD shocks. The ICD was explanted after varying delays in 4 patients (4.4%). CONCLUSION: The results of our study were comparable to major ICD studies and registries particularly in terms of procedural, late complications and the occurrence of appropriate ICD therapies.

Short, midterm and late results of percutaneous coronary interventions for left main coronary artery disease.

BACKGROUND: Left main coronary artery disease is found in 4-6% of patients undergoing diagnostic coronary angiography. Coronary artery bypass graft is the gold standard. However, percutaneous coronary intervention is a continuously evolving substitution for surgery in such patients. METHODS: We report a retrospective study of 32 patients with relevant left main coronary artery disease treated by angioplasty in our faculty, between January 2005 and March 2011. RESULTS: The mean age of the population on the study was 59.7±10.9 years. The sex-ratio was 3.57. The rate of angiographic success was 97%. The in-hospital stay was uneventful in 94%¨of our patients. Only one patient died of cardiogenic shock complicating an acute anterior myocardial infarction. After a mean follow up of 18.5 ± 15.4 months, the in-stent restenosis rate was 16.12%. The rate of major adverse cardiac events (MACE) was 29%. Independent predictive factors of MACE were: cardiogenic shock on admission (p=0.022), emergency procedures (p=0.033), Euroscore > 6 (p=0.001), Parsonnet score > 20 (p=0.036), High C réactive protein levels on admission (p=0.007),le taux de créatinine (p=0.008), un diamètre de référence du TCCG < 3.5 mm (p =0.036) et l'utilisation de stents  (p=0.036) and the use of bare metal stents (p=0.036). Independent predictive factors of in-stent restenosis were: use of bare metal stents (p=0.004) and Paclitaxel drug eluting stents (p=0.037). CONCLUSION: Percutaneous coronary intervention is safe and a validated alternative to coronary artery bypass graft for left main coronary artery disease. However, it should be reserved to selected patients and limited to experienced centers.

Right ventricular myxoma obstructing the right ventricular outflow tract: a case report.

INTRODUCTION: Primary cardiac tumors are uncommon during infancy and childhood. Myxomas originating from the right ventricle are even less common in pediatric patients. CASE PRESENTATION: Here we describe a case of an 11-year-old Tunisian boy who was referred for syncope. Transthoracic echocardiography revealed a large mobile mass attached to his right ventricle, obstructing his right ventricular outflow tract. Complete surgical excision of the mass with preservation of the pulmonary valve was performed. The diagnosis of myxoma was histologically confirmed. CONCLUSION: Cardiac myxomas located in the right ventricular outflow tract are rare and can present unusual diagnostic and therapeutic challenges.

Four successful pregnancies in a woman after Fontan palliation: a case report.

INTRODUCTION: A Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses several problems during pregnancy. CASE PRESENTATION: We report the case of four successful pregnancies in a 31-year-old Tunisian woman with congenital tricuspid atresia after Fontan operation. Her pregnancies resulted in delivery of four healthy neonates. Her clinical status remained unchanged. CONCLUSIONS: This case suggests that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae. Intensive care should be provided with specialists, including a neonatologist, anesthesiologist and cardiologist.

[Left coronaroventricular microfistula]. / Les microfistules coronaro-ventriculaires gauches.

Left coronaroventricular microfistulae is a rare malformation. The authors report 11 cases of microfistulae between coronary arteries and left ventricle diagnosed by coronary arteriographies. These cases include 6 men and 5 women. Patient's mean age was 54.4 years. The symptoms were suggestive of coronary pathology. The ECG showed myocardial ischemia signs in 5 cases. The other patients had a positive exercise-test. Microfistulae originated from the left anterior descending artery were seen in 5 cases, from the right coronary artery in 2 cases, from the circumflex in 1 case and from the lateral artery in 1 case. The microfistulae originated from both left anterior descending artery and right coronary artery were observed in 2 patients. The main mechanism of myocardial ischemia seems to be related to the coronary steal phenomenon. The diagnosis of the microfistulae is based on coronary arteriography with late recorder angiographic images. The treatment is essentially medical. Surgical and transcatheter treatments are exceptional and must be considered in only severe forms with refractory medical treatment.