[Percutaneous coronary intervention in the management of acute coronary syndromes in Ivory Coast: Challenges and outcomes]. / Angioplastie coronaire dans les syndromes coronariens aigus en Côte d'Ivoire : difficultés et résultats.

AIM: Assess the challenges and outcomes of percutaneous coronary intervention (PCI) in the management of ACS at Abidjan Heart Institute. PATIENTS AND METHODS: Prospective survey carried out from April, 1st, 2010 to April, 29th, 2016. Whole patients aged 18-year-old, admitted at Abidjan Heart Institute for ACS, and who underwent PCI were included in the Registre prospectif des actes de cardiologie interventionnelle de l'institut de cardiologie d'Abidjan (REPACI). Indications and outcomes of PCI were analyzed. RESULTS: Seven hundred and forty-nine patients were admitted for ACS, of which 165 underwent PCI. Ratio PCI/ACS was 0.22. Mean age was 55.6±9.8 years. Male were predominant (sex-ratio=12.7). Main clinical presentation was ST-elevation myocardial infarction (STEMI) in 75.1% of cases. One-vessel disease was predominant in STEMI (52.4%), and multi-vessel disease in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (51.2%). Most of patients (86.7%) underwent PCI with stent implantation. PCI was performed successfully in 97.0% of cases. Main non-fatal complications were hematoma (2.4%). In-hospital mortality-rate was 1.2%, and one-year mortality-rate was 1.6%. CONCLUSION: PCI is performed in Subsaharan Africa with safety, despite encountered difficulties in its implementation.

[Coronary artery aneurysms probably due to Kawasaki's disease]. / Anévrismes coronaires chez un adulte jeune évocateurs d'une probable maladie de Kawasaki.

We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.

[Prevalence and characteristics of acute coronary syndromes in a sub-Saharan Africa population]. / Prévalence et caractéristiques des syndromes coronariens aigus dans une population d'Afrique subsaharienne.

AIM: To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. PATIENTS AND METHODS: Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). RESULTS: Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.4±11 years. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 71.5% of subjects, non-ST-segment elevation acute coronary syndrome (NSTE-ACS) accounted for 28.5%. Two hundred and eighty patients (65.9%) were transferred by unsafe transportation. Among the 89 patients admitted within 12hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 20 patients (22.5%), or 6.6% of STEMI as a whole. Twenty-five patients (8.2%) received fibrinolytic therapy with alteplase. In-hospital death rate was 10%. CONCLUSION: The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Excessive delays of admission and limited technical facilities are the major difficulties of their management in our regions.

[Giant pulmonary artery aneurysm: etiology and an exceptional 17 years natural course]. / Anévrisme géant de l'artère pulmonaire : aspects étiologiques et évolutifs exceptionnels sur 17ans.

True pulmonary artery aneurysm (AAP) is rare and represent less than 1% of intra-thoracic aneurysms. We report a case of a AAP in a patient with a likely cor triatrium sinister, with an obstructive membrane responsible for pulmonary hypertension, explaining AAP. The long-term evolution of 17 years is made to an uncomplicated myocardial infarction. The patient died eight months later suddenly probably due to the rupture of the PAA.

[Left atrial mass observed in a patient in Abidjan, Ivory Coast]. / Tumeur de l'oreillette gauche à Abidjan (Côte d'Ivoire).

The purpose of this report is to present a case involving a tumor-like mass in the left atrium of a 27-year-old woman in Abidjan, Ivory Coast. The mass was discovered by echocardiography carried out after cardiomegaly was detected by roentgenography performed in the context of debilitated general condition, fever and positive serology for HIV1. The patient responded favorably to anti-tuberculosis treatment with complete regression of the mass and improvement of general condition. Based on this outcome, the most likely diagnosis was cardiac tuberculoma, a rare complication of tuberculosis.

[Unusual venous thrombosis revealing a human immunodeficiency virus infection and a protein S deficiency. Two cases and literature review]. / Thromboses veineuses inhabituelles révélatrices d'une infection par le virus de l'immunodéficience humaine et d'un déficit en protéine S. A propos de deux cas et revue de la littérature.

The authors report two cases of unusual venous thrombosis associated with protein S deficiency in patients with the acquired immunodeficiency syndrome. The first case was a superior mesenteric vein thrombosis caused by HIV-1 infection associated with protein S deficiency in a 53-year-old patient. The second case was a cerebral venous thrombosis in a 34-year-old patient with HIV-1 and HIV-2 infections associated with protein S deficiency. None of the two patients were receiving antiretroviral therapy at the time of diagnosis. The evolution of thrombosis was favorable in both patients with heparin therapy and antivitamin K (AVK).

[Coronary disease with normal coronarography in the black Africans: epidemiological and clinical data in 31 cases. Role of abnormal hemoglobins]. / Maladie coronaire à coronarographie normale chez le Noir africain: données épidémiologiques et cliniques dans 31 cas. Rôle des hémoglobines anormales.

The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8% of 104 coronary patients undergoing coronary angiography in this series. These 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ventricular aneurysms and 2 cases of silent ischemia in diabetic patients. Twenty-five patients were men (80.6%). There were 6 women (19.3%) two of whom presented in the post-partum period. The average age of these patients was 45 years (males: 47.7 years; females: 41.8 years). The following risk factors were noted: smoking (60%), hypertension (25.8%), obesity (29%), diabetes (12.9%), serum cholesterol (average 2.15 g/l), serum triglycerides (average 1.25 g/l). The risk index per patient was 1.29. In comparison with coronary patients with angiographic coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk factors (especially hypertension and diabetes), though this was not statistically significant. The prevalence of inaugural infarction was 81.2% in the cases of infarction with normal coronary arteries. These infarcts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6%) at coronary angiography. A provocative test was performed in only 2 cases and 1 was positive. This deserves further study and may have therapeutic implications. The authors emphasise the high incidence of hemoglobin S or C traits (57.1%). These heterozygotic hemoglobinopathies could be a risk factor in these coronary patients with normal coronary angiography.

[Spontaneous coronary artery dissection: apropos of a case with associated spasm and regression of the dissection]. / La dissection coronaire spontanée: à propos d'un cas avec spasme associé et régression de la dissection.

The authors report the case of a 34 year old woman with postpartum myocardial infarction due to spontaneous coronary dissection of the distal circumflex artery. A spontaneously regressive spasm of the right coronary artery was also observed. The outcome with heparin, glyceryl trinitrate and calcium antagonist therapy was favourable. Over one year later, coronary angiography showed total resolution of the dissection and a large aneurysm of the inferior and septal walls of the left ventricle. This case is an example of post-partum spontaneous coronary dissection, in a particular vascular context. There are, however, other causes of spontaneous coronary artery dissection (atherosclerosis, eosinophilic syndrome...). Spasm may aggravate the consequences of coronary artery dissection and cause worse myocardial damage. The medical treatment, especially with regards to thrombolytic therapy, requires further codification.

[Transposition of the great vessels in western Africa. Apropos of 17 cases observed at the Institute of Cardiology in Abidjan]. / La transposition des gros vaisseaux en Afrique noire. A propos de 17 cas observés à l'institut de cardiologie d'Abidjan.

During the last 10 years, 17 children with transposition of the great arteries (TGA) were admitted to the Cardiology Institute of Abidjan: 1 case between March 1978 and December 1985, 16 cases between January 1986 and December 1989. The average age was 58 days (range 5 to 270 days) at the first consultation, and 90 days (5 to 270 days) at the time of admission. The diagnosis was confirmed by echocardiography and hemodynamic investigation in 12 cases. There were 9 simple forms of TGA, 7 with ventricular septal defects (VSD) and 1 with VSD and pulmonary stenosis. Two children were taken back by their parents before any treatment was given. A Rashkind atrial septostomy was carried out in 11 children which increased aortic oxygen saturation from 35 +/- 18 percent to 57 +/- 19 percent; there were 3 unsuccessful procedures in children aged 2, 3 and 5 months with 2 deaths. Five patients later underwent surgical correction by a Senning procedure in 4 cases and anatomical correction in 1 case with VSD. All are well after an average 15 months follow-up (1 to 48 months). One of the 8 children awaiting surgery died. Therefore, TGA is not a rare abnormality in Black Africa; it represents 2 percent of the 887 cases of congenital heart disease observed during the same period. The inadequacy of means of diagnosis is certainly the cause of the relatively low incidence of this malformation, of the considerable delay in under specialist care and, as a consequence, of the greater difficulties in treatment, especially with regards to atrial septostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

[An attempt to quantify myocardial ischemia by selective coronary arteriography: determination of a new score. An initial study]. / Tentative de quantification de l'ischémie myocardique à partir de la coronarographie sélective: détermination d'un nouveau score. Etude préliminaire.

An original model for estimating myocardial ischaemia from coronary arteriography is proposed. Four parameters are taken into consideration: anatomical variations, the myocardial mass perfused, the degree of reduction of basal flow across the stenosis, the eventual summation of several successive stenotic lesions. This scoring system was tested by simulation on a computer and evaluated in 100 anginal patients. Analysis of our preliminary results shows statistically significant differences in the score between the following groups of patients: patients with normal and those with abnormal LV wall motion; patients with and those without previous myocardial infarction; patients with Class II stable angina and those with other forms (III, IV and unstable angina).

[Digital arteriography of the lower limbs by sequential, automatic table translation. Feasibility. Preliminary results]. / Artériographie numérique des membres inférieurs par avance séquentielle, mémorisée, du panneau de table. Faisabilité. Résultats préliminaires.

Digital subtraction angiography (DSA) as a method of evaluating lower limb arteries required examination of one limb at a time up to now. Moreover repeated injections of contrast material were necessary. This problem was mainly due to the relative small image intensifier field available and to the difficulty of repositioning the patient between mask and image acquisition. The authors report the preliminary results obtained with 24 patients studied on angiographic unit equipped with: A DSA system (DG 300-CGR) using 512 X 512 matrix size, an angiographic table (Angix M 200) allowing an automatic sequential translation, a removable image intensifier using a 16 inch field below the table. Thus, all those characteristics allow DSA of lower limb arteries. Only one injection of contrast material (Ioxaglate: 80 ml at 8-10 ml/second) was used per procedure. This, usually, allows good quality examination of lower limb arteries.

[2 cases of coronary embolism. Angiographic diagnosis and anatomopathological confirmation]. / Deux cas d'embolie coronaire. Diagnostic angiographique et confirmation anatomo-pathologique.

The authors report two cases selected from a series of 61 cases of coronary embolism observed over an 18 year period at the Cardiovascular Hospital (Lyon) out of 4,860 autopsies of adult patients who died of cardiovascular causes. These two cases underwent coronary angiography, the results of which correlated with the autopsy findings. The authors review the causes and clinical manifestations of coronary embolism and compare their results with previously reported data, to establish the radiological features of coronary embolism. They notice the regular appearance of obstruction due to embolism and underline the importance of the associated negative signs (normality of the rest of the coronary circulation, absence of collateral vessels...) which makes the angiographic diagnosis one of elimination.

[Isolated replacement of the tricuspid valve with a bioprosthesis. Apropos of 22 cases in Abidjan]. / Le remplacement valvulaire tricuspidien isolé par bioprothèse. A propos de 22 cas observés à Abidjan.

The authors reviewed the operative and function results of 24 isolated tricuspid valve replacements with bioprostheses in 22 patients. The patient population was young (average age 15 +/- 8 years). The surgical indication was massive tricuspid regurgitation due to chronic parietal endocarditis in 19 cases and to bacterial endocarditis in 3 cases. Tricuspid valve replacement was associated with 19 right ventricular endocardectomies, 2 direct closures of ventricular septal defects, 2 Wooler mitral valvuloplasties and 1 pericardectomy. The operative mortality was 13.5% and the secondary mortality 13.5%. Of the 16 survivors, 13 are in the NYHA Class I with no regular medical therapy. Their cardiothoracic ratio has slightly decreased. Two patients have permanent atrial fibrillation, and 12 have acquired definitive complete right bundle branch block. Eight of these patients had significant improvement of atrial and right ventricular pressures, of Yu's index and cardiac index at postoperative catheterisation. Three of the 16 patients developed progressive calcific degeneration of their bioprostheses. They are among the 6 patients who have been followed up for more than 3 years. There was no mortality at reoperation. Isolated tricuspid valve replacement by bioprosthesis was chosen despite the young age of these patients because of the disadvantages of mechanical prostheses which are associated with a much higher mortality related to incarceration and thrombosis of the prosthesis. The relatively high operative and secondary mortality in this series of isolated tricuspid valve replacement compared to mitral, aortic or micro-aortic valve replacement, is related to the gravity of the underlying causal pathology.

[Early coronary atherosclerosis in a malignant pheochromocytoma. Apropos of a case]. / Athérosclérose coronarienne précoce au cours d'un phéochromocytome malin. A propos d'une observation.

An observation of adrenergic myocarditis with clinical and electrical signs of coronary failure is reported. The patient had electrical and enzymatic manifestations of acute anteroseptal necrosis, complicated at the acute stage by complete atrioventricular block and fatal vasoplegic circulatory collapse. Post-mortem examination showed obstructive atherosclerosis of the anterior interventricular artery without anatomic signs of infarction. Pathogenesis of this coronary failure is discussed. In this case, functional coronary insufficiency produced by catecholamine release was associated with coronary atherosclerosis.

[Secondary bone cancer in the Ivory Coast. Apropos of 40 cases]. / Le cancer secondaire des os en Côte d'Ivoire. A propos de 40 observations.

From the statistics dealing with cancer yielded in the Internal Medicine Department, Treichville Hospital, secundary bone cancer appears with a low percentage. The short expectation of life and the reluctance of African patients to report to the hospital must be considered to appreciate these data. Most often, at their admittance, cases show numerous and large metastasises. Bone tumors related to a primitive liver cancer are rare. More often, metastasises in prostate cancer may be observed. They are generally osteocondensing. Breast cancer is, for its frequency, ranking just after it. In one third of the cases, the origine has not been cleared out.