Bloc auriculo-ventriculaire post chirurgie cardiaque: à propos de 23 cas

Le bloc auriculo-ventriculaire (BAV) représente une complication non négligeable de la chirurgie cardiaque. Il est responsable de séquelles lourdes et graves compromettant le pronostic de la maladie et conduisant à la mise en place d'un stimulateur cardiaque définitif. Il est primordial d'étudier et de déterminer les différents facteurs prédictifs de BAV post opératoire, son histoire naturelle, son incidence ainsi que le délai exact de la mise en place d'un pacemaker. Notre étude est une étude rétrospective descriptive à propos de 23 patients opérés pour chirurgie cardiaque sous circulation extracorporelle entre octobre 1989 et août 2010 ayant présentés des troubles conductifs auriculo-ventriculaires en post opératoire..Plusieurs facteurs de risque ont été étudiés dans notre série, liés surtout à l'atteinte directe du noeud auriculo-ventriculaire ou à l'ischémie myocardique. Le délai d'apparition du trouble conductif ainsi que le délai d'implantation on été également étudié. Plusieurs facteurs favorisants de survenue de BAV ont été identifiés liés essentiellement au type de la cardiopathie opérée avec une prédominance de la cardiopathie congénitale, d'autres facteurs ont été rapportés notamment la présence d'hypertrophie ventriculaire gauche (HVG) de troubles conductifs en préopératoire, une durée du clampage aortique et de CEC prolongée. La moitié des patients ont présenté un BAV immédiat. Le délai d'implantation par rapport à la date de la découverte du BAV varie dans notre série d'une implantation immédiate après le diagnostic positif (J0) à un délai d'implantation allant jusqu'à 57 jours. Plusieurs facteurs de risques déterminent la survenue de BAV post chirurgie cardiaque, leur connaissance est primordial ainsi que le délai exact de l'implantation du stimulateur cardiaque définitif

Existence of Periodic solutions of integro-differential delay equations with two variable in vector-valued function space

2The aim of this work is to study the existence of a periodic solutions of neutral integro-differential partial functional differential equations with two variable: ∂ ∂x ∂ ∂y (u(x, y)−Bu(x− r, y − r)) + Au(x, y) = x −∞ y −∞ a(x − s, y − ξ)u(s, ξ)dξds + f (x, y), x, y ∈ [0, 2π]. Our approach is based on the L p-multipliers of linear operators

Perforation d’anévrysme de la valve mitrale postérieure: complication rare de l’endocardite infectieuse: à propos d’un cas

L'anévrysme de la valve mitrale est une anomalie rare dont la physiopathologie est mal élucidée. Il se définit par une protubérance localisée au niveau du feuillet valvulaire mitral bombant dans l'oreillette gauche. La localisation sur le feuillet postérieur est exceptionnelle. Nous rapportons le cas d'un jeune homme de 26 ans suivi depuis 4 ans pour une insuffisance aortique rhumatismale qui est hospitalisé pour un syndrome fébrile avec poussée d'insuffisance cardiaque gauche. L'échocardiographique transthoracique (ETT) et transoesophagienne (ETO) ont mis en évidence des végétations sur la valve aortique avec un large anévrysme de la petite valve mitrale associé à une fuite mitrale importante. Le patient a bénéficié d'un double remplacement valvulaire mitral et aortique avec des suites opératoires simples. Une suspicion clinique avec une imagerie adaptée préopératoire et un traitement chirurgical à temps sont nécessaires pour reconnaître et traiter cette complication rare de l'endocardite infectieuse

Kearns Sayre syndrome: a rare etiology of complete atrioventricular block in children (case report)

Kearns Sayre syndrome is a rare mitochondrial abnormality first described in 1958, characterized by a triad associating progressive external ophthalmoplegia, ptosis, and pigmentary retinopathy with progressive alteration of cardiac conduction, which determines the vital prognosis of this entity. Here we report the case of a 13-year-old child of consanguineous parents who consults for recurrent syncope. The clinical exam found bilateral ptosis with complete atrioventricular block on electrocardiogram. The ophthalmological exam found pigmentary retinopathy. The patient underwent successful implantation of a double chamber pacemaker within 24 hours of admission, with an uneventful postoperative course. This case report highlights the interest of systematically assessing cardiac complications in children with mitochondrial disease such as Kearns Sayre syndrome, especially since cardiac involvement is the major prognostic factor in this disease

Enigma of Huge mass filling the apical wall of the left ventricle. Is it thrombus, tumor or endomyocardial fibrosis?

Background: Cardiac masses have a wide range of etiologies with the most common being thrombi and less commonly tumors. Certain areas of the heart have specific tumor predilections. We present an interesting case in which the diagnosis of the ventricular mass was difficult given the initial symptomatology and the patient's phobia. Case summary: A 45-year-old male patient with medical history of smoking, was admitted to the emergency room complaining of severe breathlessness, However, the patient declined any chest discomfort or pain. On physical examination he was dyspneic, with vital signs revealed heart rate of 110 beats/min, blood pressure of 125/90 mmHg. Cardiovascular examination showed regular heart rhythm and normal heart sounds. Electrocardiogram revealed sinus tachycardia, chest X-ray was suggestive of cardiomegaly. Transthoracic Echocardiography demonstrated a dilated left ventricle with severely reduced ejection fraction and diffuses kinetic disturbances. The presence of a huge mass filling the apical wall of the left ventricle, hyperechogenic in appearance and very adherent to the ventricle. In front of this doubtful appearance at the echocardiography the patient was programmed for a cardiac magnetic resonance imaging which could not be carried out because of the claustrophobic state of the patient. In the meantime, the patient had a cardiac arrest due to refractory ventricular fibrillation successfully resuscitated. In front of this complication, he benefited from an automatic implantable defibrillator as a secondary prevention. Subsequently, a coronary angiography was performed in the context of the patient's smoking habits and kinetic disorders, to our surprise showed a complete occlusion of the left anterior descending artery knowing that the patient is not diabetic and he never complained of any painful symptomatology, primary coronary intervention was successfully performed to the left anterior descending artery. The patient was started on therapeutic anticoagulation and heart failure therapy. Follow-up imaging after 6months showed a significant improvement of the left ventricular systolic function and thrombus regression to apical segment without embolic events. Conclusion: The diagnosis of a ventricular mass remains difficult, the orientation can be done initially by the ground of the patient while being helped by the transtoracic echography and the multimodality imagery at the end to specify the nature of the intra-cardiac mass for an adequate and fast management. Keywords: Thrombus, ventricular mass, coronary angiography, heart failure, oral anticoagulation. DOI: 10.7176/JHMN/98-05 Publication date:March 31st 202

Coronary Fistulas: A Case Series

Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms

Insights from magnetic resonance imaging of left ventricular non-compaction in adults of North African descent

<p>Abstract</p> <p>Background</p> <p>Left ventricular non-compaction (LVNC) is a recently recognized rare disorder. Magnetic resonance imaging (MRI) may help to clarify the uncertainties related to this genetic cardiomyopathy. Despite the fact that many articles have been published concerning the use of MRI in the study of LVNC, there is a lack of data describing the disease in the North African population. The aim of our study is to clarify MRI findings of LVNC in North African patients.</p> <p>Methods</p> <p>In our retrospective cohort, twelve patients (7 male, mean age 53 ± 8 years) underwent MRI for suspected LVNC. Correlations were investigated between the number of non-compacted segments per patient and left ventricular ejection fraction (LVEF), then between the number of non-compacted segments and left ventricular end diastolic diameter. The presence or absence of late gadolinium enhancement (LGE) was qualitatively determined for each left ventricular myocardial segment.</p> <p>Results</p> <p>Non-compaction was more commonly observed at the apex, the anterior and the lateral walls, especially on their apical and mid-cavity segments. 83% of patients had impaired LVEF. There was no correlation between the number of non-compacted segments per patient and LVEF (r = -0.361; p = 0.263), nor between the number of non-compacted segments per patient and left ventricular end diastolic diameter (r = 0.280; p = 0.377). LGE was observed in 22 left ventricular segments. No association was found between the pattern of fibrosis and non-compaction distribution (OR = 2.2, CI [0.91-5.55], p = 0.076).</p> <p>Conclusion</p> <p>The distribution of LVNC in North African patients does not differ from other populations. Ventricular dysfunction is independent from the number of non-compacted segments. Myocardial fibrosis is not limited to non-compacted areas but can extend to compacted segments.</p

Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience

<p>Abstract</p> <p>Background</p> <p>The diagnosis of constrictive pericarditis continues to be a clinical challenge. Magnetic resonance imaging provides excellent visualization of the pericardium. The aim of our study is to clarify the contribution of this non invasive exploration in the diagnosis of constrictive pericarditis in our center.</p> <p>Methods</p> <p>we conducted a prospective study over a period of two years, since 2008, covering a series of patients (n = 11), mean age 44 ± 15 years, in whom constrictive pericarditis was suspected clinically and on transthoracic echocardiography. We studied its characteristics on magnetic resonance imaging.</p> <p>Results</p> <p>Magnetic resonance imaging confirmed the diagnosis showing pericardial thickening in all cases, measuring 8.2 +/- 2.6 mm on average, circumferential in 64%, and localized in 36%. The imaging data, particularly pericardial thickening and its topography, were confirmed by surgical exploration, and results were concordant in all cases.</p> <p>Conclusion</p> <p>Magnetic resonance imaging is a powerful tool to establish constrictive pericarditis diagnosis.</p