158 Prothetic abcess complicating Infective endocarditis

The cardiac abscess formation is appraised to 20–30% during the infectious endocarditis (IE). It is more frequent during prosthesis endocarditis and it can reach 60%. The prognosis is generally reserved. Objective To determine echocardiographic, bacteriological and evolutive features of prothetic IE complicated of abscess.Retrospective study including 51 patients having certain or probable IE according to Duke criterias between 2002 and 2005. At 9 patients (17,64%) the endocarditis was complicated of prothetic abscess. It was about 6 men and 3 women with a middle age of 39 ± years. IE was la ate IE in 5 cases. Clinical and biological infectious syndrome was constant. Isolated germs were staphylococcus aureus in 2 cases, GRAM négatif Bacillus in 2 cases. Culture negative endocarditis were noted in 5 cases. Brucellosis serology was positive at one patient. Prothetic abcess was diagnosed by transthoracic echocardiography (TTE) at 2 patients and by transesophagal echocardiography (TEE) at all patients.The abcess was localized on the aortic prosthesis at 5 patients, mitral prothesis at 3 patients and mitroaortic prothesis at one patient. TEE identified annular abcess at 2 patients and a myocardial abcess at 1 patient. Secondary septic localizations were noted at 6 patients: 4 cerebral abscesses, 2 splenic localization, a renal localization and an articular localization. High degree atrioventricular blocks were observed at 3 patients. The recourse to the surgery was frequent (7 patient/9 patient). It was an emergent sugery at 2 patients because of a heart failure. For the others, the indication for surgery was medical failure treatment at a mean delay of 19 days. The evolution was fatal at 5 patients. and the evolution was favorable at the others.Prothetic endocarditis complicated of abscess are serious requiring frequently a prothetic replacement, a very high risked surgery. TEE must be systematic at all patients carrier of prosthesis if they have infectious syndrome in order to carry the early diagnosis of IE and to avoid abcess formation

034 Creatinine clearance and adverse hospital outcomes in patients with myocardial infarction

IntroductionNormal renal function has been Shown in epidemiological studies and clinical trials to be an independent predictor of survival.ObjectiveTo determine whether creatinine clearance at the time of hospital admission is an independent predictor of hospital mortality and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI).Patients231 patients hospitalized with STEMI in our institution between January 2005 to December 2006.In-hospital outcomes were compared for patients with creatinine clearance rates of > 60ml/min (normal renal function) and ≤60ml/min (moderate and severe Baseline Renal Dysfunction, BRD).ResultsPatients with BRD were older, were more likely to be women, and presented to with more comorbidites.Patients with BRD had presented more ischemic atrial fibrillation (p = 0.033).A greater number of patients with BRD had impaired left ventricle systolic performance, so this patients had more presented acute heart failure (p = 0.008), and cardiogenic shock (p = 0.017).Patients with worsened renal function had presented more mechanical complications:-free wall rupture and apical ventricular septal defect, in two separate cases, following anterior myocardial infarction, leading to immediate death of these two patients.-ischemic mitral regurgitation in one caseThe in hospital death rate of BRD patients was 6.6%, compared with 0.9% for non BRD patients.In comparison with patients with normal or minimally impaired renal function, patients with moderate renal dysfunction were seven times more likely to die (odds ratio 7, 09, 95% confidence interval 0.7 to 68) after adjustment for other potentially confounding Variables.The risk of bleeding episodes was increased in patients with worsened renal functionOnly one patient, with moderate renal dysfunction, had an ischemic stroke.ConclusionIn patients with ACS, creatinine clearance is an important independent predictor of hospital death

Midventricular Obstructive Hypertrophic Cardiomyopathy during Pregnancy Complicated by Pulmonary Embolism: A Case Report

Hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO) is a rare condition occurring in 1% of HCM patients. It is characterized by asymmetric left ventricular hypertrophy with MVO and elevated intraventricular pressure gradients. Pulmonary embolism has been associated with mid-ventricular obstructive HCM. Briefly, this case presents an unusual clinical scenario where a young pregnant woman suffering from hypertrophic obstructive cardiomyopathy presents with dyspnea hemodynamic compromise related to pulmonary embolism illustrating hemodynamic challenges created by pregnancy and surgery. We concluded that simple measures such as communication between the cardiology and obstetric teams, understanding of the hemodynamic changes, anesthetic planning, and monitoring were paramount for the success in our patient

Traitement chirurgical des fractures complexes de l´extrémité supérieure de l´humérus: étude rétrospective à propos de 25 cas

Les fractures de l´extrémité supérieure de l´humérus posent un problème thérapeutique particulièrement pour les fractures complexe à 3 et 4 fragments. Le but de notre travail est de déterminer l´aspect épidémio-clinique des fractures complexes de l´extrémité supérieur de l´humérus chez l´adulte et d´apprécier les résultats fonctionnels et radiologiques de notre série. Il s´agit d´une série de 25 cas colligés au service d´orthopédie CHU Habib Bourguiba entre 2012 et 2017. Nous avons recensé les données épidémiologiques des patients et les circonstances du traumatisme. Le traitement était de principe chirurgical sois ostéosynthèse par plaque ou clou soit un remplacement prothétique. La réduction a été évaluée sur les radiographies post opératoire. Au recul les résultats fonctionnels ont été évalués par le score de Constant. Notre série comporte 12 hommes et 13 femmes, La moyenne d´âge de nos patients était 55 ans, les accidents de la voie publique étaient notés dans 48%, Les fractures à 4 fragments ont été retrouvées dans 76% des cas. L´ostéosynthèse par plaque vissée a été utilisée dans 40% des cas et l´enclouage antérograde a été réalisé dans 40% des cas. La prothèse a été posée pour 5 patients. Le score de constant moyen était de 65,24 avec des extrêmes allant de 35 à 88. Nous avons noté une consolidation des fractures sans cal vicieux dans 68%. Dans les fractures complexes de l´extrémité supérieure de l´humérus, une ostéosynthèse bien indiquée selon le patient et la fracture et une rééducation post opératoire précoce permettent d´avoir des résultats fonctionnels acceptables

A Neovascularized Left Atrial Mass

Copyright © 2012 Rania Hammami et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The discovery of a large left atrial mass through echocardiography obliges the clinician to perform a differential diagnosis to distinguish tumor from thrombus. The neovascularization of the mass could be helpful to predict the type of the malformation and whether it is in favour of a vacular tumour rather than a thrombus. Observation. A 43-years-old man who had no cardiac antecedent reported that he have had dyspnea and palpitation since 10 months. The cardiac auscultation, revealed an irregular rhythm with diastolic murmur at the apex. The electrocardiogram showed an atrial fibrillation. The transthoracic echocardiography revealed a severe mitral stenosis with a huge left atrial mass, confirmed through transesophageal echocardiography. After 4 weeks of an efficient anticoagulant treatment, the mass was still persistent in the echocardiography. So we decided to resect the mass and to achieve a mitral valve replacement. The preoperative coronarography showed neovascularization among the mass and fistula from the circumflex artery. Considering the characteristic of the mass (neovascularization and resistance to anticoagulant), we strongly suspected a vascular tumor especially myxoma, but the histological exam revealed an organized thrombus. Conclusion. Coronary neovascularization is a specific sign for left atrial thrombus in mitral stenosis, but surgery is the best way to confirm diagnosis