Paravalvular Leaks: From Diagnosis to Management

Paravalvular leaks (PVLs) are complications of a surgical or percutaneous valve replacement. They are persistent defects between the native annulus and the sewing ring, which result in a regurgitant prosthesis. They are observed in 2–18% of patients after a surgical valve replacement (SVR) and in 7–40% after a transcatheter aortic valve replacement (TAVR). Clinical manifestations are heart failure and hemolysis. They develop in 1–5% of PVL patients, and they have a poor prognosis. Surgery was the only available treatment to improve the patient’s outcome. But it is a high-risk surgery in frail patients and PVL relapse is not rare. Percutaneous PVL closure has emerged as a promising technique. Nevertheless, it needs a careful assessment, demands high technical expertise, and still has limitations. This chapter focuses on the diagnosis of PVL after a SVR and transcatheter PVL closure (TPVL)

Drug Abuse-Induced Cardiac Arrhythmias: Mechanisms and Management

Toxicomania is a worldwide emerging problem threatening young population. Several reports highlighted its hazardous cardiovascular effects. Sudden cardiac death secondary to cardiac arrhythmias is the most occupying issue. Different forms of cardiac rhythm disorders may be induced by illicit drug abuse according to the type of drug and the mechanism involved. In this review, we exposed the main ventricular and supraventricular arrhythmia complicating the common recreational drugs, and we explained their different mechanisms as well as the particularities of management

Acute myocardial infarction in a patient with hypofibrinogenemia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Congenital fibrinogen deficiency is a rare coagulation disorder usually responsible for hemorrhagic diathesis. However, it can be associated with thrombosis and there have been limited reports of arterial thrombotic complications in these patients.</p> <p>Case presentation</p> <p>A 42-year-old Tunisian man with congenital hypofibrinogenemia and no cardiovascular risk factors presented with new onset prolonged angina pectoris. An electrocardiogram showed features of inferior acute myocardial infarction. His troponin levels had reached 17 ng/L. Laboratory findings confirmed hypofibrinogenemia and ruled out thrombophilia. Echocardiography was not useful in providing diagnostic elements but did show preserved left ventricular function. Coronary angiography was not performed and our patient did not receive any anticoagulant treatment due to the major risk of bleeding. Magnetic resonance imaging confirmed myocardial necrosis. Our patient was managed with aspirin, a beta-blocker, an angiotensin-converting enzyme inhibitor and statin medication. The treatment was well tolerated and no ischemic recurrence was detected.</p> <p>Conclusion</p> <p>Although coronary thrombosis is a rare event in patients with fibrinogen deficiency, this condition is of major interest in view of the difficulties observed in managing these patients.</p

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/1226