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

A continuous murmur following a nonpenetrating chest trauma

AbstractWe reported a rare case of non-penetrating chest trauma-induced fistula from the right sinus of Valsalva to the right heart chambers. The ruptured sinus of Valsalva aneurysm was diagnosed preoperatively and operated on successfully. The rarity of this case highlights the need for a precise preoperative diagnosis, the role of transthoracic echocardiography, and the importance of a prompt surgical management

Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary cardiac lymphoma is rare.</p> <p>Case Presentation</p> <p>We report the case of a 64-year-old non-immunodeficient Caucasian man, with cardiac tamponade and paroxysmal third-degree atrioventricular block. Echocardiography revealed the presence of a large pericardial effusion with signs of tamponade and a right ventricular mass was suspected. Scanner investigations clarified the sites, extension and anatomic details of myocardial and pericardial infiltration. Surgical resection was performed due to the rapid impairment of his cardiac function. Analysis of the pericardial fluid and histology confirmed the diagnosis of non-Hodgkin large B-cell lymphoma. He was treated with chemotherapy.</p> <p>Conclusion</p> <p>The prognosis remains poor for this type of tumor due to delays in diagnosis and the importance of the site of disease.</p

A huge cardiac hydatid cyst: An unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography (CT) scan showed several hydatid cysts in the left lung, the liver, and in both breasts. After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic

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

147: Infective endocarditis in Tunisia: A changing profile?

BackgroundSince the first description of infective endocarditis (IE), the profile of the disease has evolved continuously with stable incidence.ObjectiveTo update information gained on the epidemiology profile of IE in a Tunisian high-volume tertiary care centerPatients and methodsThis was a descriptive retrospective study of patients treated for IE from January 2001 to December 2010. The patients were divided in two groups according to the date of diagnosis of IE: group 1 (from January 2001 to June 2006) and group 2 (from June 2006 to December 2011). These groups were compared for epidemiologic factors and microbiological differences.ResultsA total of 297 patients admitted during the study period met the modified Duke criteria for IE. The comparison of demographic and microbiological characteristics of IE cases over time between the results of the two groups showed that the annual incidence of IE was stable. The sex incidence rates of IE, in particular, incidence among men was relatively stable across the study period and ranged from 60% in 2001-2006 to 58% in 2006-2010, also there was no significant increase in incidence among women (P=ns). Among incident cases, there was a significant increasing age on presentation, with median age increasing from 39.5 years in 2001-2006 to 51.5 years in 2006-2010 (P=0.05). There were no statistically significant decreases in the proportions of cases affecting the aortic valve (P=0.4) and in IE due to oral streptococci (P= ns) over time. Also there was no significant increase in the incidence of Staphylococcus IE. However, the incidence of IE with negative blood culture has remained stable and continues to be high, nearing 50%.The rate of rheumatic heart disease as an underlying heart disease was stable over time. However, the standardized incidence of IE has increased in patients with prosthetic valves (P= ns). Overall in-hospital mortality rate decreased from ((18.6% in 2001-2006 vs 14.6% in 2006-2010.ConclusionThis study has shown that the annual incidence of IE is stable in Tunisia. However, profound changes in the epidemiological profile of this disease have not been noted in our population

Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p < 0.0008). Successful catheterization was achieved in 98% for the CRA group and in 88% for the DRA group (p = 0.008). Radial artery occlusion, detected by ultrasonography, was found in 3 patients in the CRA group (3.1%) and nobody in the DRA group (p = 0.25). The median diameter of the radial artery diameter was higher in the DRA than the CRA group (2.2 mm vs 2.1 mm; p = 0.007). The distal radial approach is feasible and safe for coronary angiography and interventions, but needs a learning curve