Annales de cardiologie et d'angeiologie最新文献

Introduction: The aim of the study was to assess the level of treatment optimization after follow-up at discharge.

Methods: We conducted a retrospective study carried out from January 1st, 2016 to December 31st, 2018 in Abidjan Heart Institute with patients hospitalized for heart failure and reviewed in consultation.

Results: The study involved 350 patients with an average age of 53.53 ± 16.38 years (54% were males). The prescription of diuretics (92%) after optimization was at the mean and with maximum doses of 29.1% and 7.7%. ACEIs/ARBs (77.1%) had optimal and mean doses for ACEIs of 14.3% and 29.7%. With beta-blockers (72.6%) there was an improvement in doses at 35.4% for the average doses and 3.1%. for the maximum dose. Spironolactone (44.3%) kept the same average dose at 5.7% The median time of optimization was 287.05 days with a median of 140 days. Only 13.4% of patients were receiving optimal treatment at optimal doses. By logistic regression, the presence of LVEF ≤ 0,40 or LVEF= 0.41-0.49 or global heart failure (P < 0.001) favored drug optimization (OR = 24.68[7.15-82.22], P < 0.001); (OR = 11.39[3.25-39.86], P < 0.001) on the other hand, a high serum creatinine level was an obstacle for treatment optimization (OR = 0.92[0.88-0.96], P < 0.001).

Conclusion: The optimization of the treatment of heart failure is insufficient with too long delays in our context. The optimization time was so long. It could be improved by setting up a clinic to optimize the treatment of heart failure.

Background: Surgical management of patients with severe aortic regurgitation (AR) in the setting of significantly impaired left ventricle (LV) function generally carries very high operative risk. The aim of this study is to assess the short and long-term outcomes of aortic valve replacement (AVR) in a selected young Moroccan population.

Materiel and methods: This is a retrospective study between January 2008 and June 2022 including all patients who underwent AVR for massive isolated AR with an LV ejection fraction EF ≤35%.

Results: In this center, a total of 3820 patients were operated for valvular disease, from which 110 had important AR. Overall, 42 patients of 110 patients had an LV ejection fraction≤35%, and benefited from AVR. Rheumatic cause was predominant (50%). Preoperative characteristics find an average age of 46.3 ±14.4 years with male prevalence. Only two deaths are noted in the immediate postoperative period. At the 15 years follow-up, the survival was 86.8%. Clinical improvement was present in the majority of patients. The mean LVEF post-AVR has increased by an average of 16% with proof of reverse remodeling.

Conclusions: In this series, patients benefited largely from AVR with good postoperative outcomes. The global operative mortality was acceptable (4.7%). The long-term survival (86.8%) was better than that described in the western series. Therefore, our results should encourage a surgical approach for those patients.

Introduction: Mature teratomas, a diverse group of germ cell tumors, rarely present with complications such as rupture.

Case presentation: We present a case of a 27-year-old male who was admitted to our hospital with acute dyspnea. A tamponade was diagnosed and the patient underwent a pericardial puncture. Further radiological investigations revealed a large mediastinal teratoma with evidence of rupture, leading to pericardial effusion. Surgical intervention was performed, which involved pericardial drainage and complete resection of the teratoma. Histopathological examination confirmed the diagnosis of a mature teratoma. The patient made a full recovery postoperatively.

Discussion: This rare case underscores the importance of early recognition and prompt surgical management in patients with ruptured mediastinal teratomas to prevent complications. We discuss the clinical presentation, diagnostic workup, and surgical approach to aid in the understanding and management of similar cases.

Conclusion: Mature teratomas are relatively rare benign tumors that rarely present with complications such as tamponade. Management of tamponade remains the same, and complete surgical removal of the teratoma is essential. In general, the outcome is favorable after surgical treatment.

Introduction: We live in the era of information technology (IT) innovations in the health sector, this has led to the appropriation of new organizational models which are profoundly changing the practice of medicine. Our study aims to determine the challenges of new digital technologies in the Moroccan health system, the case of the cardiology department - B - of the Ibn Sina University Hospital Center.

Materials and methods: This is a single-center observational descriptive-analytical study carried out at the level of the cardiology department - B- for 6 months, from September 1, 2022. Questionnaires were distributed in paper form to staff-affiliated medical doctor or carrying out their internships, using a digital device within the service.

Results: Thirty-one (31) responses were collected, with a participation rate of 78%; the age of the respondents varies between 21 to 55 years with an average of 30.3± 8.71 years with a female predominance of 67.7% and almost half of the health professionals in our sample 42% were residents. The most deployed digital device is the Hospital Information System (HIS) in 80.6%; 93.5% of respondents noted that saving of time is one of the advantages of telemedicine and 71% of respondents who affirmed that the better monitoring of patients located in isolated areas in order to avoid forgoing care. 74.2% of respondents considered that technical problems constituted an obstacle to the deployment of remote procedures; compared to 22.2% for a weak diagnosis; 64.5% of respondents noted that training would be a major lever for integrating more remote activities into their practices and 54.5% of respondents are in favor of adapted time slots.

Conclusion: The benefits perceived by respondents of these digital tools are numerous, although there are obstacles preventing digital transformation from reaching its full potential. The use of new digital technologies in this health sector responds to positive challenges in terms of organizational and educational efficiency; this requires the coordination of all stakeholders. The cardiology department -B - is a space conducive to the implementation of new digital technologies.

Case report: We report the case of a 63-year-old patient who underwent aortic valve replacement with a biological valve for a bicuspid aortic stenosis, and LIMA-IVA single-bypass surgery. Two weeks later, he presented with Enterococcus faecillis bacteremia, attributed to left pyelonephritis and successfully treated with Amoxicillin. Two months after his surgery, he had a new bacteremia due to Enterococcus faecalis and we discovered a pseudo-aneurysm of the mitro-aortic trigone. Our patient is treated medically at first, before benefiting from the "Hemi-Commando" procedure.

Discussion: The mitro-aortic trigone is a fibrous area, located between the left half of the noncoronary cusp and the left coronary cusp of the aortic valve and the anterior leaflet of the mitral valve [1]. This area, important in the maintenance of mitral and aortic functions, [ii] is poorly vascularized and therefore very susceptible to infections and trauma [2]. Erosion of the aortic ring leads to the formation of a subvalvular abcess, secondarily detergated en then leads to the destruction of the trigone.

Conclusions: Pseudoaneurysm is a rare complication of aortic valve surgery and endocarditis. Given the risk of rupture, early surgery is recommended.

Introduction: Heart failure is a major public health problem because of the number and duration of hospitalizations. Patients with heart failure may have mixed etiologies that are not mutually exclusive, and etiologies vary between high-income and developing countries. The aim of our work was to study the contribution of coronary angiography in the etiological investigation of heart failure with impaired LVEF in the cardiology department of HPD.

Methodology: This was a descriptive and analytical cross-sectional study with retrospective data collection on 103 patients hospitalized in the cardiology department of DAKAR's Hospital Principal presenting with heart failure with impaired LVEF and who underwent coronary angiography from January 2019 to December 2022.

Results: Our study included 103 patients with a clear male predominance 79.6% and a sex ratio of 3.7. Their mean age was 64±13.5 years. Diabetes was prevalent at 24.3% (p=0.033). All patients had impaired segmental and/or global left ventricular kinetics. Mean ejection fraction was 28.1±6.8. The right radial route was predominantly used 83.7% of the time, and there were no procedural incidents or accidents. Diabetes was significantly associated with coronary involvement (p=0.033). Coronary angiography was normal in 37.8% of patients and showed tri-truncular lesions in 19.4% of patients and bi-truncular lesions in 17.4%. We found 91 significant lesion and 67 non-significant lesion. A total of 41 patients had ischemic heart disease, equivalent to 39.8%.

Conclusion: Our study shows that ischemic heart disease plays an important role in the etiology of heart failure with impaired LVEF, and that coronary angiography should be performed routinely.