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The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients

The radial approach for diagnostic and therapeutic procedures offers clear advantages in terms of vascular complications. The pseudoaneurysm following radial artery access is an extremely uncommon complication. We report the case of a patient who developed radial artery pseudoaneurysm 7-months after coronary angiography intervention. The clinical presentation and treatment options are discussed.

L'atteinte de la valve tricuspide a été longtemps négligée aussi bien par cardiologue que par le chirurgien, mais depuis quelques années, la fuite tricuspidienne a été démontrée comme un facteur pronostic dans l'évolution des patients opérés d'une valvulopathie du c'ur gauche. Plusieurs techniques de plastie tricuspide ont été développées et les études publiées divergent sur les résultats de ces techniques; Nous avons mené ce travail afin d'évaluer les résultats de plastie tricuspide dans une population caractérisée par une forte prévalence de la maladie rhumatismale et de comparer les techniques d'annuloplastie de carpentier versus la plastie de DeVEGA. Etude rétrospective menée sur une période de 25 ans ayant inclus les patients traités par plastie tricuspide dans le service de cardiologie de SFAX. Nous avons comparé les résultats de groupe 1 (annuloplastie de Carpentier) vs groupe 2 (plastie de DeVEGA) 91 patients étaient inclus dans notre étude, avec 45 patients dans le groupe 1et 46 patients dans le groupe 2. La plupart des patients avaient une IT moyenne ou importante (83%) avant la chirurgie, une dilatation de l'anneau a été observée chez 90% des patients sans qu'il y ait une différence significatives entre le groupe 1 et 2. Les résultats immédiats étaient comparables entre les deux techniques mais au cours de suivi une insuffisance récurrente au moins moyenne a été plus significativement fréquente dans le groupe de plastie de DeVEGA. Les facteurs prédictifs d'IT récurrente significative au long cours étaient en étude multivariée la technique de DeVEGA (OR=3.26 (1.12-9.28)) et la pression artérielle pulmonaire systolique préoperatoire (OR=1.06 (1.01-1.12)). La plastie tricuspide avec anneau de Carpentier semble garantir de meilleurs résultats que la plastie de DeVEGA, par contre une PAPS préopératoire élevée est prédictive de récurrence de la fuite tricuspidienne même après plastie d'où l'intérêt d'opérer les malades à un stade précoce.

ObjectiveBrain natriuretic peptide (BNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance and concomitant volume overload.The aim of this study was to evaluate the clinical usefulness of BNP in hypertensive patients on maintenance hemodialysis (HD).Design and Methods we measured BNP levels in 30 patients immediately before and after HD. All patients had preserved left ventricular ejection fraction (LVEF≥50%) and underwent 48-hours ambulatory blood pressure measurement. Cardiac parameters were evaluated by echocardiography.ResultsThe left ventricular mass index (LVMi) and BNP levels decreased significantly after HD (p

Background The utility of Brain Natriuretic Peptide (BNP) and cystatin C for detecting left ventricular (LV) diastolic dysfunction after myocardial infarction (MI) in patients without heart failure symptoms still unclear. In this study, we investigated the relation between BNP, serum cystatin C levels and LV diastolic dysfunction after MI in patients without systolic dysfunction. Methods We studied 127 patients without renal dysfunctionafter first acute coronary syndrome (ACS). LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E’ wave velocities (E/E’), was used to detect LV filling pressures. Patients were divided in three groups according to E/E’ ratios 15 (group III). Plasma concentrations of BNP and serum cystatin C were measured at admission. Results The BNP and serum cystatin C levels were positively correlated significantly with E/E’ ratio (r=0.786, p 15 had highest BNP (321±75pg/mL) and cystatin C (1.1±0.2mg/L) levels. E/E’ 10 to 15 group had a mean BNP level of 151±28pg/mL and a mean cystatin C value of 0.78±0.1mg/L, and those with E/E’ 15. Conclusion The assessment of the blood concentration of BNP and cystatin C is of potential value for identification of those patients after myocardial infarction to detect early cardiovascular changes, especially LV diastolic dysfunction.

BackgroundThe utility of Brain Natriuretic Peptide (BNP) and cystatin C for detecting left ventricular (LV) diastolic dysfunction after myocardial infarction (MI) in patients without heart failure symptoms still unclear. In this study, we investigated the relation between BNP, serum cystatin C levels and LV diastolic dysfunction after MI in patients without systolic dysfunction.MethodsWe studied 127 patients without renal dysfunction after first acute coronary syndrome (ACS). LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echo-cardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E’ wave velocities (E/E’), was used to detect LV filling pressures. Patients were divided in three groups according to E/E’ ratios15 (group III). Plasma concentrations of BNP and serum cystatin C were measured at admission.ResultsThe BNP and serum cystatin C levels were positively correlated significantly with E/E’ ratio (r=0.786, P15 had highest BNP (321±75pg/mL) and cystatin C (1.1±0.2mg/L) levels. E/E’ 10 to 15 group had a mean BNP level of 151±28pg/mL and a mean cystatin C value of 0.78±0.1mg/L, and those with E/E’15.ConclusionThe assessment of the blood concentration of BNP and cystatin C is of potential value for identification of those patients after myocardial infarction to detect early cardiovascular changes, especially LV diastolic dys-function.

arginine and molecular oxygen in vascular endothelial cells (Kincl et al.2009). Angiotensin-converting enzyme (ACE), present on the surface of vascularendothelial cells, generates the potent vasoconstrictor angiotensin II from angio-tensin I and inactivates the vasodilator bradykinin (Erdo¨s 1990). Angiotensin IImodulates NO synthesis in cardiovascular tissue, and NO modulates the action ofangiotensin II (Dubey et al. 1995; Nakagami et al. 1999). Many polymorphismslocated in the ACE and NOS3 genes have been reported to play a major role in thepathogenesis of coronary artery disease (CAD) and related outcomes (Cambienet al. 1992; Yoshimura et al. 2000; Bor-Kucukatay et al. 2010; Hamelin et al. 2011).The -T786C polymorphism in the NOS3 gene causes a reduction of promoteractivity and has been reported as a risk factor for coronary spasm in a Japanesepopulation (Nakayama et al. 1999). The Glu298Asp polymorphism has been

We 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.

Resume Buts de l’etude Etudier les profils epidemiologiques, cliniques, therapeutiques et pronostiques de l’infarctus de myocarde (IDM) chez les insuffisants renaux chroniques. Montrer l’impact de l’insuffisance renale chronique (IRC) a court, moyen et long termes. Determiner les facteurs predictifs d’evenements cardiovasculaires et cerebraux majeurs (MACCE) hospitaliers et a moyen terme chez les insuffisants renaux chroniques. Patients et methodes Etude retrospective incluant 231 patients hospitalises entre janvier 2005 et decembre 2006 pour IDM avec sus-decalage persistant de ST. Notre population a ete repartie en deux groupes : groupe 1 : debit de filtration glomerulaire (DFG) superieur ou egal a 60 ml/min : 112 patients ; groupe 2 : DFG inferieur a 60 ml/min : 119 patients. Resultats Les insuffisants renaux avaient plus d’antecedents d’accidents vasculaires cerebraux et d’hypertension arterielle. Le recours aux therapies medicamenteuses et de reperfusion urgente etait moindre dans le groupe 2. En multivariee, l’IRC etait un facteur predictif de survenue de MACCE hospitaliers ( p = 0,016), a six mois ( p = 0,003), a un an ( p = 0,004) et a deux ans ( p = 0,015). Les facteurs predictifs de MACCE hospitaliers chez les insuffisants renaux etaient : le recours au tonicardiaques ( p = 0,001) et l’angioplastie (ATL) primaire ( p = 0,043). A un an apres l’IDM, seul le pontage aortocoronaire etait predictif de MACCE ( p = 0,03). Conclusion Un lien significatif a pu etre demontre entre l’IRC et la survenue de MACCE apres IDM. Nos resultats confirment la necessite de la prise en compte de la fonction renale lors de la prise en charge et l’evaluation du risque de l’IDM.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.

A 45 day old new-born with arrhythmia-induced cardiomyopathy complicated by thrombus formation is presented. Drug treatment produced immediate symptomatic relief and subsequent reversion to normal cardiac function. The thrombus disappeared a few days later.

Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q) scan or by a spiral computed tomography (CT) scan showing one or more filling defects in the pulmonary artery or its branches. Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%). The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24%) developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2%) were hypotensive, 23 (67.7%) had systemic inflammatory response syndrome (SIRS), three (8.8%) had clinical manifestations of deep venous thrombosis (DVT), and 32 (94%) had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94%) and low molecular weight heparin was used in two cases (4%). The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock) (Odds ratio (OR) = 9.96) and thrombocytopenia (OR = 32.5).Moreover, comparison between patients with and without PE showed that the predictive factors of PE were: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2 /FiO 2 < 200 mmHg, the presence of spine fracture, and the presence of meningeal hemorrhage. Conclusion: Despite the high frequency of DVT in post-traumatic critically ill patients, symptomatic PE remains, although not frequently observed, because systematic screening is not performed. Factors associated with poor prognosis in the ICU are the presence of circulatory failure (shock) and thrombocytopenia. Predictive factors of PE are: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2 /FiO 2 < 200, the presence of a spine fracture, and the presence of meningeal hemorrhage. Prevention is highly warranted.

Right ventricular dysfunction in cirrhotic patients is not well described, we suggest that cirrhosis will result in an increase of pulmonary resistance and the post-charge of RV, we aim to assess ventricle function in cirrhotic patients and the correlation between the severity of cirrhosis and the RV dysfunction. Methods We assessed echocardiographic RV systolic function in 80 patients with cirrhosis. We compared compensated (n = 39) and uncompensated patients (n = 41) to controls (n = 80). The severity of cirrhotic disease was assessed by Child and Mild scores. Results RV was significantly enlarged in cirrhotic patients compared to controls and in uncompensated patients compared to compensated patients (RV diastolic area = 16.7 ± 5 cm2, 14.5 ± 4 cm2, P = 0.01). The TAPSE and the S wave were significantly lower in cirrhotic patients (P = 0.007) compared to controls but there were no difference between the sub-groups. Longitudinal peak systolic speckle tracking of lateral RV wall was significantly decreased in cirrhotic patients (P Conclusion The present study illustrated RV systolic function impairment in cirrhotic patients. The lack of correlation between the right ventricle dysfunction and the severity of cirrhosis suggest a complex mechanism. Right ventricular dysfunction in cirrhotic patients is not well described, we suggest that cirrhosis will result in an increase of pulmonary resistance and the post-charge of RV, we aim to assess ventricle function in cirrhotic patients and the correlation between the severity of cirrhosis and the RV dysfunction. Methods We assessed echocardiographic RV systolic function in 80 patients with cirrhosis. We compared compensated (n = 39) and uncompensated patients (n = 41) to controls (n = 80). The severity of cirrhotic disease was assessed by Child and Mild scores. Results RV was significantly enlarged in cirrhotic patients compared to controls and in uncompensated patients compared to compensated patients (RV diastolic area = 16.7 ± 5 cm2, 14.5 ± 4 cm2, P = 0.01). The TAPSE and the S wave were significantly lower in cirrhotic patients (P = 0.007) compared to controls but there were no difference between the sub-groups. Longitudinal peak systolic speckle tracking of lateral RV wall was significantly decreased in cirrhotic patients (P Conclusion The present study illustrated RV systolic function impairment in cirrhotic patients. The lack of correlation between the right ventricle dysfunction and the severity of cirrhosis suggest a complex mechanism.

Introduction Chronic kidney disease (CKD) is a worldwide public health problem associated with increased morbidity and cardiovascular diseases. Purpose Our aim was to investigate left ventricular (LV) myocardial function throughout the cardiac cycle with speckle tracking echocardiography (STE) in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD). Methods The study population consisted of 30 maintenance HD patients. These patients were examined just before and after HD. LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) peak systolic strain was measured with 2D-STE and 3D-STE. BNP levels were measured before and after HD. Results Increased LV mass index (LVMi) and a decreased E/A ratio were found in hemodialysis patients. LV global longitudinal and radial peak systolic strain was decreased in the study group population. Strain values improved in longitudinal and radial directions after HD [pre-HD vs. post-HD; GLS: −16.43 (1.7) vs. −18.49 (1.9) %, P Conclusion STE may be used to identify early abnormalities in patients with ESRD undergoing hemodialysis with preserved LV ejection fraction. HD treatment results in immediate improvement in all strain directions. LV hypertrophy may play a role in the deterioration of LV mechanics in patients with ESRD.

Background In many studies, female gender was considered as a risk factor for onset of atrial fibrillation (AF) and its complication of thromboembolic events. The aim of our study was to compare according to gender, predictive factors, causes and complication of AF. Methods We carried out in our department a study including 642 patients with AF. Patients were divided into two groups according to gender: a “Female” group and a “Male” group to demonstrate the and less ischemic heart disease (8% vs. 16.5%, P = 0.001) in the “Female” group. For the complications of AF, there were no significant differences between the two genders regarding thromboembolic events (8.3% vs. 6.1%, P = 0.28) and bleeding caused by oral anticoagulation (6.4% vs. 6.4%, P = 1). 52.5% 48.5% 51% 49%. Prevalence of diabetes rate of male and female difference in predictive factors, causes and complications of AF between the groups. Results A total of 642 patients were studied with the mean age was 63.2 ± 15.7 years. The number of female patients was 314 (48.9%). The prevalence of hypertension was 52.5% and that of diabetes mellitus was 27.1%. The prevalence of hypertensive heart disease, valvular heart disease and ischemic heart disease were 10.1%, 36.8% and 12.3% respectively. The comparison of the “Female” group and “Male” group showed that there was more hypertension (57.6% vs. 47.7%, P = 0.001), more renal failure (6.2% vs. 2.1%, P = 0 .01) and less smoking (1.4% vs. 22.6%, P Conclusion In our study, in female gender, hypertension and renal failure are the most frequent predictive factors of AF. Valvular and hypertensive heart diseases are the first etiologies of AF in women, whereas for men it is more ischemic heart disease. Thromboembolic and hemorrhagic complications are not influenced by gender.

In end-stage renal disease patients with preserved LV ejection fraction undergoing chronic hemodialysis, we investigated the relationship of left atrial deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and brain natriuretic peptide level. The study group enrolled 30 patients treated with chronic hemodialysis three times weekly. Two-dimensional transthoracic echocardiography and Doppler studies were performed 44.93 (13.46) immediately before and after HD. All patients had preserved left ventricular ejection fraction. The mean age of patients was 44.93 ± 13.46 years. The mean brain natriuretic peptide (BNP) value after HD was 221.56 ± 197.79 pg/ml. BNP values were significantly higher before HD (p = 0.004), the anteroposterior diameter, area, and the volumes of the LA decreased significantly after HD. On the other hand, the left atrial ejection fraction (LAEF) and the peak LA strain during LV systole (LAGS) were found to be higher. Before HD, there were significant inverse correlations between LAGS and BNP levels (r = −0.482, p = 0.007), E/E′ (r = −0.33, p = 0.049), LAVmax (r = −0.366, p = 0.047), and LAVmin (r = –0.579, p = 0.001). LAGS had a significant correlation with E′ velocity (r = 0.557, p = 0.001) (Table 5) and LAEF (r = 0.58, p = 0.001). After HD, there were also significant correlations between LAGS and echocardiographic parameters of systolic and diastolic LV function. We observed that left atrium global peak systolic strain values decreased consistently with deteriorating systolic and diastolic function. Our results suggest that LAGS measurements may be helpful as a complimentary method to evaluate diastolic function.

Aims: Cystatin C is an endogenous marker of renal function. It is a well established better marker of glomerular filtration rate than serum creatinine. There is also evidence that cystatin C is associated with atherosclerotic disease. The present prospective study evaluated the prognostic value of cystatin C after myocardial infarction in patients without chronic kidney disease. Methods and results: A total of 127 patients who underwent coronary angiography after an acute coronary syndrome (ACS) were included. Cystatin C was associated with the severity of coronary artery disease (CAD). Cystatin C levels were significantly higher in patients with 3-vessels disease and severe CAD according to GENSINI score (p = 0.01 and p

The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.

ObjectiveTo determine the efficacy and the safety of percutaneous balloonmitral commissurotomy (PBMC) in young patients (aged under 18 years – olds) with rheumatic mitral stenosis and to compare these results with those of adult patients.Patients and MethodsPercutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 480 patients with rheumatic mitral stenosisbetween 1998 and 2013. 41 were aged under 18 years – old (group 1). The other 439 patients (group 2) had a mean age of 34±11.9 years. All patients were assessed clinically. An echocardiography was performed before and after the procedure.ResultsMean age in group 1 was 15±2.95 years (range 8 to 18) with a women predominance (73.2% vs. 26.8%.). In group 1, there was a significant increase of the mean mitral valve area index (MVAI) (0.84±0.24 vs 1.78±0.39cm2, p

Intracardiac thrombosis is an exceptional complication of Behçet's disease. The management of this involvement is difficult due to the risk of recurrence. We present the case of a young man admitted to our hospital for intermittent fever. The microbiologic investigations did not show any causative germ. We discovered a right ventricle thrombus on echocardiography. We confirmed the diagnosis of pulmonary embolism on CT angiogram. The patient developed oral and genital ulcerations which were consistent with Behçet's syndrome. The thrombus had disappeared after treatment with anticoagulant, corticosteroid and immunosuppressors. Intracardiac thrombosis can reveal Behçet's disease. An exhaustive examination and close monitoring should be performed in order to reveal pathognomonic signs as soon as possible and to promptly start the appropriate treatment.

Surgical reintervention (or redux surgery) for prosthetic valve (PV) replacement is increasingly performed nowadays. Nonetheless, this intervention is not devoid from adverse outcomes including higher morbidity and mortality rates than in the index surgery. We sought to study the causes and the in

The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain. In very elderly patients, there are no randomized trials relative to the impact of statins on morbi-mortality in primary prevention as well in secondary prevention. Adverse effects in the elderly seem to be statistically similar to those occurring in young people , but the prescription in very old people should be individualized, taking into account the life expectancy, the life quality, the comorbidities, and especially the risk of drug interactions.

L'endocardite à Bartonalla est une infection ubiquitaire, son diagnostic est difficile vu qu'il s'agit souvent d'endocardite à hémoculture négative. Lebut de cette étude est d'analyser les particularités lésionnelles et évolutives de cette entité dans un pays du nord d'Afrique, la Tunisie et dedémontrer la gravité de cette infection. Nous avons étudié rétrospectivement les dossiers médicaux de 20 patients atteints d'endocardite à Bartonella, confirmée selon les critères de Dukes modifiés. L'âge moyen de nos patients était 37 ans avec une prédominance masculine (SR=3). Tous nos malades avaient un niveau socio-économique bas. Le motif essentiel de consultation était la dyspnée, 6 patients étaient admis dans un tableau d'insuffisance cardiaque congestive. Une prédilection des lésions au niveau de la valve aortique a été notée (14 cas). Quatorze patients avaient des végétations endocarditiques avec une taille qui dépasse 10 mm chez 8 malades. La majorité des patients (18 patients) présentaient une régurgitation valvulaire massive en rapport principalement avec des mutilations importantes (6 cas de ruptures de cordages mitraux, 2 cas de déchirures des sigmoïdes aortiques, un cas de perforation valvulaire aortique, un cas de désinsertion de prothèse mitrale). Quinze malades (3/4) avaient nécessité une chirurgie à la phase active de la maladie, l'indication majeure était l'insuffisance cardiaque. Une complication neurologique était notée chez 2 malades et une complication rénale chez 3 malades. Treize patients étaient guéris, 5 malades étaient décédés et 2 malades opérés ont présenté une réinfection à staphylococcus aureus et à candida albicans en postopératoire. L'endocardite à Bartonella est une infection grave. Cette Bactérie possède un potentiel destructif important. Le recours à la chirurgie est quasi constant. La morbi-mortalité est élevée. La recherche de cette bactérie devrait être alors systématique chez nos malades suspects d'endocardite d'autant plus que la bartonellose est endémique sur nos terres.

Authors describe the case of a patient with breast cancer and multiple myeloma as the second metachronous disease responsible for spinal cord compression. Synchronous occurrence of bone marrow breast cancer disease and multiple myeloma has not been described in the literature, as in this case. By presenting this case, we point to possible association between both diseases and the possible factors involved in the development of second malignant disease.Key words: Myeloma, breast cancer, spinal cord compression

The vagal maneuver is the first line of therapeutic available for patients with paroxysmal supraventricular tachycardia. It increases vagal tone and includes the traditional ocular compression, carotid sinus massage, and Valsalva maneuver. A 40-year-old man was admitted because of 180 beats/min regular narrow QRS-complex tachycardia. The physician in the emergency department had performed an ocular compression, and at its ending, the tachycardia degenerated into unstable hemodynamically high ventricular rate atrial fibrillation. It was reverted to sinus rhythm by electrical shock. The electrophysiologic study documented a latent posterolateral bypass tract, with an anterograde refractory period of 210 milliseconds, which was successfully ablated.

Introduction PCI has become increasingly practiced in left main stenosis (LMS). The purpose of this study was to determine predictors of mid term major cardiovascular events in 110 cases of unprotected left main PCI. Methods Clinical and angiographic data were collected retrospectively for all patients with LMS, admitted to the cardiology center of Sfax between 2002 and 2013 and for which urgent or scheduled percutaneous revascularization was performed. The occurrence of cardiovascular events, or MACCE: death, MI, heart failure, angina or stroke recurrence was assessed at 12 months. Results During the study period, 110 patients underwent an unprotected LM PCI. These patients were predominantly male (72.7%). The death rate intra – hospital was 4.5% and 12 months mortality was 3.6%. 31 patients (28.2%) had nonfatal events during follow up. The clinical presentation at admission and diabetes were MACCE predictors at 12 months (p=0.04 and 0.05 successively). The distal LM location with bifurcation involvement, the multivessel disease associated and a high Syntax score> 32 are predictors of the occurrence of MACCE in the medium term (p=0,03; p=0001; and p=0001 successively). The type and length of the stent used in the LMS are also predictors of the occurrence of MACCE (49.1% for BMS versus 9.8% for DES, p Conclusion The unprotected LM PCI became promising thanks to developpemet of angioplasty techniques and equipement especially intracoronary imaging.

To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects (OS ASDs) using Amplatzer septal occluder.It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic (TTE) and transoesophageal echocardiographic (TEE) monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure.From the 34 patients, 28 (82%) were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm.The final success rate of the procedure was 90.9% (30/33). One patient was excluded from transcatheter occlusion and three patients (8,6%) had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients (11,7%) underwent surgery. No major complication (thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis) or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts.Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital.

The following information was missing from the Funding section: "This work has been supported in part by grants to M. Lathrop from Genome Quebec, le Ministere de l'Enseignement superieur, de la Recherche, de la Science et de la Technologie (MESRST) Quebec, and from the ANR in France for the Labex project "Medical Genomics".

Introduction 3D speckle tracking imaging (3D-STI) is a new technique in the assessment of several heart diseases. We aim to delineate the effect of arterial hypertension (HTN) on left ventricle (LV) through a STI study. Patients and Methods We studied 31 HTN patients and 30 age-matched healthy volunteers. The main exclusion criteria were atrial fibrillation, coronary artery disease, severe valvular heart diseases and liver or kidney dysfunction. Therefore, each subject underwent an echocardiogram with 3D-STI and serum NTproBNP was determined. Results Among HTN patients, near 55% were women. Systolic and diastolic blood pressure were 149,6±17 and 89±10mmHg (vs. 119,7±7 and 77,6±6mmHg; p 2 which was significantly higher than healthy subjects (75±18g/m 2 ; p Only 6 HTN patients had eccentric LV hypertrophy. NTproBNP was greater in HTN patients (31,3 vs. 13 ng/ml; p=0,01). 3D LV peak longitudinal strain (3D-PSLG) was lower in HTN group (–14±2 vs. –19±2; p Conclusion: 3D-STI is a useful technique in the assessment of hypertensive heart disease. This study highlighted the relation between LV concentric geometry (RWT) and PSLG.

Objective The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed. Methods Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries. The prevalence rate of this entity was 1.5% (21 out of 1,400 Q wave MI patients). These patients were characterized by their young age (the mean age=44.95±14.86), male dominance (90.47%), and a high prevalence of smoking (85.71%). In this study, 4 patients have an evident spontaneous spasm shown on coronary angiography which disappeared after intracoronary injection of nitrates. Coagulation Disorders, such as activated protein C resistance (APC) resistance, protein C deficiency and antiphospholipid antibody syndrome were found in 4 of 12 patients who underwent systematic examination. One patient had a history of lung cancer which may be associated with a hypercoagulable state and may explain the occurrence of myocardial infarction with a normal coronary artery. The mean left ventricle ejection was 56. 5±12. The mean follow-up was 24±10 months. Six patients developed residual chest pain which was generally easily controlled by anti-spastic therapy and no patient had a major cardiovascular event. Conclusion Patients with Q-wave MI and with normal coronary arteries seem to have a good short and long-term prognosis especially when they are treated with an exclusive medical strategy.

This case report represents the difficulties in diagnosing brucellosis, which is an enigma with unusual cardiovascular complications. A 32-year-old Caucasian man with acute chest pain was examined at Sfax Hedi Chaker's Hospital. He had a night fever, although his cardiac examination was normal. Further laboratory analyses showed an elevated C-reactive protein of 20.8 mg/dL and troponine I of 1.469 IU/L. A cardiac MRI using delayed enhancement was then performed. The T2-weighted short-axis showed a subepicardial delaying enhancement of infero-lateral and the basal walls of the left ventricle. Accordingly, a diagnosis of Brucella-related myocarditis was made.

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.

Objectifs La pression arterielle (PA) presente une variation continue durant le jour et la nuit. Les patients traites par hemodialyse (HD) subissent un rythme particulier impose par les seances d’HD un jour sur deux. La relation entre le niveau de la PA et la morbi-mortalite cardiovasculaire ne simule pas celle observee chez les sujets a fonction renale preservee. Le dilemme d’epidemiologie inverse a meme ete introduit. Les donnees issues des mesures ambulatoires de la PA (MAPA) permettent une meilleure caracterisation de la PA durant les activites quotidiennes et le sommeil, et, surtout, une meilleure correlation avec l’atteinte des organes cibles que la mesure clinique de la PA. L’objectif de notre travail est de mieux definir le role de MAPA chez les hemodialyses (HD) chroniques et d’evaluer la correlation de ses resultats avec les donnees echocardiographiques. Methodes Il s’agit d’une etude transversale, portant sur des patients traites par HD chronique a raison de 3 seances par semaine, durant une periode allant du 1 er mars 2014 au 30 decembre 2014. Nous avons realise une MAPA de 48 heures (jour de dialyse (J1) suivi de jour de non dialyse (J2)) chez tous les patients a titre externe. Un bilan standard et une echocardiographie (avant et apres HD) etaient pratiques chez tous les patients. Resultats La population d’etude comprenait 17 patients. Les patients normotendus permanents etaient 4 (23.5 %), les hypertendus permanents etaient 6 (35.3 %), les patients avec HTA masquee etaient 7 (41.2 %). Aucun patient n’avait une HTA blouse blanche. L’HTA etait traitee par une monotherapie chez 2 (11.8 %), bitherapie chez 4 (23.5 %) et trithe-rapie chez 2 (11.8 %) patients. Le tableau suivant resume les chiffres tensionnels obtenus : avec un p significatif si p inferieur ou egal a 0.05 (see table below). L’etude de la variation nocturne de la PA a objective un profil dipper dans 3 (17.6 %), non-dipper dans 12 (70.6 %), Inverted-dipper dans 2 (11.8 %) cas. Aucun cas d’hyper- dipper n’a ete identifie. Trois patients (17.6 %) avaient une HVG echocardiographique. Nous avons constate une baisse significative de la masse du ventricule gauche (VG) apres HD (p = 0.002). Abstract P-170 – Table PA systolique (mmgh) PA diastolique (mmgh) MAPA 48h MAPA J1 MAPA J2 PA avant HD (mesure clinique) PA apres HD (mesure clinique) MAPA 48h MAPA J1 MAPA J2 PA avant HD (mesure clinique) PA apres HD (mesure clinique) 147,89 144,08 150,19 127,29 130,47 88,49 83,6 90,41 81,94 84,24 p vs PA48h 0,05 0,42 0,005 0,017 vs PA48h 0,001 0,14 0,13 0,31 PAJ1vsJ2 0,13 PA J1vsJ2 0,006 Conclusion Notre etude confirme la prevalence elevee des anomalies ten-sionnelles a la MAPA chez les HD. Non seulement la MAPA aide dans le diagnostic et la categorisation de l’HTA, mais peut egalement fournir des donnes pronostiques. Nous suggerons que la MAPA devrait devenir la norme pour le diagnostic de l’HTA et l’evaluation pronostique chez les HD chroniques en collaboration avec l’echocardiographie.

Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS) in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high level of CRP). Anticardiolipine was present in the 2 cases. However, anti B2 glycoprotein I antibodies were detected in only one case. Emergency percutaneous transluminal coronary angioplasty (PTCA) with direct stenting had been performed successfully only in the first case, and the follow-up was uncomplicated. Thereafter, long-term oral anticoagulant appeared to be effective. The last patient was admitted because of peripheral acute ischemia of legs. Standard electrocardiogram showed signs of previous silent anteroseptal wall myocardial infarction confirmed by echocardiography. The latter revealed an apical thrombus and a very low left ventricular ejection fraction. Amputation of the right leg was necessary because of consultation occurred too late. However, he died four weeks later. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of this complication.Key words: Antiphospholipid syndrome, acute myocardial infarction, coronarography

L'endocardite à Bartonalla est une infection ubiquitaire, son diagnostic est difficile vu qu'il s'agit souvent d'endocardite à hémoculture négative. Le but de cette étude est d'analyser les particularités lésionnelles et évolutives de cette entité dans un pays du nord d'Afrique, la Tunisie et de démontrer la gravité de cette infection. Nous avons étudié rétrospectivement les dossiers médicaux de 20 patients atteints d'endocardite à Bartonella, confirmée selon les critères de Dukes modifiés. L’âge moyen de nos patients était 37 ans avec une prédominance masculine (SR=3). Tous nos malades avaient un niveau socio-économique bas. Le motif essentiel de consultation était la dyspnée, 6 patients étaient admis dans un tableau d'insuffisance cardiaque congestive. Une prédilection des lésions au niveau de la valve aortique a été notée (14 cas). Quatorze patients avaient des végétations endocarditiques avec une taille qui dépasse 10 mm chez 8 malades. La majorité des patients (18 patients) présentaient une régurgitation valvulaire massive en rapport principalement avec des mutilations importantes (6 cas de ruptures de cordages mitraux, 2 cas de déchirures des sigmoïdes aortiques, un cas de perforation valvulaire aortique, un cas de désinsertion de prothèse mitrale). Quinze malades (3/4) avaient nécessité une chirurgie à la phase active de la maladie, l'indication majeure était l'insuffisance cardiaque. Une complication neurologique était notée chez 2 malades et une complication rénale chez 3 malades. Treize patients étaient guéris, 5 malades étaient décédés et 2 malades opérés ont présenté une réinfection à staphylococcus aureus et à candida albicans en postopératoire. L'endocardite à Bartonella est une infection grave. Cette Bactérie possède un potentiel destructif important. Le recours à la chirurgie est quasi constant. La morbi-mortalité est élevée. La recherche de cette bactérie devrait être alors systématique chez nos malades suspects d'endocardite d'autant plus que la bartonellose est endémique sur nos terres.

Introduction Primary cardiac lymphoma is rare. Case Presentation 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. Conclusion The prognosis remains poor for this type of tumor due to delays in diagnosis and the importance of the site of disease.