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The tricuspid valve has long been described as the "forgotten valve". In recent years, diagnostic and therapeutic advances have led to a better understanding of tricuspid valve pathology. From echocardiography to interventional treatment, the management of tricuspid regurgitation appears to be the focus of numerous academic papers. Surgical management of tricuspid regurgitation, is increasingly being performed in isolation. A better understanding of its physiology and pathophysiology is shedding light on the consequences of delayed correction in terms of mortality and morbidity. In this study, we will focus on the mainly rhythmic complications of this surgery, namely atrial fibrillation that holds her fair share of complications, while attempting to identify factors predictive of its occurrence. This is a monocentric retrospective observational study during which 60 patients were enrolled in our center (Cardiology Department A and Cardiovascular Surgery Department B, at Ibn Sina University Hospital, Rabat). The data was collected from anonymized patient files in the department's archives. The data processing form included demographic and epidemiological characteristics, as well as clinical and ultrasound information, in an attempt to ensure the broadest possible screening of possible causes in line with the main points found in the literature. The statistical study was carried out using Jamovi software. Apart from the demographic criteria describing our population, it would appear that the surface area of the atria, as well as the patient weight, are risks factor for the occurrence of AF in the immediate postoperative period with a significant P -value. Other factors also appear to be associated with the occurrence of AF, namely extracorporeal circulation time and the use of catheters in the atria. In conclusion, although isolated tricuspid regurgitation surgery improves patient prognosis, it is still associated with a number of complications, notably atrial fibrillation. Various factors seem to be involved in its development, including the size of the atria preoperatively, the patient's weight, the use of catheters in the atria, and so on. Knowledge of these complications not only helps prevent them from occurring in the first place, but also ensures better management when they do occur. [ABSTRACT FROM AUTHOR]

Traditionally reflecting critical stenosis of the proximal left anterior descending (LAD) artery, Wellens' syndrome (WS) is an electrocardiogram (ECG) pattern of biphasic or deeply inverted T waves in leads V2 and V3. This critical stenosis can progress to an extensive anterior myocardial infarction (MI) if early and appropriate management is not received promptly. The diagnosis of severe stenosis of the LAD coronary artery can be made by using electrocardiographic changes in Wellens' syndrome. Due to the significant area that the LAD vascularizes, patients who exhibit symptoms and test results suggestive of this syndrome should be referred right away for an angiographic exploration in order to confirm the diagnosis and guide treatment. We report a case of a 71-year-old male admitted to our department for acute chest pain. His ECG showed Wellens' syndrome type 2 during both chest pain and pain free with slightly elevated troponin. His TIMI score was 3 and the GRACE score was 136. Critical stenosis of the LAD coronary artery was found in the coronary angiography, which required a drug-eluting stent. The patient was discharged asymptomatic from medical therapy. The diagnosis was established on the basis of the patient's interview, ECG analysis, and coronary angiography., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Acute coronary syndromes are a clinical entity frequently encountered in practice and are responsible for significant morbidity and mortality, despite therapeutic advances. The initiation of early reperfusion therapy reduces mortality and morbidity and improves patients' prognosis, but this depends on how quickly patients receive their treatment. Although it is often easy to diagnose in the presence of typical symptoms, certain patients, such as diabetics, sometimes have atypical symptoms, resulting in a delay in management. In nearly 50% of cases, inferior wall ischaemia is accompanied by right ventricular myocardial infarction; the clinical outcomes range from no hemodynamic compromise to severe hypotension and cardiogenic shock. In this article, we present the case of a 54-year-old male patient with active smoking and poorly controlled type 2 diabetes as cardiovascular risk factors who initially consulted at the first hour for epigastric pain, for which he received symptomatic treatment. As the symptoms persisted, he was admitted to our department at the eighth hour, where he was diagnosed with a biventricular infarction., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Mitral valve masses are uncommon. These tumors and tumor-like lesions may have similar morphological and clinical characteristics, but different outcomes. Unlike valvular tumors, caseous calcification of the mitral annulus (CCMA) is a benign degenerative disorder, commonly misdiagnosed, thus differentiating it from other mitral valve masses is important to avoid unnecessary surgery. Multimodality imaging can prove a valuable tool for definitive diagnosis. We present a case of a 72-year-old female patient, with coronary artery disease, referred for angina symptoms. Echocardiography detected a mass in the mitral valve annulus. Cardiac magnetic resonance imaging showed a mobile mass respecting the myocardium suggestion an atypical papillary fibroelastoma and surgery was indicated. However, the definitive diagnosis, after histological examination, was CCMA. The aim of this case report is to illustrate the difficulty in differentiating between mitral valve masses and the repercussion on the subsequent management, emphasizing the pivotal role of multimodality imaging., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Antiphospholipid syndrome is a rare entity that must be systematically evoked in front of recurrent miscarriages associated with venous or arterial thrombosis, its diagnosis is based on a set of clinico-biological arguments. In rare cases, it can be associated with postpartum cardiomyopathy, which is defined by a dysfunction of the left ventricle with an LVEF<45%, which may or may not be associated with a dilation of the left ventricle. This association is rare and poorly described in the literature, which makes management difficult and uncodified. In this context we report the case of a 33-year-old patient with cardiovascular risk factors such as arterial hypertension 2 previous miscarriages and repeated phlebitis, she was admitted to the emergency room for the management of acute dyspnea related to a proximal right pulmonary embolism and in whom the transthoracic echocardiography had objectivated a dilated left ventricle and an alteration of the ejection fraction of the left ventricle, the coronary angiography came back without particularity as part of the etiological work-up, a biological work-up was carried out, which came back in favor of an antiphospholipid syndrome. This case shows diagnostic difficulties and management of this disease., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

A 70-year-old woman was referred to our cardiology department for the management of dyspnoea. Cardiovascular examination revealed a loud P2, with no sign of right-sided heart failure. Chest X-ray showed a convex left medium cardiac border and a double contour along the right cardiac border. Transthoracic echocardiogram revealed a cystic mass attached to the right ventricle apex. Computed tomography scan showed cyst with fluid density on the apex of the right ventricle; and a honeycomb-like aspect cyst with partial occlusion in the left pulmonary artery. Cardiac magnetic resonance imaging revealed the presence of hydatic intrapericardial cyst that compresses the right ventricular apex; associated with intraluminal left pulmonary artery cyst. Hydatic serology was positive. The patient refused surgery and was discharged on a regimen of Albendazole. She has been followed up closely with a good outcome., Competing Interests: No conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press.)

Background: MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale., Methods: Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected., Results: A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up., Conclusion: MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Suicide left ventricle (SLV) remains an underdiagnosed cause of haemodynamic compromise following surgical or transcatheter aortic valve replacement (AVR). Risk factors include female sex and a small left ventricular cavity with asymmetric septal hypertrophy. We present the case of a 63-year-old woman, with a medical history of diabetes mellitus, arterial hypertension and dyslipidaemia who was diagnosed with severe aortic stenosis with normal left ventricular ejection fraction and concentric hypertrophy. She underwent surgical AVR using a bioprosthetic valve, but a few hours after surgery, she developed sudden cardiogenic shock. An urgent transthoracic echocardiogram was performed showing marked systolic anterior motion of the mitral valve resulting in severe dynamic left ventricular outflow tract obstruction and intraventricular gradient. The diagnosis of SLV was made. The patient was managed conservatively with volume loading and oral beta-blockers and her haemodynamic state improved gradually. She was then discharged after favourable evolution. Medical management of SLV includes volume loading to expand the ventricular volume and beta-blockers for their negative inotrope effect. When medical therapy fails, surgical myectomy or alcohol septal ablation can be proposed to remove the obstacle. Some authors have proposed these procedures as prophylactic measures to prevent SLV in high-risk patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chraibi et al.)

In multi-vessel coronary artery disease, concomitant ST-segment elevation myocardial infarction (STEMI) in simultaneous two culprit lesions have been rarely reported. In this regard, the recurrence in a short period of time of a STEMI in a different coronary artery is also rare. We describe the case of a 56-year-old male smoker, who was presented with an anterior STEMI. The coronary angiography demonstrated a significant lesion in the left main coronary (LMC) and an occlusion of the left anterior descending artery (LAD), and was referred for surgery. Four days later, he experienced symptoms of acute ischemia of the inferior territory. A newly formed culprit lesion of the circumflex artery (Cx) was detected and benefited from angioplasty. The patient expired the next day from sudden arrythmia. This case report shows two consecutive STEMI situations in separate coronary arteries, which commonly can occur in atherosclerotic patients with very poor prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Agoumy et al.)

Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)

Introduction and Importance: Amyloidosis is an infiltrative multisystem disease due to extracellular deposition of fibrils in tissues and organs. Cardiac involvement can result in progressive heart failure, conduction abnormalities and arrhythmias and is associated with a poor prognosis. Atrial arrhythmias and non-sustained ventricular arrhythmias are the most common arrhythmias in cardiac amyloidosis. However, the association of sinus node dysfunction and sustained ventricular arrhythmia is quite exceptional., Case Presentation: A 59-year-old male patient was admitted with a gradually worsening dyspnea with a lipothymic discomfort. Upon emergency department, an initial electrocardiogram revealed a severe bradycardia related to a sinus node dysfunction. A transthoracic echocardiography and cardiac magnetic resonance imaging showed features suspicious for cardiac amyloidosis. The diagnosis of AL cardiac amyloidosis with multiple myeloma was confirmed based on histological evidence. During hospitalization, the patient presented a sustained unstable ventricular tachycardia which has been converted by electrical cardioversion. He was treated with an implantable cardioverter-defibrillator (ICD) for secondary prevention with one episode of appropriate therapy. Unfortunately, the patient died few weeks later., Clinical Discussion: The AL subtype of cardiac amyloidosis is associated with higher rates of arrhythmias, especially VT. The management of arrhythmias in cardiac amyloidosis is complex and remains challenging given the lack of evidence. ICD was not associated with longer survival; these findings underscore the importance of careful patient selection for ICD., Conclusion: As prognosis improves with the advances made in the medical treatment of cardiac amyloidosis, further studies are required to guide the management of all types of arrhythmias in cardiac amyloidosis., Competing Interests: All the authors declare that they have no competing interests., (© 2022 The Authors.)

Introduction and Importance: Lead dislodgement syndromes (Twiddler, Ratchet or Reel syndromes) are rare causes of cardiac stimulation device malfunction that can occur most commonly early after device implantation. Each one of them associated with a unique pattern of lead coiling and dysfunction. Our clinical case reports an unusual association and shed the light on the available diagnostic modalities., Case Presentation: A 62-year-old woman who was referred to our hospital for a symptomatic high degree AV block, she underwent dual chamber pacemaker implantation. She experienced 3 weeks following implantation a rhythmic twitching of the right arm without syncope. The device interrogation revealed an increase in both leads pacing impedance and chest X-ray showed leads had pulled out of the heart and were tangling and wrapped repeatedly around the pulse generator. Revision procedure was performed to reposition the leads., Clinical Discussion: Recognizing this complication early can prevent life threatening complication and is then of the utmost importance. Twiddler's syndrome is due to rotation of the device along its long axis. Reel syndrome is produced by device rotation along the transverse axis. In most cases, lead replacement or reposition is needed. Preventive measures such as patient education and use of a smaller pocket will reduce the risk of developing the syndrome., Conclusion: Our case highlights the available diagnostic modalities for early detection of twiddler's syndrome. The unique nature of this case increases the importance of considering device lead dislodgement as the cause for patients presenting with extra-cardiac symptoms., Competing Interests: All the authors declare that they have no competing interests., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Persistent left superior vena cava (PLSVC) is a rare anomaly of the systemic venous circulation. We report the case of a 22-year-old female that had history of multiple repair surgeries for her esophageal atresia, as well as a right lobectomy for bronchiectasis 15 years prior. She was admitted to the surgical ward for complete resection of the right lung. A trans-thoracic echocardiography was performed as part of the pre-surgical work-up and it revealed a dilated coronary sinus which led us to suspect the presence of a PLSVC. The latter was confirmed by a simple "Bubble study" and confirmed by CT angiogram. We will discuss throughout this paper, the clinical and radiological features, as well as the embryology of this anomaly, so that the knowledge of the existence of this anatomical variant, especially if surgery or catheterization is at reach of the medical team, may lead to avoid serious complications., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Libman-Sacks endocarditis is an uncommon cardiac manifestation of lupus, characterized by noninfective heart valve vegetations. Most patients are asymptomatic. However, clinical manifestations of acute forms can mimic infectious endocarditis and complicate both differential diagnosis and treatment. We here report the case of a 28-year-old female patient with lupus erythematosus followed up from 2018. She had signs and symptoms supporting the diagnosis of infective endocarditis. Assessments allowed for the diagnosis of superinfection Libman-Sacks endocarditis. The patient died despite the combination of bi-antibiotic therapy and corticosteroids., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Nuance Divine Tchiloemba Tchibinda et al.)

Rheumatic mitral stenosis is the most common organic valvular heart disease in developing countries. These patients are at risk of decompensation during pregnancy. We here describe our experience with percutaneous dilation of mitral stenosis in patients with severe pulmonary hypertension during pregnancy. Percutaneous balloon mitral valve commissurotomy was performed in two hundred and twenty-three pregnant women between January 2009 and December 2015. Forty-three (19%) of these patients had severe pulmonary hypertension (SPAP > 70 mmHg). All pregnant women in our study had very severe symptomatic rheumatic mitral stenosis despite well-performed medical treatment. All patients had clinical improvement after percutaneous balloon mitral valve commissurotomy. The severity of mitral insufficiency progressed by one grade in two patients. One patient had tamponade with favorable outcome after a pericardial puncture. No abortion occurred after the procedure and two preterm deliveries were reported. Patients with severe rheumatic mitral stenosis during pregnancy should receive multidisciplinary care involving an obstetrician, anesthetist and cardiologist. Percutaneous balloon mitral valve commissurotomy is currently the standard treatment for rheumatic mitral stenosis during pregnancy., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Fatima Azzahra Benmessaoud et al.)

Arythmogenic right ventricular dysplasia (ARVD) was supposed to be a part of VHL diseases; ARVD is in fact a well defined anatomo-pathological entity, originally described by Fontaine and Frank in 1977. The authors report 4 new cases of ARVD were desmitted at the department of cardio A. The disease was announced by the usual rhythmic disorders. The diagnostics of ARVD was based upon a bundle of electrical, echocardiographic and histological arguments. The rhythmic stability was obtained in three cases with medical treatment, the endocavity ablation was necessary in one case. A study of the diagnostic and therapeutic forms is performed from a literature review.

The first case of chronic cardiac toxicity due to an antimalarial agent was reported in 1971 and since then several cases of heart failure, restrictive cardiomyopathy or atrioventricular block have been ascribed to this family of drugs. We report the case of a 43-year-old woman who developed juvenile chronic arthritis at the age of ten, followed in adulthood by sero-positive rheumatoid arthritis. In 1980 she was put under chloroquine sulfate (hydroxychloroquine was not available) in a dose of 200 mg/d (152.66 mg of chloroquine), with 10 mg/day of prednisone. She developed myalgia and increased skin pigmentation, but disregarded recommendations that these symptoms required discontinuation of chloroquine therapy. She was lost to follow-up, but continued the chloroquine therapy of her own accord. In December 1993, she developed a third-degree atrioventricular block with syncopes requiring implantation of a pacemaker. The rare but well-documented myopathy induced by antimalarial agents can produce early severe lesions of the cardiac muscle, which may have a predilection for the interventricular septum, explaining the risk of atrioventricular block. Although histologic studies were not performed in our patient, the clinical evidence of toxicity, absence of underlying heart disease and fairly young age of the patient pointed to chloroquine toxicity. Periodic cardiac investigations including electrocardiography may be warranted in patients under antimalarial therapy.

Between 1983 and 1991, 86 cases of ventricular tachycardia (VT) resistant to antiarrhythmic therapy were treated by endocardious catheter fulguration: there were 21 cases of right ventricular dysplasia (RVD), 35 chronic myocardial infarctions (MI), 11 dilated cardiomyopathies (DCM), 10 bundle branch VT, 5 idiopathic septal VT, 3 operated Fallot procedures, 1 Ebstein's anomaly. There were 69 men and 17 women aged 14 to 76 years (average 45 +/- 18 years). The ejection fraction was under 30% in 37 cases. Forty-five VTs were permanent or recurred several times daily; 6 were inducible despite drug therapy and 35 patients had monthly recurrences. A total of 141 different forms of VT were treated in 133 procedures. One session was sufficient in 49 cases; 2 sessions were required in 29 cases; 3 sessions in 6 cases and 4 sessions in 2 cases. A total of 480 DC shocks were delivered with energies of 160 to 300 joules. The CPK-MB levels were 37 +/- 30 i.u./l. The following complications were observed: 7 perioperative deaths, 2 cardiac tamponades requiring surgical drainage, 1 permanent AV block, 5 reversible left ventricular failures. Follow up concerned 79 patients: 5 were followed up for less than 3 months with death occurring from cardiac failure which had been present before the ablation procedure without recurrence of VT. Seventy-four patients were followed up from 3 to 111 months (56 +/- 33 months). Thirty-two patients were without any antiarrhythmic therapy and had no recurrence of VT. Two of these patients developed a different form of VT 2 and 6 years after the catheter ablation.(ABSTRACT TRUNCATED AT 250 WORDS)