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Introduction : Valvular disease is common in Morocco, frequently followed by a heart surgery. Cardiac rehabilitation can improve functional and cardio-respiratory capacities after valve surgery, joining training sessions, therapeutic education, and optimization. The present study features the results in Moroccan patients. The objective of the study is to confirm the hypothesis that cardiac rehabilitation is beneficial after valvular surgery. Methods : Its a retrospectivestudy made between November 2017 and January 2020 including40 patients after valvular surgery incardiac rehabilitation unit of cardiology centerof Mohamed V Military Hospital.All of them had aclinical examination, laboratory test, ECG, echocardiography, 6 minuteswalk test and test with VO2 max. Results :The average age was 45.6 ± 12.3 years with a male predominance.Regarding cardiovascular risk factors, we found sedentary lifestyle, smoking, dyslipidemia, hypertension, and diabetes.Echocardiography showed a preservedejection fraction (EF = 55.69 % ± 11.02 %).After 20 cardiac rehabilitation sessions, all patients improved their effort capacities.They increased the distance covered in6-minutes walk test from 500 to 545.7m, andstress test parameters from 82.5 ± 32.93 W to 100.2 ± 36.8 W for the load, from 32 ± 8.24 to 21.7 ± 9.8 ml/kg/min for the VO2 max and the training heart rate decreased from 111.5 bpm to 107.6 bpm (beats per minute). Conclusion :This study demonstrated that cardiac rehabilitation program is clearly beneficial in patients after valvular surgery by theimprovement of their functional and cardio-respiratory capacities.

Infectious endocarditis is an infrequent pathology but with a very significant morbidity and mortality context. The MostCommon responsible germs are streptococci and staphylococci.Neisseria is a strain of bacteria characterized by several subgroups such as gram-negative diplococci which are present in the respiratory tract and which are generally harmless and other gram-negative bacteria such as Neisseria gonorrhoeae which are known to be pathogens involved in several pathologies.We report a case of infectious endocarditis in 37-year-old patient with mitral valve replacement who presented a prolonged febrile syndrome with discovery on transesophageal echocardiography of vegetation and blood cultures of an SP Neisseria.

La Covid 19 est une maladie virale due au SARS-COV2 pouvant etre responsable dun syndrome grippal, dune pneumonie, mais egalement daccidents thromboemboliques aussi bien veineux (le plus souvent) quarteriels. Le cas que nous allons presenter est celui dun jeune homme de 48 ans diagnostique porteur de la covid 19, stable sur le plan respiratoire et ayant presente 2 complications thromboemboliques : un accident vasculaire cerebral ischemique et une embolie pulmonaire.

Residual atrial septal defect (ASD) is a rare complication after percutaneous closure of an ostium secundum atrial defect in eligible patients. Cardiac imaging, mainly transthoracic and transesophageal echocardiography is essential to establish the diagnosis. Surgical closure is the therapeutic strategy of choice. We present the case of a 54-year-old woman who presented with a residual left-to-right atrial shunt four years after percutaneous closure of an ASD ostium secundum. &nbsp

Cerebrovascular events are rare but devastating events that can complicate any coronary intervention. In the vast majority of cases, they involve major cerebral arteries. We report the case of a 56-year-old woman admitted for unstable angina associated with severe left systolic dysfunction. She developed moderate cerebellar stroke while undergoing percutaneous coronary intervention, with a national institutes of health stroke scale score of 5. Immediate systemic thrombolysis was performed, but her neurological status deteriorated. A large hemorrhagic transformation was then diagnosed, and she died despite surgical intervention. Periprocedural strokes are marred with high morbidity and mortality, therefore preventionis key, as many risk factors can be controlled or mitigated. Our patient presented many of these factors; they can be procedure-related (transfemoral approach, anticoagulation) or patient-related (age, diabetes mellitus, uncontrolled hypertension, diffuse atherosclerosis).

Infectious endocarditis is an infrequent pathology but with a very significant morbidity and mortality context. The MostCommon responsible germs are streptococci and staphylococci.Neisseria is a strain of bacteria characterized by several subgroups such as gram-negative diplococci which are present in the respiratory tract and which are generally harmless and other gram-negative bacteria such as Neisseria gonorrhoeae which are known to be pathogens involved in several pathologies.We report a case of infectious endocarditis in 37-year-old patient with mitral valve replacement who presented a prolonged febrile syndrome with discovery on transesophageal echocardiography of vegetation and blood cultures of an SP Neisseria. &nbsp

Cardiac metastases are uncommon in neuroendocrine tumors (NET). Features of patients with metastatic carcinoid tumor involving the heart have not been well described. Although carcinoid tumors have been described in almost every organ, few reported cases of confirmed cardiac involvement. The overall incidence of myocardial carcinoid metastases among patients with metastatic carcinoid disease is about 4%. There is limited knowledge on the prevalence, clinical presentation, and management of heart metastasis. The availability and increasing use of modern imaging techniques leads to more frequent discovery of rare metastatic sites. Our aim is to further clarify the clinical manifestations of heart metastasis, to increase the knowledge of rare localizations of NET metastasis and insist on the systematic screening of metastatic carcinoid heart disease as an integral part of the echocardiographic evaluation in patients with carcinoid syndrome. We report the case of a 67-year-old male with history of a low differentiated neuroendocrine tumor, presenting with palpitations and dyspnea and which investigations have led to diagnose myocardial metastasis signing the progression of the NETs.

International Journal of Advanced Research (IJAR)

Right heart thrombi can formin situor lodge in the right cardiac chambers, originating from deep venous thrombosis. The latter carries a poor prognosis, taking into account the very high mortality rate. We herein report a case of an 83-year-old man who developed thrombus in the inferior vena cava that extended up to the right atrium, along with two distinct masses attached to the right ventricle wall.

Background: The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (sarscov2), has been shown to cause conventional respiratory distress, in addition to that, there has been recent reports suggesting the cardiovascular system involvement during the course of the infection, including microthrombosis and cardiopulmonary serosal layers infection and inammation although being separately described. The present paper demonstrates the rst reported case of the concomitant presence of intra-cardiac free- oating microthrombi and pericardial effusion secondary to COVID-19 infection, beyond the casual clinical presentation. Case report :A 51 year-old man with no medical history, presented to the emergency department, with a progressively worsening dyspnea, he had an oxygen saturation of 85% on rst medical contact. The chest radiography and the baseline ECG showed respectively multifocal bilateral patchy opacities and a sinus tachycardia with low QRS voltage and t wave inversion in all leads. On further assessment, the echocardiography revealed the presence of free-oating microthrombi in the right atrium and a moderate pericardial effusion. Biological ndings and pulmonary computed tomography were suggestive of sarscov2 infection. Interestingly, there was no evidence of pulmonary embolism. The patient, thus, received heparin therapy and colchicine. We noted a rapid improvement in the following seven days, the hospital discharge was, hence, deemed warranted. Conclusions: This case highlights an unusual presentation of COVID-19 infection, the diagnostic and therapeutic challenges we are facing in this setting. Moreover, it raises the question about the emergent need of a therapeutic regimen, in order to better manage this unique condition and a fortiori mitigate the COVID-19 complications.

Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and secondary prevention measures. The aim of our study is to determinate the nutritional habits and obesity status of Moroccan patients in Cardiac Rehabilitation. Materials and methods It's a prospective study included 130 patients admitted in Cardiac Rehabilitation unit, Cardiology centre, Mohammed V Military Hospital, Rabat, Morocco, all of them had measured of weight, body mass index, waist size and evaluation of statements about nutrition habits such as consuming oily and sugary foods, salt use, liquid type of drinking daily, eating meat, consuming food sold outside and consuming foods made with fruits and vegetables. Results The average age of patients was 56,27 ± 8,1 years with male predominance (85%), they have more than three cardiovascular risk factors dominated by smoking and hypertension, they were overweight with 79,9 ± 11,1 kg, an average BMI (26,58 ± 7,4 kg/m2) and waist size at 99,7 ± 11,6 cm. Most of patients were eating 4 times a day, consuming more bread, oily and sugar foods, and eating meat more than three time a week. After 20 sessions of cardiac rehabilitation and dietetic sessions, patients stopped smoking, they have a best quality of life, they showed lower BMI (24, 04 ± 6, 3 kg/m2), they changed their nutritional habits, consuming less bread and meat and more fruits and vegetables. Conclusion This study demonstrated that cardiac rehabilitation is clearly benefit for patients to change their nutritional habits and having balanced diet to reduce their weight and being more healthy.

Objectives: To describe modes of clinical presentation and echocardiographic, angiographic, and rhythmic features, and prognostic characteristics of left ventricular noncompaction cardiomyopathy (LVNC) in North African adults, through one of the first series in Morocco. Background: LVNC is a rare congenital disorder, described for the first time by Engberding in 1984. The suspected diagnosis in thromboembolic, hemodynamic, or rhythm events requires both echocardiography and cardiovascular magnetic resonance (CMR). Its therapeutic management is not yet well codified but akin to that proposed for dilated cardiomyopathy. Patients and design: This study included a retrospective, descriptive, and analytical cohort of 23 cases of cardiomyopathy with LVNC diagnosed in the Noninvasive Explorations Laboratory at the Military Hospital of Rabat, Morocco, between January 2009 and October 2014. The echocardiographic criteria for LVNC include the absence of any coexisting cardiac anomalies. The characteristic appearance of numerous excessively prominent trabeculations and deep intertrabecular recesses and intertrabecular spaces filled by direct blood flow from the ventricular cavity, as visualized on color Doppler imaging with noncompacted/compacted ratio > 2 according to Jenni criteria. Twenty-three adults fulfilled the diagnostic criteria and were followed prospectively. Results: At diagnosis, the mean age was 47 ± 13 years with a male predominance at 65.2%. Of them, 56.5% had a left bundle branch block and 21.7% were in atrial fibrillation. Left ventricular end-diastolic diameter was 67.7 ± 6.6 mm and ejection fraction was at 27 ± 8%. Apex and/or midventricular segments of both the inferior and lateral wall were involved in more than 80% of patients with an average of 4.8 noncompacted segments. CMR was performed in 12 patients and was decisive for the diagnosis. Major complications were heart failure in 31% of patients, ventricular tachycardia in three patients, and thromboembolic events in one patient. Twenty eight point six percent of patients started a long-term anticoagulant therapy. One patient underwent implantation of a double-room pacemaker. Automated defibrillators were implanted in two patients. There were three deaths: one sudden death and two end-stage heart failure. Conclusion: LVNC should be looked for at any dilated cardiomyopathy particularly in young patients. It requires a careful echocardiographic examination and sometimes CMR to confirm the diagnosis. It is characterized by severe systolic and diastolic dysfunction that would provide poor prognosis.

Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and therapeutic education. The aim of our study is to determinate the impact of exercise training in heart rate recovery of patients in cardiac rehabilitation. Materials and methods It's a prospective study included 132 patients admitted in Cardiac Rehabilitation unit, Cardiology centre, Mohammed V Military Hospital, Rabat, Morocco, all of them had clinical evaluation, echocardiography and cardio respiratory capacities evaluation. Results The average age of patients was 57.26 ± 8.2 years with male predominance, they have more than three cardiovascular risk factors dominated by smoking and hypertension, the average BMI is 26.58 ± 7.4 kg/m2, coronary artery disease is the most frequent, they had conserved ejection fraction (EF: 54 ± 9.3%). After 20 sessions of cardiac rehabilitation; patients stopped smoking, they have a best quality of life, they significantly recovered their heart rate; from 68.07 ± 11.4 to 65.28 at rest and from 118.24 ± 38.4 to 114.72 ± 35.05 at the effort (0.001), they improve the maximal work load (from 89.6 ± 35.9 watt to 116.2 ± 33.8 watt) and VO2max (from 21.1 ± 6.9 ml/kg/min to 25.7 ± 4.7 ml/kg/min). Conclusion This study demonstrated that exercise training is clearly benefit for patients to improve their exercise capacities and recover their heart rate.

Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and therapeutic education. The aim of our study is to evaluate the management of Moroccan Women compared to Men in cardiac rehabilitation. Materials and methods It's a prospective study included 156 patients, divided in 2 groups (group 1: 30 women and group 2: 126 men) admitted in Cardiac Rehabilitation Unit, Cardiology Centre, Mohammed V Military Hospital, Rabat, Morocco. All of them had clinical evaluation, echocardiography and cardio respiratory capacities evaluation. Results The average age of patients was (group 1: 59, 7 ± 7, 2 years and group 2: 57, 68 ± 6,7 years), they have more than three cardiovascular risk factors dominated by hypertension in group 1 and smoking in group 2, coronary artery disease is the most frequent etiology, women are overweight than men (BMI: 29,7 ± 4,3 kg/m2 in group 1 and 27,6 ± 3,2 kg/m2 in group 2). After 20 sessions of exercise training, therapeutic education and diet program, women have significantly lose weight (from 29,7 ± 4,3 kg/m2 to 26,8 ± 3,4 kg/m2) compared to men (from 27,6± 3,2 kg/m2 to 26,1 ± 2,6 kg/m2, two groups are significantly improve the maximal work load (from 87,6 ± 21,9 watt to 112,.2 ± 32,8 watt in group 1 and from 89,6 ± 23,9 watt to 116,.2 ± 33,8 watt in group 2) and VO2max (from 21,1 ± 4,9 ml/kg/min to 25,7 ± 5,7 ml/kg/min in group 1 and from 23,1 ± 4,9 ml/kg/min to 26,7 ± 6,7 ml/kg/min in group 2). Conclusion This study demonstrated that exercise training is clearly benefit for both men and women to improve their exercise capacities and quality of life.

Introduction The Diagnosis Center of Cardiology in Rabat welcomes patients from different regions of Morocco. The long-distance travel, difficulty of access to care in rural Morocco, To avoid this problem, we followed our patients by social messaging platforms, then judged the effectiveness of this method a year later. Materials and methods This is a prospective, comparative analytic study of 200 patients under oral anticoagulant therapy based on vitamin K antagonists (VKA), followed in cardiology consultation, all of whom come from rural areas where access to care is difficult. These 200 patients were followed during 1 year in consultation, 100 of them (group 1) in standard consultation according to the appointments elaborated by the computerized system of the Diagnosis Center. The other 100 (group 2) were followed, moreover, by their doctor via telephone. One year later, the patients of the 2nd group (group followed by telephone) were well anticoagulated most of the times with more frequent INR tests; 1305 INR performed by the 2nd group (1.09 per patient per month) compared with 500 INR by the 1st group (0.41 per patient per month). The number of complications was lower in the 2nd group as 5 patients presented a symptomatic overdose to anticoagulants and have evolved well, versus 12 for the 1st group, 4 of whom required hospitalization in the Intensive Care Unit for serious bleeding events, one of them has deceased and another had a hemostasis gastrectomy. Four patients in the first group had embolic events: 1 ischemic stroke with sequelae, 1 transient ischemic attack (TIA), and 2 prosthetic thromboses with one treated medically and the other surgically. Transportation expenses of the 2nd group were much smaller. Conclusion Health policy should consider telemedicine as a solution for a better management of the Moroccan population and as a solution for health problems in the framework of the citizen approximation initiative.

Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and secondary prevention measures. The aim of our study is to evaluate cardio respiratory efficiency in patients with coronary artery disease. Materials and Methods Its a prospective study included 110 patients with coronary artery disease (CAD) admitted in Cardiac Rehabilitation unit, Cardiology centre, Mohammed V Military Hospital, Rabat, Morocco, all of them had a clinical examination, an electrocardiogram, biological test, Echocardiography and Ergospirometry. Results The average age of patients was 57,29 ± 10,1 years with male predominance (87%), they have more than three cardiovascular risk factors dominated by smoking and hypertension, they were overweight with an average BMI (26,56 ± 7,3 kg/m2), clinical examination was normal and Transthoracic Echocardiography showed preserved left ventricular ejection fraction (EF: 51,87 ± 12,3%). After 20 sessions of cardiac rehabilitation, patients stopped smoking, they have a best quality of life, they showed lower BMI (24,04 ± 9,3 kg/m2), a significant higher maximal work load (from 101,13 ± 32,1 to 130,37 ± 41,7 watts, P = 0,01) and a significant higher VO2max (from 27,5 ± 5,1 to 35,16 ± 8,36 ml/kg/min, P = 0,02). Conclusion This study demonstrated that cardiac rehabilitation is clearly benefit for patients with coronary artery disease to improve their exercise capacity and reduce their cardio vascular risk factors.

Introduction Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and secondary prevention measures. The aim of our study is to evaluate the benefit of cardiac rehabilitation in Moroccan patients. Materials and Methods It's a prospective study included 70 patients admitted in cardiac rehabilitation unit, cardiology centre, Mohamed V military hospital in Rabat, Morocco. All of them had clinical examination, an electrocardiogram, echocardiography, biological test and Ergospirometry. Results The average age of patients is 56.57 ± 10.2 years, with male predominance, they have more than three cardiovascular risk factors dominated by hypertension and smoking, 70% of patients have coronary artery disease, the BMI was 25.8 ± 4.5 kg/m2, clinical examination was normal. Transthoracic Echocardiography showed preserved left-ventricular ejection fraction (56.1 ± 7.7%). After 20 sessions of cardiac rehabilitation, patients have a blood pressure in the target, they stopped smoking, they have a best quality of life, they have a significant improvement in the maximal work load, from 102.6 ± 38.4 to 133.3 ± 11.5 watt (P = 0,01) and a significant improvement in VO2max, from 27.8 ± 7.6 to 34.4 ± 9.8 mL/kg/min (P = 0.02). Conclusion This study demonstrates that cardiac rehabilitation is clearly benefit for patients, to increase their exercise capacity, to reduce their cardio vascular risk factors and to improve their quality of life.

Background Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. The presence of spontaneous echo contrast in the left atrium and left atrial appendage has been reported to be an independent predictor of thrombo-embolic risk in patients with mitral stenosis. The objective of this study was to retrospectively investigate various clinical and echocardiographic variables to predict the spontaneous echo contrast in these patients. Methodology This is a bicentric retrospective study which includes 159 cases of symptomatic mitral stenosis from January 2011 to June 2012. All of the patients had transthoracic and transesophageal echocardiography. Patients who had significant mitral regurgitation (> Grade I), significant aortic valve disease, previous mitral valvulotomy and anticoagulation or antiplatelet therapy were excluded from the study. Our study population was divided into two groups based on the presence (Group I) or absence (Group II) of spontaneous echo contrast. Result Left atrial spontaneous contrast was present in 34.6% of cases. Patients in this group have more frequent atrial fibrillation (P = 0.001), larger left atrial area (P = 0.027) and diameter (P=0.023), smaller mitral valve area (P = 0.025), and higher mean transmitral diastolic gradient (p = 0.003) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean age (p = 0.38), duration of symptoms (p = 0.4) and left ventricular ejection fraction (p = 0.7) between patients with and without spontaneous echo contrast. On multivariate analysis, only mitral valve area and transmitral diastolic gradient (OR: 18.753, 1.21, CI [1,838-191,332], [1,064-1,376], p: 0.013, 0.004, respectively) were found to be independently associated to the presence of spontaneous echo contrast. Conclusion Patients with severe rheumatic mitral stenosis in atrial fibrillation or sinus rhythm have a higher risk of developing spontaneous echo contrast. These patients might benefit from prophylactic anticoagulation. The long-term outcomes can be ascertained in a study over a longer period and with periodic follow-up.

Behçet's disease is a chronic autoimmune disease with vascular complications that are most frequently manifested as thromboembolism in veins and pseudoaneurysm in arteries. We report the case of a 13-year-old boy admitted for clinical and biological signs of rheumatic fever associated with chest pain. The clinical examination found heart sounds with a discrete systolic murmur of mitral regurgitation. The electrocardiogram showed a microvoltage with diffuse repolarisation disorder. Biologically, he had inflammatory syndrome. Transthoracic echocardiography showed circumferential pericardial effusion with anterosepto-apical hypokinesia of the left ventricle with systolic dysfunction, and a minimal mitral regurgitation. The patient was treated by corticotherapy and antibiotherapy. The outcome was marked by orogenital aphthous ulceration and decreased visual acuity related to intermediate uveitis. The retinal angiography showed a vasculitis. The late appearance of this symptom led to the right diagnosis of Behçet's syndrome. Transthoracic echocardiography showed a hypokinetic dilated cardiomyopathy left ventricular with septo apical and anterior akinesia and severe systolic dysfunction, with a defect of the inferior septal with a collar communicating the left ventricle with a giant pseudo aneurysm. Magnetic resonance imaging showed a giant pseudoaneurysm communicating with the left ventricle. The coronary computed tomography was normal. The patient had undergone surgical treatment for the pseudoaneurysm with good outcomes.

Double orifice mitral valve is a rare congenital anomaly presenting as the division of the mitral orifice into two anatomically distinct orifices, it is most often associated with other congenital heart defects such as left-sided obstructive lesions, ventricular septal defects or aortic coarctation. We report the case of a 15 year’s old boy, admitted for arterial hypertension, auscultation revealed a rude aortic systolic murmur. Femoral pulses were weak. Owing to the suspicion of aortic coarctation, transthoracic echocardiography was performed, the aortic coarctation with dilation of the aorta proximal to the stenosis was confirmed and bicuspid aortic valve was found with good function. The mitral valve was dysmorphic, having two orifices; it was divided into 2 separate valve orifices by a fibrous bridge. No mitral or aortic regurgitation was documented by color Doppler flow imaging. The left ventricular ejection fraction was normal. There was a small peri membranous ventricular septal defect with left to right shunt. Owing to the severity of the aortic coarctation and taking into account the anatomy and characteristics of the patient, he was made a surgical correction of aortic coarctation with good outcome.

Myxoma is the most common primary tumor of the heart and can arise in any of the cardiac chambers. This paper reports A 50 -year-old woman without medical history and any cardiovascular risk factors was hospitalized for exertional dyspnea and palpitations from three months and signifiant weight loss. Transthoracic echocardiogram showed a giant left atrial myxoma mobile confined to the left atrium in systole, in diastole the tumor was seen prolapsing across the mitral valve into the left ventricle and partially obstructing it and causing severe functional mitral stenosis with a mean gradient of 21,3 mmHg. Severe pulmonary hypertension was confirmed by Doppler PAPs =137 mmHg. The patient was scheduled for cardiac surgery with good outcome.