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1. Neonatal cardiogenic shock revealing obstructive cardiac Hibernoma: case report

Author

Rym Gribaa, Marwen Kacem, Sami Ouannes, Wiem Majdoub, Houssem Thabet, Imen Ben Ali, Aymen Elheraiche, Mehdi Slim, Sihem Hmissa, Elyes Neffati, Taieb Cherif, Chokri Kortas, Jamli Marah, and Sofiene Jerbi

Subjects
Cardiac tumors, Pediatric cardiology, Cardiac surgery, Hibernomas, case report, Surgery, RD1-811, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background Cardiac Hibernomas are very rare benign tumors and usually remain asymptomatic. Neonatal cardiogenic shock due to cardiac tumors is extremely very rare. Until this date a few cases of cardiac hibernoma have been reported in the literature. Transthoracic echocardiography help in the differential diagnosis, but the definitive diagnosis is histological. The management strategy is not clearly codified. The Aim is to report and discuss the clinical features of a cardiac Hibernoma and review the relevant literature. Case presentation We describe a case of a 2-day-old Caucasian full-term male neonate admitted in neonate intensive care with cardiogenic shock, having fluid resuscitation and inotropic drugs. Ventilatory support was started immediately with the subsequent reestablishment of normal blood pressure. Then he was transferred to the echocardiography laboratory. Transthoracic echocardiography showed two echogenic masses in the right atrium and right ventricle. The masses were extended to the pulmonary trunk. Pulmonary artery flow measurements showed the presence of pulmonary and tricuspid obstruction. Surgery was rapidly considered since the baby was hemodynamically unstable. Intraoperative evaluation showed a mass embedded in the interventricular septum that occupy the right ventricular cavity and the right atrium. The tumor involved also the chordae of the tricuspid. Partial resection was done. Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The specimen was sent for histopathological analysis. The baby died immediately after surgery. Histological examination of the surgical specimen revealed clear multivacuolated cells filled with lipid droplets and granular intense eosinophilic cytoplasm which confirms the diagnosis of Hibernoma. Conclusion Cardiac Hibernomas are rare benign tumors. The prognosis and treatment strategy is closely dependent on the location, initial clinical presentation and possible complications. The prognosis can be unfavorable if the tumor was obstructive and infiltrate the myocardium.

Published
2021
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2. Abstracts of the Tunisian Society of Cardiology and Cardiovascular Surgery congress, STCCCV 2021

Author

Afef, Ben Halima, Hichem, Aouina, Agnès, Hamzaoui, Leila, Gharbi, Nawel, Chaouech, Besma, Dhahri, Hédia, Ghrairi, Sarah, Maazaoui, Imen, Sahnoun, Amani, Ben Mansour, Sabrine, Louhichi, Jihen, Ben Amar, Redha, Lakehal, Emna, Allouche, Habib, Ben Ahmed, Mohamed Selmen, Aissa, Marwa, Fathi, Feten, Boudiche, Hakim, Ben Jemaa, Mohamed, Béji, Wejdène, Ouechtati, Leila, Bezdah, Mohamed Aymen, Ben Abdessalem, Khalil, Cheikh Sidiya, Ahmed Fekih, Romdhane, Zied, Ben Ameur, Hamza, Mosrati, Fares, Ammar, Hatem, Bouraoui, Samia, Hajri, Abdallah, Mahdhaoui, Gouider, Jeridi, Khaoula, Nasser, Aymen, Elhraiech, Marouen, Kacem, Mohamed Ali, Tekaya, Ayoub, Meddeb, Khaldoun, Ben Hamda, Faouzi, Maatouk, Oussema, Wachem, Saoussen, Antit, Ridha, Fekih, Cyrine, Antit, Elhem, Boussabah, Moez, Thameur, Lilia, Zakhama, Soraya, Ben Youssef, Marwa, Ben Doudou, Sofien, Kamoun, Imtinene, Ben Mrad, Fathia, Ben Moussa, Sana, Fennira, Khedija, Mzoughi, Ihsen, Zairi, Sondes, Kraiem, Yosra, Messaoudi, Marwa, Ben Abdallah, Oumaima, Ghabi, Nejeh, Ben Halima, Sobhi, Mleyhi, Tarek, Sandi, Rim, Miri, Tesnim, Besbes, Faker, Ghédira, Skander, Ben Omrane, Raouf, Denguir, Mariem, Drissa, Asma, Brahim, Essia, Mousli, Cyrine, Ousji, Hassen, Abou Nada, Asma, Bouslimi, Amani, Merdassi, Oumaima, Taher, Habiba, Drissa, Wael, Yaakoubi, Manel, Ben Hlima, Bassem, Rekik, Med Amine, Soula, Fourat, Zouari, Slim, Boudiche, Fathia, Mghaieth, Sana, Ouali, Mohamed Sami, Mourali, Karima, Taamallah, Mariem, Abid, Nadhem, Hajlaoui, Aabdedeyem, Haggui, Wafa, Fehri, Moslem, Ben Abdallah, Fares, Azaiez, Nour, Cherif, Fakher, Jaoued, Rami, Tlili, Youssef, Ben Ameur, Ali, Khorchani, Zineelabidne, Ben Ali, Ala Eddine, Dali, Sami, Milouchi, Amine, Boufares, Iheb, Ben Krayen, Hichem, Mtimet, Mohamed Ghassen, Ben Haj Mbarek, Oussama, Bouhamed, Safa, Dardouri, Rym, Gribaa, Imen, Ben Ali, Mehdi, Slim, Elyess, Neffati, Emna, Damak, Chaker, Jaber, Taieb, Cherif, Mouna, Bousnina, Amine, Jemel, Sofiane, Jerbi, Yassine, Marzouki, Syrine, Neji, Mohamed, Beji, Imene, Chaabene, Soumeya, Tahri, Malek, Kechida, Syrine, Daada, Sonia, Hammami, Wajih, Ben Abdallah, Rim, Klii, Ines, Khochtali, Emna, Rekik, Marwa, Abdelhedi, Neji, Lahbib, Dorra, Aouadi, Souha, Abid, Boutheina, Besbes, Zeineb, Oumaya, Noufeil, BelKahla, Ibrahim, Arbaoui, Fatma, Daoued, Hela, Jebali, Ella, Lahmaier, Emna, Chaabouni, Mariem, Hajji, Mohamed Karim, Zouaghi, Maroua, Abdallah, Souheil, Mlayah, Yassine, Selmi, Hibar, Idriss, Jamel, Ahmed, Oumeima, Brahim, Elyes, Turki, Raja, Ghzel, Khalil, Ouaghlani, Kaouthar, Hakim, Amine, Boussema, Houda, Ben Arbia, Sana, Said, Hela, Msaad, Fatma, Ouarda, Roueida, Khalifa, Ghada, Hamila, Syrine, Triki, Sawsen, Ataoui, Asmaou, Keita, Rihab, Ben Othman, Houda, Ghardallou, Rahma, Karmous, Mouad, El Bardi, Chiraz, Lassoued, Lilia, Laadhar, Yassine, Khadhar, Fatma, Aouini, Melek, Ben Mrad, Nabil, Ben Romdhane, Sana, Hamdi, Sarra, Chenik, Yassine, Jabloun, Amira, Talhaoui, Houaida, Mahfoudhi, Mariem, Ghardallou, Aymen, Noamen, Haythem, Raddaoui, Chedia, Chourabi, Amani, Amorri, Houssem, Boukhili, Ahlem, Khannouch, Molka, Louati, Hassan, Alzain, Achref, Hamdani, Sabrine, Bousnina, Zeineb, Ajra, Refaat, Gheni, Riadh, Ben Hmida, Taha, Ounissi, Zied, Ibn Elhadj, Wafa, Fekih, Maha, Ben Yedder, Wafa, Medi, Jamel, Elghoul, Afef, Ben Dayekh, Bechir, Ben Radhia, Khawla, Nasser, Haifa, Mtir, Chokri, Kortas, Imene, Mgarrech, Marah, Jamli, Hela, Kaddour, Nouha, Mekki, Imene, Amamou, Assil, Achour, Sami, Ouannes, Sameh, Ben Farhat, Abdelaziz, Jaouadi, Saeb, Ben Saad, and Rim, Letaief

Subjects
Cardiovascular Diseases, Cardiology, Humans
Published
2022

3. Transcatheter closure of residual Gerbode defect after aortic valve replacement surgery

Author

Mehdi Slim, Nouha Mekki, Sami Ouannes, and Elies Neffati

Subjects
Cardiology and Cardiovascular Medicine
Abstract

A 42-year-old man with a history of surgically repaired coarctation of the aorta presented with a refractory right heart failure. Echocardiography revealed a calcified bicuspid aortic valve both regurgitant and stenotic and a defect within the membranous septum with left to right shunt from the left ventricle (LV) to the right atrium. The patient was referred to surgery for an aortic valve replacement and closure with patch repair of the Gerbode type defect. Post-operative course was complicated by refractory heart failure with a persistent left to right shunt through the defect due to loose sutures. Taking into account the high surgical risk, percutaneous closure of the defect was decided. An Amplatzer Duct Occluder (St Jude Medical, USA) I device was successfully released within the defect. The patient was completely asymptomatic on follow-up.

Published
2022

4. Trans-Catheter Closure of Patent Ductus Arteriosus, which device should we use?

Author

Rym, Gribaa, Sami, Ouannes, Heithem, Tangour, Sameh, Ben Farhat, Houssem, Thabet, Mehdi, Slim, Aymen, Elheraiche, and Elyes, Neffati

Subjects
Cardiac Catheterization, Catheters, Treatment Outcome, Child, Preschool, Humans, Ductus Arteriosus, Patent
Abstract

Despite the operational experience in the percutaneous closure of Patent ductus arteriosus (PDA), complications can arise during the procedure. To overcome these complications the choice of the device must be adapted to each patient.To report the experience of the cardiology department in the transcatheter device closure of PDA and to determine the influencing factors of choice of the device.Our study included patients with patent ductus arteriosus that are admitted for transcatheter closure, between September 2003 and June 2016.One hundred and fifty-three patients were included in our study. Transcatheter closure was not done in 9 cases. The transcatheter closure was successful in 140 patients. The complications were observed in 11 patients that includes device embolization in 3 cases, aortic protrusion in four cases pulmonary protrusion in three cases and inguinal hematoma in one another. Three predictive factors of complications were: age2 years, tubular PDA type C and ratio duct diameter/weight0.95. A mild residual shunt was observed at the end of the procedure in 22.85 % of the patients. The risk of residual shunt was significantly increased when the age2 years, the large PDA, the presence of pulmonary hypertension and the tubular C PDA.The choice of the device depends essentially on age, the weight and the duct anatomy.

Published
2022

5. Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study

Author

Hanene Charfeddine, Khaled Ben Jemaa, Fares Azaiez, Achraf Gargouri, Selma Charfeddine, Sabeur Mnif, Tawfik Kateb, Karim Bejjar, Leila Bezdah, Mohsen Ben Jemaa, Sana Fennira, Chiheb Hamza, Abdelkader Maalej, Moufid Hadrich, Bassem Rekik, Sami Marouene, Amin Bahloul, Souad Mallek, Yassine Ellouz, Rania Hammami, Walid Jomaa, Mohamed Aymen Ben Abdessalem, Bassem Jerbi, Nizar Saadaoui, Faycal Elleuch, Slim Boudiche, Jamel Langar, Leila Abid, Zahreddine Smiri, Samir Kammoun, Amine Amara, Faouzi Maatoug, Sami Ouannes, Habib Ben Ahmed, Wafa Fehri Siala, Tarek Ellouz, Maher Sahnoun, Faouzi Drissi, Abdeljelil Farhati, Sondes Kraiem, Chedly Abbassi, Ahmed Siala, Nejeh Ben Hlima, Sami Fourati, Zied Ibn Bel Hadj, Amir Zouari, Mohamed Akrem Drissa, Tarek Ben Chedli, Amin Hadiji, Mariem Dghim, Elyes Kharrat, Rami Tlili, Majed Hassine, Nidhal Bouchahda, Kais Battikh, Elyes Nafati, Mokdad Ayari, Morched Hadrich, Rym Gribaa, Nebil Hamrouni, Yamen Maazoun, Hichem Denguir Denguir, Nabil Marsit, Salem Kachboura, Hassen Hadj Amor, Salem Abdesselem, Hatem Bouraoui, Sofiene Zayed, Hedi Ben Slima, Mohamed Hmem, Kamel Kamoun, Gouider Jeridi, Zeineb Grati, Khaldoun Ben Hamda, Helmi Ben Salem, Wacef Ayadi, Mostari Gharbi, Fatma Boujelben Masmoudi, Slim Chtourou, Youssef Ben Ameur, Mohamed Sahnoun, Habib Gamra, Imtinen Ben Mrad, Ahmed Jamel, Imen Gtif, Helmi Kamoun, Mohamed Sami Mourali, S. Milouchi, Abdallah Mahdhaoui, L. Zakhama, Lobna Laroussi, Sabri Maaoui, Morched Marouene, F. Addad, and Aymen Noamen

Subjects
Protocol (science), medicine.medical_specialty, business.industry, medicine.medical_treatment, Emergency medicine, Medicine, Percutaneous coronary intervention, Observational study, General Medicine, business
Abstract

Background Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. Objective The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. Methods We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. Results In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial Registration Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID) RR1-10.2196/24595

Published
2022

6. Prevalence and factors associated with spontaneous closure of congenital ventricular septal defects

Author

Sameh, Ben Farhat, Mehdi, Slim, Aymen, ElHraiech, Rym, Gribaa, Imene, Ben Ali, Houda, Ghardallou, Rym, Letaief, Houceme, Thabet, Sami, Ouannes, and Elies, Neffati

Subjects
Heart Septal Defects, Ventricular, Male, Time Factors, Remission, Spontaneous, Infant, Newborn, Infant, Child, Preschool, Prevalence, Humans, Female, Heart Aneurysm, Child, Follow-Up Studies, Retrospective Studies
Abstract

Most of congenital ventricular septal defects evolve towards spontaneous closure of different mechanisms depending on their location.To determine the prevalence and factors associated with spontaneous closure of congenital ventricular septal defects.We conducted a retrospective study of 1000 patients diagnosed with congenital ventricular septal defects in our department from January 2000 to December 2017.After an average follow-up of 52.65 months (± 76.93 months), 183 (18.88%) of ventricular septal defects closed spontaneously. The average time for spontaneous closure was 45.78 months (76.34 months). 30.77% of trabecular ventricular septal defects (p0.05) and 16.93% of perimembranous defects closed spontaneously (p=0.17). 28.5% of perimembranous defects associated with aneurysm formation versus 17.4% of those without associated aneurysm evolved to spontaneous closure (p0.05). 65.6% of spontaneous closure occured during the first 3 years of life. In multivariate analysis, trabecular site [OR=2.85; CI (2.05-3.97)] and aneurysms of membranous septum [OR=1.9; CI (1.41-2.8)] were independent factors associated with spontaneous closure of defects.The highest VSD closure rate was observed during the first three years of life. Trabecular site and aneurysms tissue of membranous septum were found as independent factors associated with spontaneous closure.

Published
2021

7. Design and Rationale of the National Tunisian Registry of Percutaneous coronary Intervention: Protocol for a Prospective, Multicenter Trial (Preprint)

Author

Rania Hammami, Slim Boudiche, Rami Tlili, Nejeh Ben Hlima, Ahmed Jamel, Bassem Rekik, Rym Gribaa, Imtinen Ben Mrad, Selma Charfeddine, Tarek Ellouz, Amin Bahloul, Hedi Ben Slima, Jamel Langar, Habib Ben Ahmed, Zied Ibn Bel Hadj, Mohamed Hmem, Mohamed Aymen Ben Abdessalem, Sabri Maaoui, Sana Fennira, Lobna Laroussi, Majed Hassine, Sami Ouannes, Faouzi Drissi, Souad Mallek, Abdallah Mahdhaoui, Mariem Dghim, Walid Jomaa, Sofiene Zayed, Tawfik Kateb, Nidhal Bouchahda, Fares Azaiez, Helmi Ben Salem, Morched Marouene, Aymen Noamen, Salem Abdesselem, Hichem Denguir Denguir, Hassen Hadj Amor, Abdeljelil Farhati, Amine Amara, Karim Bejjar, Khaldoun Ben Hamda, Chiheb Hamza, Mohsen Ben Jemaa, Sami Fourati, Faycal Elleuch, Zeineb Grati, Slim Chtourou, Sami Marouene, Mohamed Sahnoun, Morched Hadrich, Abdelkader Maalej, Hatem Bouraoui, Kamel Kamoun, Moufid Hadrich, Tarek Ben Chedli, Mohamed Akrem Drissa, Hanene Charfeddine, Nizar Saadaoui, Achraf Gargouri, Ahmed Siala, Mokdad Ayari, Nabil Marsit, Sabeur Mnif, Maher Sahnoun, Helmi Kamoun, Khaled Ben Jemaa, Mostari Gharbi, Nebil Hamrouni, Yamen Maazoun, Yassine Ellouz, Zahreddine Smiri, Amin Hadiji, Bassem Jerbi, Wacef Ayadi, Amir Zouari, Chedly Abbassi, Fatma Boujelben Masmoudi, Kais Battikh, Elyes Kharrat, Imen Gtif, Sami Milouchi, Leila Bezdah, Salem Kachboura, Faouzi Maatoug, Sondes Kraiem, Gouider Jeridi, Elyes Nafati, Samir Kammoun, Youssef Ben Ameur, Wafa Fehri Siala, Habib Gamra, Lilia Zakhama, Faouzi Addad, Mohamed Sami Mourali, and Leila Abid

Subjects
cardiovascular diseases
Abstract

BACKGROUND Coronary diseases remain the first cause of death in the world; the management of this condition has improved, thanks to new technical tools and multicentric registries. Recently in Tunisia, the number of intervention procedures has markedly increased, giving the explosion of cardiovascular risk factors among Tunisian people. OBJECTIVE The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI) in Tunisia. METHODS We will conduct a prospective, multicentric, observational study including patients > 18 year-old who underwent a PCI between 31January and 30 June 2020. The primary end point are the occurrence of a major adverse cardiovascular event , defined as cardiovascular death, myocardial infarction, cerebrovascular accident, and target vessel revascularization with either repeat PCI or coronary artery bypass surgery (CABG). Secondary end-points consist in procedural success rate, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. RESULTS Results will be available at the end of the study as well as the demographic profile and general risk profile of Tunisian patients undergoing PCI. The complexity level of procedures, as left main, bifurcation, chronic occlusion PCI will be analyzed and immediate as well as long term results will be determined. NATURE-PCI will be the first national multicentric registry of angioplasty in Africa. CONCLUSIONS This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of contemporary coronary artery disease in this developing region. CLINICALTRIAL clinicaltrials.gov

Published
2020

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