[Epidemiologic and clinical features of congenital heart diseases in children at the Bizerta Hospital]. / Profil épidémiologique et clinique des cardiopathies congénitales chez l'enfant à l'Hôpital de Bizerte.

UNLABELLED: The aim of this study is to establish the epidemiologic profile of congenital heart disease in newborns in a Tunisian department of the north west of Tunisia. METHODS: We report 79 cases of congenital heart defects treated which are followed up in the department of general paediatrics in the University Hospital of Bizerta during 9 years. The informations concerning the patients is taking to a data file. The newborns included had a congenital heart disease suspected clinicly or confirmed by a cardiac echography. RESULTS: The sex-ratio was 0,79 with a mean of weight birth of 3075 g. The prematurity reaches 20.1%. The consanguinity was 30.5%. Congenital heart defects were detected the first week of life in 47% with a murmur on 77.6%, cyanosis on 70%, dyspnea on 89%. The annual incidence was evaluated 2.5% per hundred. One hundred and Twelve heart defects were diagnosed. The medical treatment was indicated on 46.3% and the surgery on 22.5%. Mortality was on 23.8%. CONCLUSION: Congenital heart disease particularly in neonatal period are crippled by a high morbidity and mortality, it's a case of emergency in pediatric cardiology.

[Relevant factors in mitral valve reconstructive surgery. Report of 150 cases]. / Les facteurs determinants dans la chirurgie reconstructrice de la valve mitrale. A propos de 150 cas.

150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years, 39% were less than 15 years of age. 60% of the patients were in Class II NYHA and 40% in Class III and IV. According to Carpentier's classification, isolated type I was present in 18 patients (12%), type II in 98 patients (64%) and type III in 34 cases (24%). Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6% (4 patients). All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients (92%), grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients (8%). In the late post-operative period, three patients were lost to follow-up. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7% (10 patients). Out of 126 reviewed survivors on the long run, 71 patients (56%) are asymptomatic in class I, 53 patients (42%) in class II and 2 patients in class III NYHA. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.