Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou.

Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology.

[Protein C deficiency in black African with venous thromboembolism in Cotonou, Benin]. / Étude du déficit en protéine c dans la maladie thromboembolique veineuse au CNHU de Cotonou : étude réalisée chez 54 patients noirs africains vivant à Cotonou.

The aim of this study is to evaluate the frequency of protein C deficiency in venous thromboembolism in black African patients of Benin. It is a descriptive study. Inclusion criteria were: acceptance- having a venous thromboembolism. No exlusion criteria was retained. Protein C deficiency was diagnosed by quantitative technic with a Minividas materiel in the blood. Protein C dosage has been done before antivitamin k therapy and a second dosage has been done if the first one demonstrated a low level of protein C. Acuired aetiology have been research. For the 54 patients of this study mean age was 52.7±14.1 and sex-ratio 1.08. The frequency of protein C deficiency was 9.3% in all patients and 12.5% in those with clinical thrombophily (p=1). No acquired deficit has been found.

[Cardiovascular risk evolution in patients treated for high blood pressure at the Armies Instruction's Hospital of Cotonou]. / Évolution du risque cardiovasculaire des patients traités pour HTA à l'hôpital d'instruction des armées de Cotonou.

UNLABELLED: This study was initiated to determine the progression of the cardiovascular risk (CR) in a 5-years period for those who went through high blood pressure treatment. It is a retrospective and descriptive study over a period of 9 years. Were included in that category, African patients treated in that period of time and who at least benefited from a 5-years medical care period. The total CR was calculated afterwards, for the needs for the study, using the tables of Framingham. All the data were collected after the first evaluation then brought up to date at the terms of 1, 3 and 5 years and with a last consultation for the patients whose medical care follow-up exceeded 5 years. For the 103 patients who had complete data, the average age was of 49.11±8 and the sex ratio of 2. Among them 14 (13.6%) died of cardiovascular complications. Among the 89 remaining patients, the CR at the beginning was very high in a proportion of 10.1%, high in 49.4%, moderated in 22.5% and weak in 18%. The general evolution is characterized by a stability of the proportion of the moderated CR (20 - 23%) and high CR (43 - 50%) but a very important increase in the proportion of the very high CR (10 to 21%) to the detriment of the weak CR (18 to 10%). The analysis of the individual evolution reveals an improvement of the CR among 19 patients (21.3%), its stability among 39 patients (43.8%) and a worsening among 31 patients (34.8%). These data are confirmed in a widened population of 321 patients of which the less complete data allow an estimate of the CR. CONCLUSION: The cardiovascular risk is difficult to evaluate. It is badly controlled in the long run.

[Serum selenium and dilated cardiomyopathy in Cotonou, Benin]. / Sélénium plasmatique et cardiomyopathie dilatée à Cotonou (Bénin).

PURPOSE: Peripartum cardiac failure is common in savannah-Sahelian Africa. It is due to a form of dilated cardiomyopathy (DCM) known as peripartum cardiomyopathy (PPCM) that results from undetermined causes. Numerous risk factors have been identified and dietary selenium deficiency has been proposed as a possibility. The purpose of this study was to measure serum selenium levels in patients presenting cardiac insufficiency due to PPCM and DCM (nonpostpartum) in Cotonou, Benin and to compare patients with healthy postpartum women with comparable or identical obstetric features. METHODS: Measurements of selenium status were performed in 10 women (mean age, 27.1 years) with PPCM, 18 patients of both sexes (male/female, 11/7; mean age, 38.9 years) with DCM (non-peripartum), and 46 healthy recent post partum women (mean age, 29.8 years). The Wilcoxon nonparametric test was used for data analysis with a statistical significance level at a p-value <0.05. RESULTS: Mean serum selenium values were near similar in patients presenting PPCM and DCM (non peripartum): 94 +/- 12 microg/L versus 97 +/- 19 microg/L respectively. This difference was not significant. No value was less than 72 microg/L. Conversely significantly lower mean values were observed in the 46 healthy recent postpartum women: 76 +/- 13 microg/L (p = 0.0002). The lowest value was 57 microg/L. CONCLUSION: Serum selenium measurements in Cotonou showed that levels were higher in patients presenting PPCM or DCM (nonperipartum) than in healthy controls. Extremely low values were never observed. These results differed from those obtained in Bamako, Mali and in Niamey, Niger and argue against considering selenium deficiency as a risk factor for development of DCM (peripartum or not) in Cotonou.

[Atypical venous thrombosis and protein S deficiency: report of a case]. / Thromboses veineuses atypiques multiples révélatrices d'un déficit en protéine S: a propos d'un cas.

A 29 year old man is admitted for hypovemic shock and abdominal pain. This critical condition was due to a diffuse mesenteric venous thrombosis and intestinal infarction. Five meters of small bowel are resected. Few days later a superficial brachial venous thromboembolism grows to superior cava venous and bilateral pulmonary embolism. A plasmatic protein S level was 17%. This deficiency is considered to be the support of these atypical extended and repetitive venous thromboembolism. With an optimal nutrition and long oral anticoagulation this patient is alive 17 months after his admission.

[Recurring pulmonary embolism despite the presence of a vena cava filter: a case report from the CNHU Cotonou-Benin]. / Embolie pulmonaire récidivante malgré la présence d'un filtre cave définitif: á propos d'un cas observé au CNHU de Cotonou-Bénin.

A 50-year-old man presents several clinical signs of pulmonary embolism, but this diagnosis was excluded due to the lack of venous thrombosis of the lower limbs and because the presence of a vena cava filter. The same signs reoccurred a few months later, leading to the diagnosis of venous thrombosis of the lower limbs with severe successive pulmonary embolism. This clinical case illustrates the potentially incomplete efficacy of vena cava filters for the prevention of pulmonary embolism.

[Epidemiology of chronic obstructive arterial disease of the lower limbs and diabetic patients at the University Hospital of Cotonou (Benin)]. / Epidémiologie de l'artériopathie chronique oblitérante des membres inférieurs chez le diabétique au CHU de Cotonou (Bénin).

The aims of this study were to determine the prevalence of chronic obstructive arterial disease of the lower limbs and to identify the factors which contribute to its occurrence in a population of adult African francophone diabetics. This was a prospective study which included all consenting diabetics systematically over a 6 month period at the out patient clinic or during hospital admission. Patients with incomplete data were excluded. An ankle systolic pressure index of less than 0.9 was required for the diagnosis of obstructive arterial disease. Demographic parameters, the characteristics of the diabetes, the quality of blood sugar control, the presence of classical cardiovascular risk factors and the results of their treatment, the nature and distribution of the arterial lesions on ultrasonography were all studied. A univariate analysis and a multivariate analysis of their correspondences were undertaken to determine the correlation coefficients. The prevalence of arterial disease of the lower limbs in the 102 diabetics retained for the study (average age 53 years) was 33.3%. The arterial disease was distal in 47% of cases and diffuse in 26.5% of cases. The arterial wall was calcified in 19.6% of cases. In univariate analysis only age was correlated with arterial disease (p = 0.04), the duration of diabetes tended to be related (p = 0.07). In multi-factorial analysis of Correspondences with other factors, hypertension, hyperlipidaemia and multiple cardiovascular risk factors seemed to be correlated with arterial disease of the lower limbs. Therefore, arterial disease of the lower limbs is very common and an early complication of diabetic patients in Benin. Predisposing factors were age and, probably, duration of diabetes, hypertension, hyperlipidaemia and multiple cardiovascular risk factors.