[Maternal mortality due to cardiovascular diseases in France 2016-2018]. / Mortalité maternelle par pathologies cardiovasculaires en France 2016­2018.

Between 2016 and 2018, cardiovascular diseases were responsible for 41 deaths, making it the leading cause of maternal death within 42 days postpartum in France. The maternal mortality ratio (MMR) for cardiovascular disease is 1.8 per 100,000 NV, a non-significant increase compared with the 2013-2015 triennium (MMR of 1.5 per 100,000 NV). Deaths from cardiac causes accounted for the majority (n=28), with 26 deaths secondary to cardiac disease aggravated by pregnancy (indirect deaths) and 2 deaths related to peripartum cardiomyopathy (direct deaths). Deaths from vascular causes (n=13) corresponded to 9 aortic dissections and 4 ruptures of large vessels, including 3 ruptures of the splenic artery. Preventability of death (possible or probable) was found in 56% of cases compared with 66% in the previous triennium. Care was considered sub-optimal in 57% of cases, down from 72% in the 2013-2015 triennium. In women with known cardiovascular disease, the areas for improvement concern multidisciplinary follow-up, repeated assessment of the cardiovascular risk (WHO grade) and early referral to an expert centre (expert cardiologists, obstetricians, anaesthetists and intensive care). In all pregnant women or women who have recently given birth, a cardiovascular etiology should be considered in the presence of suggestive symptoms (dyspnea, chest or abdominal pain). Ultrasound "point of care" examination (fluid effusions, cardiac dysfunction) and cardiac enzymes assay can help in the diagnosis. Finally, the woman must be involved in her own care.

[Delayed renal infectious aneurysm 3 months after cardiac surgery for a Streptococcus pyogenes infective endocarditis ; case report and literature review]. / Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature.

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature. We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts. He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization. This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

[Vascular manifestations of Behcet's disease]. / Les complications vasculaires de la maladie de Behçet.

Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet.

[Coronary artery aneurysm in Kawasaki disease and its risk factors : a retrospective study about 65 Tunisian children]. / Les complications coronaires de la maladie de Kawasaki et ses facteurs de risque : à propos de 65 cas d'enfants tunisien.

INTRODUCTION: Kawasaki syndrome (KS) is a systemic vasculitis of unknown etiology that affects medium and small blood vessels. The aim of our study is to analyze coronary artery lesions in children with KS and their risk factors. MATERIAL AND METHODS: All children under the age of 15 years-old presenting KS and admitted in the pediatric department of three university hospital (Sahloul hospital, and Farhat Hached hospital of Sousse, Ibn El Jazzar hospital of Kairoun) from January 2000 to December 2018 were included. RESULTS: Sixty-five patients were included in our study. The mean age at diagnosis was of 29.9 months [2-120 months] and the sex ratio was of 1.7. Echocardiography was performed in all patients. It showed coronary dilation in 37% of patients with coronary artery diameter of 4.2 mm on average [3.2-7mm]. The coronary aneurysm was small in 19 cases and medium in 5 cases. No giant aneurysm has been identified. In univariate analysis, the predictors of coronary artery lesions were male sex, atypical form, fever duration more than 10 days, hepatic cytolysis, thrombocytosis and anemia. In multivariate analysis, only the last four parameters were the predictive factors of the coronary artery involvement. CONCLUSION: Several risk factors can be used to determine which children are predisposed to develop coronary dilations. In case of patient with risk factors, intravenous immunoglobulins should be initiated early to avoid these serious complications.

[Opportunistic screening for abdominal aortic aneurysm during echocardiography in patients with coronary artery disease: Utility or futility?] / Dépistage opportuniste de l'anévrysme de l'aorte abdominale lors de l'échocardiographie chez le patient coronarien : utile ou futile ?

Abdominal aortic aneurysm is a chronic degenerative disease that is usually silent until rupture occurs and this complication is still associated in contemporary era with a high rate of mortality. Screening programmes for abdominal aortic aneurysm have been shown to be effective in reducing global mortality in the screened population but these programmes are poorly implemented in the Western countries. As coronary artery disease and abdominal aorta aneurysmal disease share many risk factors, the cardiologist is centrally positioned in the screening strategy, not only to identify patients with higher risk of developing abdominal aortic aneurysm, but also to perform an opportunistic screening during echocardiography. This paper summarises evidence about the feasibility, indications, modalities, benefits and risks related to the opportunistic screening for abdominal aortic aneurysm during echocardiography with a particular emphasis on the population of patients with coronary artery disease.

[Embolization of splenic artery aneurysms: Treatment of choice. About a case and review of the literature]. / Embolisation des anévrysmes de l'artère splénique : traitement de choix. À propos d'un cas et revue de la littérature.

Splenic artery aneurysms constitute 60% of digestive artery aneurysms. They are often discovered incidentally and by imaging. Currently, endovascular treatment is considered the first-line treatment, as it is less invasive with less morbidity and mortality than surgery. An aggressive approach in their management is certainly justified because the overall mortality of ruptured splenic aneurysms is 25%. False splenic aneurysms have a greater potential for rupture than true aneurysms because they grow faster. Endovascular treatment is generally indicated for aneurysms larger than 2cm or with an increase in size of more than 0.5cm/year. Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels. Embolization is performed using different materials including coils, which can be used alone or with other embolic agents. Post-embolization syndrome can be seen with persistent pain, fever and other systemic symptoms. Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy. Endovascular treatment and especially coil embolization are starting to be the standard treatment. Surgical and laparoscopic treatment are reserved for ruptured aneurysms which are burdened with significant mortality, especially in pregnant women. We report the case of a 66-year-old female patient in whom a splenic artery aneurysm was discovered incidentally during an ultrasound for an ovarian cyst.

[Painful cervical mass revealing an aneurysm of the internal jugular vein]. / Masse cervicale douloureuse révélant un anévrysme de la veine jugulaire interne.

Internal jugular vein aneurysms or phlebectasia of the internal jugular vein are considered a benign pathology. They are more and more diagnosed with the evolution of imaging techniques : ultrasonography, angioscanner and MRI. Clinically they are often by chance, however accompanying clinical signs can be seen such as pain, hoarseness or vocal cord paralysis. Several differential diagnoses can be mentioned such as laryngocoele, gill cyst, paraganglioma and hemangioma. They are of unknown etiology with several hypotheses on the etiopathogenesis and on the frequent localization on the right. Conservative treatment can be chosen for small aneurysms and in children. Surgical treatment finds its indication especially in the event of a complication such as thrombosis or for an aesthetic interest; other treatments such as endovascular treatment are being evaluated. We report the case of a 67-year-old woman admitted for a painful latero-cervical mass, and in whom the diagnosis of an aneurysm of the internal jugular vein was suspected and confirmed by ultrasound and CTscan. The patient received successful surgical treatment.

[Isolated atrial septal aneurysm: Exceptional cause of digital ischemia - a case report]. / Anévrysme isolé du septum interauriculaire : cause exceptionnelle d'ischémie digitale.

An atrial septal aneurysm (ASA) is a rare but well recognized entity characterized by saccular deformity of the atrial septum that bulges into the right or left atrium. Diagnosis can be established using transthoracic and transesophageal echocardiography. Although this abnormality is considered clinically benign, it has been independently associated with systemic or cerebral embolism. We present a unique case of isolated atrial septal aneurysm complicated by digital ischemia in a 51 years old woman.

Sexual dysfunction after elective laparoscopic or endovascular abdominal aortic aneurysm repair in men.

INTRODUCTION: Infrarenal abdominal aortic aneurysm (AAA) repair can lead to ejaculation and erection troubles in men. There are few studies on sexual dysfunction after endovascular repair (EVAR) but they suggest less retrograde ejaculation than after open repair. We assessed the sexual dysfunction and ejaculation troubles after elective laparoscopic repair or EVAR. METHODS: We conducted a monocentric prospective study on 124 patients undergoing AAA repair between 2013 and 2015. Sexual function was evaluated using the IIEF-15 questionnaire and questions on ejaculation. RESULTS: Only 45 patients (36.3%) accepted to complete the IIEF preoperatively with 20-37.8% having preoperative sexual dysfunction. Among them, 21 (46.7%) accepted to complete the questionnaire at 3, 6 and 12 months. Mean age at inclusion was 65±5.6 years in the laparoscopic group and 77±10.5 years in the EVAR group (P=0.003). Erectile and sexual function were slightly improved at 12 months in the laparoscopic group (+1.4 for erectile score and +4.6 for IIEF score) with no significant difference (P=0.83 and 0.74) whereas 8 patients (61.5%) had persistent ejaculation troubles at 3 months. In the EVAR group, patients had moderate sexual dysfunction at baseline without improvement at 12 months, but only one patient reported ejaculation troubles. CONCLUSIONS: Most patients eligible for AAA repair present with baseline erectile and sexual dysfunction. Laparoscopic AAA repair provides no onset of erectile or sexual dysfunction but a global improvement after surgery. Ejaculation troubles are frequent and persistent at 1 year. However, EVAR treatment, doesn't allow recovering of sexual function at 1 year. LEVEL OF EVIDENCE: 4.

[Conservative aneurysmorrhaphy for hemodialysis arteriovenous fistula]. / Anévrysmorraphie conservatrice des fistules artérioveineuses pour hémodialyse.

The aim of this study was to evaluate the results of conservative surgical treatment of the aneurysmal complications of arteriovenous hemodialysis fistulae and to determine the factors predictive of long- and mid-term patency of treated fistulae. The surgical treatment was mainly based on caliber reduction and reconstruction. METHODS: This was a descriptive retrospective study with a five-year duration, going from January 2013 to December 2018. This study included 40 patients presenting aneurysmal complications of their hemodialysis vascular access who were treated with aneurysmorrhaphy. RESULTS: The mean age of the aneurysmal-complicated hemodialysis vascular access was 42 months. The indications for treatment were puncture-related difficulties in 42.5% of cases, rapid increase of the aneurysmal diameter in 27.5%, skin thinning in 25% and aneurysmal rupture in 5%. The mean aneurysmal course was 6.6 months with an average diameter of 3.25cm at the moment of management. The initial technical success rate was 100%. Twenty patients had complications in the postoperative period. Patency rates at 3, 6, 12 and 24 months were 89.5%, 81.6%, 71% and 63.1%, respectively. Factors predictive of thrombosis were diabetes (P=0.001), peripheral arterial disease (P=0.003), number of punctures per week (P=0.003) and context of emergency presentation (P=0.001). CONCLUSION: Aneurysmorrhaphy seems to be the best conservative surgical treatment for aneurysmal complications of hemodialysis vascular access fistulae. This surgical approach allows us to conserve the native autologous vascular access and spare the patient's venous network.

Prolonged fever and intra-cardiac thrombosis revealing Behçet's disease.

BACKGROUND: Prolonged fever (PF) is a challenging problem for physicians since it can be the first manifestation of a large variety of pathologies. Exceptionally, intra-cardiac thrombus (ICT) could explain PF and reveal Behçet's disease (BD). We are reporting a 45-year-old man with BD who has these unusual manifestations. CASE REPORT: A 45-year-old man presented with PF and inflammatory biological syndrome during a few months. Echocardiography showed an inhomogeneous and mobile mass in the left auricle. During his hospitalization, the patient had multiple oral aphtosis. The angioscanner showed a sacciform aneurysm of the coeliac trunk. The diagnosis of BD was retained and he was treated with high doses of steroids and cyclophosphamide with a favorable follow-up. CONCLUSION: The search for BD should be systematic in view of any suggestive manifestation of severe cardiovascular complications like ICT especially in a young adult man from a high endemicity region.

[Tocilizumab for refractory Takayasu arteritis with aortic aneurysm]. / Traitement par tocilizumab d'une artérite de Takayasu réfractaire avec anévrysme aortique.

Takayasu arteritis (TA) is a form of large vessel vasculitis (LVV) which affects the aorta and the main arteries. Many reports showed efficacy of biologic drugs (TNF α inhibitors and interleukin 6 inhibitors) in refractory TA cases. We report the case of a 46-year-old woman with refractory TA complicated by giant aortic aneurysm (AA) and severe hypertension, treated efficacy with tocilizumab (anti-interleukin 6 receptor monoclonal antibody).

[Atheromatous extra-coronary injury in patients with coronary disease: Result of a cross-sectional centre study carried out in the east of Algeria]. / Atteinte athéromateuse extracoronaire chez le coronarien : résultats d'une étude transversale monocentrique à l'est d'Algérie.

INTRODUCTION: Patients with coronary heart disease often suffer from damage in another vessel which has, in some cases, no clinical signs. These combined conditions are important to be diagnosed in order to treat the patients thoroughly. AIM: To estimate the frequency of other peripheral atheromatous injuries especially carotid artery disease, Abdominal aortic aneurysm (AAA) and Peripheral artery disease (PAD) in patients with coronary disease which were enrolled in the cardiology department of the university hospital of Constantine, Algeria. PATIENTS AND METHODS: This descriptive cross-sectional monocentre study was carried out in the cardiovascular exploration unit in the university hospital of Constantine, Algeria. Enrolled patients had at least one significative coronary injury≥50 in one of the major coronary arteries. All of the patients have had an ultrasound examination (supra-aortic trunks doppler, aorta and inferior limbs doppler). Data were processed and analysed using SPSS 22 software. RESULTS: The frequency of the association PAD with CAD was 34.7% which accounts for the highest frequency. Haemodynamic carotid injury (≥50%) and AAA were respectively associated with CAD in 12% and 4.6% of the cases. The triple associations CAD with AAA and Haemodynamic carotid injury was observed in 2.67% of the cases while CAD with PAD and carotid artery stenosis (≥50%) in 6.67% of the cases. The frequency of the association CAD with PAD and AAA was estimated at 3.66%. CONCLUSION: Coronary artery disease goes often hand in hand with other heart conditions, which should be systematically considered in patients with CAD. Clinical examination along with recommended non-invasive imaging techniques can help improve the medical assessment of patients with CAD. Only with these means, thorough personalised and cost-beneficial medical care can be obtained.

Urinary retention revealing a large common iliac artery aneurysm.

Isolated aneurysms of the common iliac artery are rare, affecting less than 0.01% of the general adult population. Most of these aneurysms are asymptomatic and are discovered as an incidental finding. We describe an elderly patient presented with a urinary retention, which the investigations had led to the diagnosis of a large left common iliac artery aneurysm.

Open surgical repair of abdominal aortic aneurysms in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem chronic autoimmune inflammatory disorder that involves multiple organs. Arterial involvement in BD is rare. Aortic involvement is one of the most severe manifestations and is associated with a much higher mortality. In this article, we will present our experience in open surgical repair of abdominal aortic aneurysm combined with immunosuppressive therapy. METHODS: Between January 2010 and December 2017, 7 patients were treated for abdominal aortic aneurysms (5 infra-renal and 2 supra-renal, in 1 woman and 6 men). All patients were Moroccan, the age range being 25-59 years, mean age 43.2 years. Three Dacron tube grafts, two Dacron aortobiiliac grafts and two patch closures were used. All 7 patients received immunosuppresive therapy after surgery. RESULTS: All patients underwent successful open surgical repair without major complications during the 30 days immediately after the procedure. During a mean follow-up of 36 months, there was no recurrent aneurysmal localization, but one patient had lost their sight. Until now, we have been following 6 patients and they continue to receive immunosuppressive therapy. CONCLUSION: Long-term immunosuppressive therapy after aneurysm repair is important to limit pseudoaneurysm recurrence. Through our serie, we describe the results of the combination of surgical treatment and adjunctive immunosuppressive therapy, with a literature review.

[Are abdominal aortic aneurysm screening guidelines followed? Prospective study in Dunkerque's hospital emergency room]. / Les recommandations de dépistage de l'anévrysme de l'aorte abdominale sont-elles respectées ? Étude prospective aux urgences de Dunkerque.

AIM OF THE STUDY: Are the recommendations issued by the Haute Autorité de santé in 2012 on screening for abdominal aortic aneurysm (AAA) being applied? METHOD: We interviewed the target patients, ex. male patients aged 65 to 75, smokers or former smokers, or as young as 50 in the event of a family history of AAA in the parents or siblings, entering the emergency room of Dunkerque between May 7 and December 31, 2015. We asked them if they had had an abdominal aortic ultrasound, or an abdominal ultrasound, or an arterial Doppler ultrasound of the lower limbs, and when, to see if they had had an AAA test since November 2012. RESULTS: We included 55 patients and excluded 5 of 180 eligible patients (31 %). It was not possible to conclude for 4 patients due to missing data. Thirteen of 46 patients (28.3 %, 95 % CI [16.0-43.5]) have had AAA ultrasound screening since November 2012; 33 have not (71.7 %, 95 % CI [56.5-84.0]) and no screening was offered. Of the 13 patients screened, 7 were screened by the attending physician (53.9 %, 95 % CI [25.1-80.8]) and 6 by another specialist (46.2 %, 95 % CI [19.2-74.9]). CONCLUSION: AAA screening in our population is low. Physicians should be urged to publicize and implement the November 2012 French recommendations to reduce AAA-related mortality.

[Hughes-Stovin syndrome: About one case in a young man with recurrent thrombosis and pulmonary artery aneurysm and literature review]. / Syndrome de Hughes-Stovin : à propos d'un cas chez un jeune patient avec thromboses récurrentes et anévrysme de l'artère pulmonaire et revue de la littérature.

INTRODUCTION: First described in 1959, Hughes-Stovin syndrome is a very rare disorder combining vascular aneurysms, especially from pulmonary arteries, and thrombosis. The disease affects mostly the young male and is sometime associated with Behçet' disease. CASE REPORT: Here, we report the case of a 19-year-old man with hemoptysis and dyspnea revealing recurrent pulmonary embolisms despite efficient anticoagulant therapy. The patient subsequently developed fever and an inflammatory syndrome. Physical examination showed ulcers of the tongue. Angio-CT revealed recent pulmonary embolism, femoral vein thrombosis, and a unique threatening aneurysm of a left pulmonary artery segment. The aneurysm was embolized and simultaneously a vena cava filter was inserted. CONCLUSION: Hughes-Stovin syndrome requires immediate therapeutic decision, with an important risk of the anticoagulation. High dose steroids and in most cases, intensive immunosuppressive therapies are required such as cyclophosphamide.

[Prevalence and risk factors of sub-renal abdominal aortic aneurysm in an Algerian population aged over 60]. / Prévalence et facteurs de risque de l'anévrysme de l'aorte abdominale sous-rénale dans une population algérienne âgée de plus de 60 ans.

INTRODUCTION: The prevalence of abdominal aortic aneurysm (AAA) in the general population in our country is not known, our aim was to evaluate it in patients over 60 years of age, to specify the risk factors and to evaluate the extension of aneurysmal disease and multisite subclinical atherosclerosis. METHODS: Descriptive, transversal, study collecting the data of a systematic ultrasound screening of sub-renal AAA in subjects receiving care in two Algerian hospital structures. Epidemiological data, AAA risk factors, cardiovascular disease risk factors (CVD RF) and the personal history (cardiovascular diseases, chronic obstructive pulmonary disease) and family history of AAA were collected during the screening. An abdominal echography was performed in all patients. A biological and morphological assessment was carried out for AAA cases detected. Multivariate logistic regression analysis was used to study the factors associated with AAA. RESULTS: Systematic screening for 600 patients revealed an overall AAA prevalence of 2.2% (n=13). In multivariate analysis a positive association with AAA was observed with active smoking, its duration in years and its intensity in year-packages; with hypertension, dyslipidemia and a history of cardiovascular events. While a negative association was observed with a smoking cessation of more than 20 years, type 2 diabetes and android obesity. The study of detected AAA cases found five cases of aneurysm isolated from the primary iliac artery but no popliteal and/or femoral aneurysm. The carotids were atheromatous in more than 80% of cases and the arteries of the lower limbs in more than one-third of cases. CONCLUSION: The prevalence of AAA in our population (2.2%) corresponds to the prevalence reported recently in Europe, but it would have been higher if the screening had targeted males and smokers. The factors associated with AAA in our patients are similar to those described in the literature.