[Echocardiographic profile of Congolese hypertensive patients]. / Profil échocardiographique des patients hypertendus Congolais.

OBJECTIVES: To assess echocardiographic aspect of Congolese hypertensive patients, and to identify predictive factors of left ventricular hypertrophy (LVH). PATIENTS AND METHODS: A transversal study was lead in Brazzaville from January 2011 to December 2013 (36 months). In total, 1125 hypertensive patients under treatment underwent transthoracic echocardiography. The test was carried out either as part of an initial assessment of the hypertension disease or during the development of evocative symptom or complication. Patients' sociodemographic data and echocardiographic parameters were collected and analyzed. RESULTS: There were 621 males (55.2%) and 504 females (44.8%), mean age 54.7±12 years. The main indication of the test were the hypertension initial evaluation in 792 cases (70.4%), dyspnea in 122 cases (10.8%), investigation of ischemic stroke in 101 cases (9%), cardiac failure and chest pain in respectively 58 and 52 cases. 5.3±4.7 years known duration of hypertension status was associated with overweight/obesity in 829 cases (73.7%), physical inactivity in 669 cases (59.5%), hypertension family history in 540 cases (48%), diabetes mellitus in 122 cases (10.8%), dyslipidemia in 82 cases (7.3%), smoking in 29 cases (2.6%). Echocardiographic test was abnormal in 590 cases (52.4%) and showed hypertrophic cardiomyopathy in 510 cases (45.2%), dilated and hypertrophic cardiomyopathy in 46 cases (4.1%), dilated cardiomyopathy with systolic dysfunction in 31 cases (2.8%), coronary artery disease in 4 cases (0.4%). LVH was concentric in 470 cases (84.6%), eccentric in 70 cases (12.6%), and in 16 cases (3%), it was a concentric left ventricular remodeling. The left ventricular's systolic ejection fraction average was 70.5±9.3%, relaxation disorders in 480 cases (42.6%). Age, male gender, income, known duration of hypertension and treatment were predictive factors of LVH. CONCLUSIONS: Echocardiographic profile of the Congolese hypertensive is quite various, left ventricular hypertrophy is the most predominant abnormality. Efficient management on the hypertension will lead to reduce its morbidity and mortality.

[Evaluation of venous thromboembolism risk and prophylaxis among hospitalized patients in Brazzaville]. / Évaluation du risque de maladie thromboembolique veineuse et de sa prévention chez des patients hospitalisés à Brazzaville.

OBJECTIVES: To identify patients at risk of venous thromboembolism and to evaluate the use of preventive measures. METHODS: A cross-sectional given-day observational and descriptive study was conducted among patients in the Brazzaville University Hospital. All hospitalized adult patients were included. Compliance with the recommendations of the American College of Chest Physicians (2004 version) on the risk of venous thromboembolism and use of prevention was evaluated. The study included 292 patients hospitalized from July 1 to 4, 2014 in eight medicine and four surgery and gynecology-obstetrics wards. RESULTS: The study population included 214 (73.3 %) patients at risk of venous thromboembolism hospitalized in medicine (n=83, 38.7 %), surgery (n=82, 38.3 %), and gynecology-obstetrics (n=49, 23 %) wards. There were 92 men (43 %) and 122 women (57 %), mean age 45.9±17.7years (range: 18-88). The risk of venous thromboembolism was low in 15 patients (7 %), moderate in 104 patients (48.6 %), and high in 95 patients (44.4 %). The main risk factors identified were: for surgical patients, long immobilization (42.6 %) and age>40years (33.1 %); for medical patients, long immobilization (24.7 %) and age>60years (18.5 %); for gynecology-obstetrics patients, age<60years (44 %), multiparity (15.4 %) and long immobilization (10.7 %). One hundred sixty-nine patients (79 %) had received one measure of prevention. There were 45 (54.2 %) medical patients, 81 (99 %) surgical patients and 43 (88 %) gynecology-obstetrics patients. Pharmacological prevention was used in 97 patients (57.4 %), mechanical prevention in 33 patients (19.5 %), and the two types of prevention in 39 patients (23.1 %). CONCLUSIONS: The risk of venous thromboembolism is common in hospitalized patients in Brazzaville, and the need for prevention is perceived but poorly understood. It is therefore essential to improve our knowledge of venous thromboembolism and its prevention.

Cost of management of nonvalvular atrial fibrillation in Brazzaville (Congo): preliminary findings.

The frequency of nonvalvular atrial fibrillation is increasing in sub-Saharan Africa, particularly as a consequence of population aging and the high prevalence of hypertension. The aim of this descriptive study was to determine the cost of management of this disease in the cardiology department at University Hospital of Brazzaville. The study included 50 patients aged 67.3 ± 12.8 years (range: 34 to 88 years). Among them, 21 (42%) were unemployed, and 49 (98%) had no health insurance. Their average monthly salary was 152.8 ± 149 € (range: 0 to 686 €). The mean total cost of care was 442.4 ± 109.8 € (range: 146.6 to 646.2 €). The average monthly salary was higher than the average cost of drugs (P <0.0001), or of additional tests (P <0.0001), or of hospital hospitality (P <0.0001). But the overall cost of care was substantially higher than the patients' mean salary (p <0.0001). This study illustrates the increasing healthcare costs related to the growing burden of cardiovascular disease in sub-Saharan Africa.

[Short-term prognosis of heart diseases managed at the pediatric intensive care unit of the Brazzaville University Hospital]. / Pronostic immédiat des cardiopathies prises en charge dans le service des soins intensifs pédiatriques du CHU de Brazzaville.

OBJECTIVE: To determine the main heart diseases of children admitted to our pediatric intensive care unit. PATIENTS AND METHODS: This cross-sectional study was conducted in 2011 (January to December) in the pediatric intensive care of the Brazzaville University Hospital. RESULTS: The study included 42 children, 27 of them girls (64.3%). Their mean age was 2.6 ± 3.4 years, and the mean age of their mothers 26.6 ± 5.1 years. The reasons for admission were dyspnea (n = 34, 81%), fever (n = 21, 50%), edema syndrome (n = 8, 19%), squatting (n = 5, 12%), impaired consciousness (n = 4), seizures (n = 3, 7.1%), shock (n = 2, 4.8%), and malaise (n = 1, 2%). Associated signs included coughing (n = 30, 71.4%), impaired general condition (n = 14, 33.3%), cyanosis (n = 9, 21.4%), and chest deformity (n = 15, 35.7%). Heart failure was found in 28 cases (66.7%), as was congenital heart disease. The main heart diseases were ventricular septal defects (n = 13), cardiomyopathy (n = 9), and the tetralogy of Fallot (n = 6). The most common factors of decompensation were anemia (n = 12, 28.6%) and bronchopneumonia (n = 11, 26.2%). The immediate mortality rate was 23.8%. CONCLUSION: The heart diseases in children admitted in critical situations usually required surgical care, not available in our country. Rapid treatment is possible by strengthening South-South cooperation with neighboring countries where cardiac surgery is available.

[Gender and stroke in Brazzaville]. / Genre et accidents vasculaires cérébraux à Brazzaville.

BACKGROUND: The relationship between gender and cerebrovascular disease is controversial. The aim of our study was to evaluate the relationship between gender and vascular risk factors, biological variables and the severity of the neurological deficit in stroke. METHODS: This cross-sectional study, conducted from March to August 2011 in the department of neurology of the university hospital of Brazzaville which included all patients hospitalized for confirmed stroke. The study variables were: age, sex, vascular risk factors, NIHSS scores and Glasgow, blood pressure, and the biological exams and complications. Statistical analysis was performed on SPSS12. RESULTS: Eighty patients were included. The mean age was 62.7 ± 11.2 years, with 58.8% of men. Alcohol intake and smoking were more frequent in men than women respectively P=0.005 and P=0.032. Psychosocial stress was more often declared by women than men (P=0.042). However there was no significant difference in biological variables, the severity of stroke and the occurrence of complications CONCLUSION: Our study suggests that in the Congolese context, gender does not influence significantly most parameters during stroke, but men consume more alcohol and women are exposed to psychosocial stress.

[Impact of severe hypertension in acute heart failure in Brazzaville (Congo)]. / Impact de l'hypertension artérielle sévère dans l'insuffisance cardiaque aiguë à Brazzaville (Congo).

This retrospective study to assess the role of hypertension in acute heart failure (HF) reviewed the case records of 86 patients, including 35 men (41%) and 51 women (59%), mean age 55.6 ± 18 years, who were hospitalized for an acute exacerbation of HF. The cardiovascular risk factors considered were hypertension (56%), diabetes (8%), and smoking (13%); 11 patients were alcoholics (13%). HF was global in 71 cases (83%). Among the underlying heart diseases, hypertensive cardiomyopathy was noted in 22 patients (26%) and valvular disease in 17 patients (20%); the precise cause was not elucidated in 40 (47%). A decompensation factor was identified in 53 cases (62%). Among the patients admitted on an emergency basis for acute HF, the relative risk (RR) of severe hypertension (n = 41, 48%) was 3.75 (95% CI: 2.31 to 6.08, p<0.0001), of heart rhythm disorder (n = 25 cases, 29%) 0.96 (95% CI 0.6 to 1.4, p = 0.5), and of poor adherence to standard treatment (n = 16, 18%) 2.2 (95% CI, 1.6 to 2.97, p<0.0001). Other decompensation factors were severely impaired renal function in 8 cases (9%) and stroke and anemia in 6 cases each (7%).

Effects of biomarkers of oxidative stress damage on prevalence and severity of visual disability among black Central Africans.

BACKGROUND: Because of the demographic transition, lifestyle changes, urbanization, and nutrition transition, Central Africans are at higher risk of ocular diseases associated with oxidative stress and visual disability. This study aimed to estimate the normal values of oxidant status defined by oxidized low-density lipoprotein (Ox-LDL), 8-Isoprostane and 8-hydroxy-deoxyguanosine (8-OHdG) and to determine their pathogenic role in the prevalence and the severity of visual disability among these black Africans. METHODS: This was a cross-sectional study, run in a case-control study randomly selected from Kinshasa province, DR Congo. The study included 150 type 2 diabetes mellitus (T2DM) patients (cases) matched for sex and age to 50 healthy non diabetic controls. Logistic regression models were used to identify independent determinants of visual disability. RESULTS: The presence rates were 8.5% for blindness, 20.5% for visual impairment and 29% for visual disability including blindness and visual impairment. After adjusted for taro leaves intake, red beans intake, T2DM, aging, waist circumference, and systolic blood pressure, we identified low education level (OR=3.3 95%CI 1.5-7.2; p=0.003), rural-urban migration (OR=2.6 95% CI 1.2-5.6; p=0.017), and high Ox-LDL (OR=2.3 95% CI 1.1-4.7; p=0.029) as the important independent determinants of visual disability. After adjusted for education, intake of red beans, intake of taro leaves, triglycerides, and T2DM, we identified no intake of safou fruit (OR=50.7 95% CI 15.2-168.5; p<0.0001), rural-urban migration (OR=3.9 95%CI 1.213; p=0.012), and high 8-OHdG (OR=14.7 95% CI 3.9-54.5; p<0.0001) as the significant independent determinants of visual disability. After adjusted for education level, no intake of red beans, no intake of Taro leaves, triglycerides, and T2DM, we identified no intake of Safou fruit (OR=43.1 95% CI 13.7-135.4; p<0.0001), age ≥ 60 years (OR=3.4 95% CI 1.3-9; p=0.024), and high 8-Isoprostane (OR=11 95% CI 3.4-36.1; p<0.0001) as the significant independent determinants of visual disability. CONCLUSIONS: Visual disability remains a public health problem in Central Africa. Antioxidant supplement, fruit intake, nutrition education, control of migration, and blocking of oxidative stress are crucial steps for delayed development of vision loss.

[Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo]. / Les urgences hypertensives au Centre Hospitalier et Universitaire de Brazzaville (Congo).

The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.

[Non traumatic thoracic pain in adults: etiology and management at the CHU of Brazzaville (Congo)]. / Douleurs thoraciques non traumatiques de l'adulte: etiologies et prise en charge au CHU de Brazzaville (Congo).

This retrospective survey that is about the adult's non traumatic thoracic pains has been achieved during one period of three months in the service of the emergencies of the hospitable and academic center of Brazzaville. Her goal was to determine the prevalence of the thoracic pains, to specify their causes and the place of the cardiovascular diseases. We collected 88 cases left in 40 men (45.5%) and 48 women (54.5%). The sex-ratio was of 1.2. The middle age of the population of survey was of 38.8+/-17.3 years (extreme 18 and 74 years). The prevalence of the non traumatic thoracic pains was of 9.1%. Twenty-one patients (23.9%) were HIV, 9 patients (10.2%) were active smoke or weaned since less than three years. The associated signs were represented by the fever in 42 cases (47.7%), the dyspnoea in 37 cases (42%) and the cough in 33 cases (37.5%). The main diseases was represented by the respiratory diseases in 52 cases (59%), the oesophagus and gastric diseases in 16 cases (18.2%) and the cardiovascular disease in 10 cases (11.4%). The treatment analgesic has been used among 44 patients (50%) outside of the treatment of causes. The middle length of hospitalization in the service of the emergencies was of 25.7+/-8.3 hours, with the extremes of 12 and 48 hours. No deaths have been recorded.

[Cost of emergency cardiovascular care at the University Hospital Center in Brazzaville, Congo]. / Coût financier de la prise en charge des urgences cardiovasculaires au Centre Hospitalier et Universitaire de Brazzaville (Congo).

The purpose of this cross-sectional retrospective study was to evaluate the cost of managing cardiovascular emergencies in the Emergency Department of the Brazzaville University Hospital in the Republic of the Congo. This study included 197 patients admitted for stroke in 90 cases, heart failure in 65 and hypertensive emergency in 42 from July to December 2006. The mean duration of hospitalization was 45.2 +/- 18.3 hours (range, 6 to 72 hours). Cost calculation took into account consultation fees, blood tests, imaging, medication, therapeutic procedures and the first day of hospitalization. The overall cost of stroke care ranged from 147.000 to 177.000 CFA francs (220.50 to 265.50 euros), i.e., a mean per-patient cost of 158.120 +/- 6.900 CFA francs (237.18 +/- 10.35 euros). The overall cost of heart failure care ranged from 69.000 to 99.600 CFA francs (104.4 to 149.4 euros), i.e., a mean per-patient cost of 81.900 +/- 10.474 CFA francs (122.85 +/-15.71 euros). The overall cost of hypertension emergency care ranged from 74.600 to 18.4600 CFA francs (111.90 to 276.90 euros), i.e., a mean per-patient cost of 159.600 +/-44.107 CFA francs (239.40 +/- 66.20 Euros). Most people living in Brazzaville cannot afford emergency care for stroke, cardiac failure or hypertensive emergency. These findings underline the urgent need to implement a health insurance system and to encourage the use of generic drugs.

[Heart failure in elderly patients in Brazzaville, Congo: clinical and etiologic aspects and outcome]. / Insuffisance cardiaque du sujet âgé à Brazzaville: aspects cliniques, étiologiques et évolutifs.

The aim of the study is to report clinical, etiologic aspects and the outcome of heart failure in elderly hospital patients treated in Brazzaville, Congo. This retrospective study was carried out over a 20-month period from January 1, 2005 to August 31, 2006. In addition to age over 60 years, the main inclusion criteria was diagnosis of heart failure based on clinical, radiological, electrocardiographic, and echocardiographic evidence. A total of 223 patients, i.e., 50.0% of 446 patients over the age of 60 years evaluated, were included in the study. There were 125 women (56.1%) and 98 men (43.9%) (p = 0.0105). Mean age in the overall population was 70.4 +/- 6.2 years (range, 60 to 100 years). Heart failure was global in 148 cases (66.4%), left sided in 49 (22.0%), and right sided in 26 (11.6%). Left ventricular dysfunction was systolic in 93 cases (47.2%) and diastolic in 83 (42.1%) (p = 0.31). Underlying causes were hypertension in 77 cases (34.5%), coronary disease in 57 (25.6%), valvulopathy in 21 (9.4%), and myocardiopathy in 17 (7.6%). Chronic pulmonary heart disease was diagnosed in 25 cases (11.2%). Other cardiac diseases were found in 8 cases (3.6%). All patients underwent medical treatment. Thrombolytics were not used in cases involving myocardial infarction. The death rate was 20.2% (n = 45), i.e., 12 cases involving hypertensive cardiopathy, 8 involving coronary artery disease, 3 involving valvular cardiopathy, and 5 involving chronic pulmonary heart disease. The type of cardiopathy was undetermined in 17 cases. Heart failure is common in the elderly. Prevention depends on reducing cardiovascular risk factors especially arterial hypertension.

[Rheumatic heart disease in schoolchildren in Brazzaville]. / Les Cardiopathies rhumatismales en milieu scolaire à Brazzaville.

The purpose of this study is to screen for rheumatic heart disease as a basis for treatment of the disease and determination of its prevalence in schoolchildren in Brazzaville, Congo. Surveying was conducted in 4 schools located in suburban districts of Brazzaville from May to June 2005. A cohort of 2250 school children was enrolled by random sampling at 3 levels. Age ranged from 5 to 17 years. The variables recorded were age, sex, socioeconomic status, clinical features, and laboratory findings. Clinical selection was based on cardiac auscultation. Data analysis was performed using the Epi Data 3.1 and Stata 8.2 software packages (differences being considered as significant at p< 0.05). A total of 2232 children underwent testing including 1900 from public schools (boys, 47.5%; girls, 52.5%) and 332 from private schools (boys, 47.3%; girls, 52.7%) (p>0.05). The prevalence of rheumatic heart disease was 3,5 per thousand overall, 3.6 per thousand in children in the low socioeconomic status group, and 3 per thousand in the high socioeconomic status group (p<0.05). The ages of children presenting valvular cardiopathy ranged from 7 and 16-years-old and 75% lived in overcrowded dwellings. One or more previous episodes of strep throat were noted in all cases and had not been treated in 7 out of 8 cases. Valvular disease was significantly correlated with history of strep throat, overcrowded living conditions, and low socioeconomic status (p<0,01). Compliance with prophylactic treatment using benzathyn penicillin was 75% after one month of follow-up and 37.5% after three months.

[Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman]. / Hypertension artérielle: aspects epidémiologiques et facteurs de risque chez la gestante et l'accouchée.

OBJECTIVES: Determine frequency of hypertension in pregnancy and delivered women at the Teaching Hospital of Brazzaville and identify epidemiological aspects and risk factors. PATIENTS AND METHODS: A prospective and transversal study was realized from november 2004 to january 2005 in the Teaching Hospital of Brazzaville. Forty two patients (8 pregnant women, 34 delivered) with hypertension, have been enregistered among 825 admissions in the departments of gynecology and obstetric. Arterial hypertension was defined by a blood pressure at 140/ 90 mm Hg or above. RESULTS: Arterial hypertension constituted 5.1% of the total admissions. Average of the patients was 27 +/- 8 years (age range: 14 and 40 years). Two patients (4.8%) haven't been sent to school, 29 (69%) had the secondary level, twenty (47.8%) were housewives. Seventeen patients (40.5%) had realized 2 prenatal consultations at the most. Patients were divided in 4 groups: Chronic hypertension (n = 4), pre eclampsia surimposed on chronic hypertension (n = 4), pregnancy hypertension only (n = 15), preeclampsia (n = 19). Prim gravidity (38.1%) and family history of hypertension (40.4%) were the most frequent risk factors. Obesity, gemality, previous pre eclampsia represented respectively 14.3%, 9.5% and 4.8%.

Liver cysts in Congolese patients with autosomal dominant polycystic kidney disease follow a family pattern.

BACKGROUND: It is now well established that at least two genes are associated with autosomal dominant polycystic kidney disease (ADPKD). OBJECTIVE: To analyse the clinical expression of ADPKD in Congolese patients and to compare ADPKD expression between families. METHODS: Following informed consent, ADPKD patients admitted to Brazzaville University Hospital (Congo) were reviewed and their relatives aged 20 years and older were screened by means of a clinical examination, abdominal ultrasound, urinalysis and determination of serum creatinine. RESULTS: We found 7 patients with ADPKD, belonging to 7 distinct families, and identified 100 relatives of whom 50, aged from 20 to 68 years, were diagnosed as having ADPKD. Polycystic kidney disease was associated with polycystic liver in 4 families. In the remaining 3 families no liver cysts were found. No family had a mixture of members with kidney cysts only and members with kidney and liver cysts. This finding was age-independent. CONCLUSION: Liver cysts follow a family pattern in our ADPKD patients. We suggest that our patients may carry at least two different genes for ADPKD, one of which may be associated with renal cysts alone and other with both renal and liver cysts.

[Idiopathic subvalvular aneurysm of the left ventricle. Anatomical, clinical and developmental characteristics. Apropos of 13 cases]. / Anévrismes sous-annulaires idiopathiques du ventricule gauche. Caractères anatomiques, cliniques et évolutifs. A propos de 13 cas.

The authors report 13 cases of idiopathic subvalvular left ventricular aneurysm (ISVLVA), observed over a 7-year period in a total of 29,617 patients (0.04%). They describe the clinical features, results of complementary investigations and clinical course of this disease. The diagnosis was based on angiographic and anatomical findings in 4 cases and on echocardiographic findings in 10 cases. This series consisted of 10 females and 3 males with a mean age of 37.3 +/- 2.1 years (range: 9 to 72 years). Clinical signs consisted of palpitations in 2 cases, angina pectoris in 4 cases, heart failure in 9 cases, and systolic murmur of mitral incompetence in 13 cases. Chest x-rays showed vaulting of the left ventricle in 8 cases (61.5%). ECG showed sinus rhythm in 11 cases, atrial fibrillation in 2 cases, ventricular tachycardia in 1 case and junctional tachycardia in 1 case. The erythrocyte sedimentation rate was raised in 10 cases (76.9%). Complementary examinations revealed ISVLVA, which was often very large, calcified (7 cases), thrombosed (6 cases), situated on the posterolateral surface of the left ventricle, in a mitral subvalvular position (13 cases) and responsible for mitral incompetence (13 cases). The coronary arteries were normal in the 5 cases in which they were studied. No aetiology was found. Complications included death (1 case), heart failure (9 cases) and arrhythmias (3 cases). No systemic embolism was observed. Medical treatment (digoxin, furosemide, antiarrhythmics) was considered to be fairly effective, but insufficient to prevent episodes of heart failure and arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tricuspid infectious endocarditis in Brazzaville. Apropos of 12 cases]. / Endocardites infectieuses tricuspidiennes à Brazzaville. A propos de douze cas.

The authors report their experience of the clinical and echocardiographic aspects and course of tricuspid infectious endocarditis, based upon 12 cases collected between September 1985 and December 1992. The diagnosis was confirmed on the basis of the association of signs of septicemia (12 cases), at least two positive blood cultures for the same organism (9 cases) and well-defined vegetations seen by trans-thoracic echocardiography (12 cases). All patients were young women: mean age = 21.8 +/- 4.7. None were heroin addicts but one was positive for human immune deficiency virus. Tricuspid infectious endocarditis was most often acute (9 cases), primary (10 cases, post-abortum (11 cases), due to Staphylococcus aureus (5 cases), and complicated by cardiac failure (12 cases) and lung abscess (4 cases). Four patients died of septicemia (2 cases), of cardiac failure and lung abscess (2 cases). One had severe tricuspid incompetence requiring surgery. It has not yet been possible to operate on this patient because of the lack of cardiac surgery facilities in Congo. The prevention of tricuspid infectious endocarditis depends above all on the fight against clandestine abortions and against the development of intravenous drug abuse.

[Infectious endocarditis of gyneco-obstetric origin. Apropos of 15 cases]. / Endocardite infectieuse à porte d'entrée gynéco-obstétricale. A propos de 15 cas.

With the object of analyzing current characteristics of post-partum and post-abortum infective endocarditis (IE), authors carried out a retrospective study of 15 cases between september 1985 and may 1992. Mean age was 22.2 +/- 4.0 years. Origin of sepsis was delivery (1 case), abortion (14 cases). There was no underlying cardiac lesion in 9 cases, rheumatic heart disease in 6 cases. Infecting organisms were Staphylococcus aureus (n = 6), streptococcus D (n = 3), Clostridium perfringens (n = 2). There were 10 acute and 5 subacute IE, 7 right-sided, 7 left-sided, and 1 right and left-sided IE. Vegetations were determined by transthoracic echocardiography in 12 cases (80%). The main complications were heart failure (15 cases), and pulmonary or arterial embolism (7 cases). Lethality was 53.3% and was not different in tricuspid acute IE and left-sided IE. Treatment was the more difficult as cardiac surgery is expensive or even inaccessible. Accordingly, prevention is primordial. It consist of antibiotic prophylaxis and fight against illicit abortion.

[Infectious endocarditis. Experience of a service in Brazzaville. 47 cases]. / Endocardite infectieuse. Expérience d'un Service Brazzavillois. A propos de 47 cas.

The aim of this study was to report the authors' experience of infective endocarditis (IE) from 47 cases collected between 1976 to 1991. Infective endocarditis (IE) was documented with surgical (n = 9), microbiological (n = 26), and echocardiographic (n = 30) criteria. There were 11 male, 36 female: mean age, 26.2 +/- 10.3 years (extremes: 17 and 47). The authors noted a great importance of gynecological portal entry (13 cases), acute infective endocarditis (23 cases i.e. 48.9%), heart failure (39 cases i.e. 82.9%), and pulmonary (4 cases i.e. 8.5%) and systemic (8 cases i.e. 17.0% embolism. Surgical treatment was impossible in Brazzaville. Trans-thoracic echocardiography was performed in 38 cases and revealed vegetations in 30 cases i.e. 78.9%. Twenty patients died (42.5%) because heart failure. There was no significant difference in letality between infective endocarditis treated surgically or no, between native valve or prosthetic valve infective endocarditis, between culture negative or culture positive infective endocarditis (IE). This study corroborate that infective endocarditis is a heavy illness, characterized by high frequency of heart failure. The authors insist upon the prevention of infective endocarditis.