Prosthetic valve endocarditis: clinical, bacteriological and therapeutic aspects.

BACKGROUND: The prosthetic valve endocarditis(PVE) is a serious complication of valve replacement surgery. The aim of this work was to analyze the clinical and echocardiography characters of the PVE, deduce surgery indication, and determinate the prognostic factors Methods :We presented a retrospective descriptive study from 2000 to 2014 which included 30 patients hospitalized in department of cardiology in la Rabta hospital for certain PVE according to DUCKES criteria. RESULTS: Our study consisted of 18 male patients with sex ratio of 1.5 ,the mean age was 44 years; These PVE were early in 6 cases and delayed in 24 cases. Fever was present in 28 patients..splénomegaly was present in 7 patients and cutaneous signs were present in 6 patients Blood cultures were negatives in 16 patients .Staphylococcus was isolated in 7 cases (23.3%), a streptococcus in 5 cases (16.6%), a gram negative bacillus in 1 case (3, 3%) and one enterococci in 1 case (3.3%).The transesophageal and transthoracic echocardiography performed in all patients showed vegetation for 17 patients, a Dishence of prosthetic valve in 14 patients, prosthesis obstruction in two patients and annular abscess in 4 patients . 22 complications were reported in 21 patients; il was an hemodynamic complication in 13 cases , a septic complication (uncontrolled infection ) in three patients, embolic complication (ischemic transit stroke ) in 4 cases and mixed (hemodynamic and septic) in one patient. The indication for surgery was retained in 18 patients; the need for early surgery was because of congestive heart failure in 14 patients and uncontrolled infection in 4 patients ; but it was performed in 13cases with a period between 1 and 30 days the operation the global mortality was about 30%. he predictors factors of mortality released from our study are: the early character of EPV, heart failure, uncontrolled infection, staphylococcal endocarditis and dishence of prosthesis with significant regurgitation. CONCLUSION: PVE is still a serious complication leading to high mortality . Combined medical and surgical treatment is recommended.

[Diagnostic accuracy, limits and practical implications of Multidetector Computed Tomography Coronarography. About 105 cases]. / Performances, limites et implications pratiques du coroscanner. A propos de 105 cas.

BACKGROUND: Non-invasive examination of coronary artery disease is an attractive and rapidly evolving possibility. In certain clinical situations ,multi-detector computed tomography coronarography (MDCT) is currently considered as a promising technique alternative to conventional coronary angiography (CCA). PURPOSE: We suggest from our personal study and from a review of the literature, to analyze diagnostic accuracy of MDCT , its limits and to deduct, its practical implications and its indications. METHODS: 105 patients underwent 64-slice MDCT . Coronary angiography was performed every time when the MDCT was pathologic. In two cases the MDCT was realized in complement of inconclusive coronary angiography .Study of coronary arteries was based on "per -segment" and "per- patients" analyse Results : The mean age was 63,3 years., sex ratio was 0 ,7. Hypertension was noted in 63% of cases 29 ,9 % of patients had mellitus diabetes.The initial clinical presentation was unusual chest pain in 46 patients, exercise chest pain in 40 cases. the MDCT was done for the detection of silent ischemia In 5 cases, for screening of CAD in patients with dilated cardiomyopathy in 5 cases , before cardiac surgery in 3 case and before non cardiac surgery in 2 cases. MDCT was normal in 30 patients ( 28% ) so coronary angiography was avoided in 60% of patients with unusual chest pain, and in 50% of patients with dilated cardiomyopathy and in also in 50% of patients selected for cardiac or non cardiac surgery. In per-segment study the sensitivity, specificity, positive and negative predictive value of the MDCT in detecting coronary stenosis were respectively 89 %,98% , 91% and 97% versus, 98%,89%,94%, 95% the per-patient evaluation .The MDCT was inclusive in10 patients because .of calcifications in 8 cases and because uncontrolled unchecked heart rate in 40 cases Conclusion : our results for negative predictive value of MDCT are similar to reports from the literature. This suggests that in this clinical setting , MDCT may replace coronary in patients with low probability of coronary artery diseases, its is also useful for assessment of cardiomyopathy and before cardiac or non cardiac surgery.

[Epidomiological characteristics of infective endocarditis: a study of 135 cases]. / Caractéristiques épidémiologiques de l'endocardite infectieuse: etude de 135 cas].

BACKGROUND: Infective endocarditis (IE) is a serious pathology which is in a continuum evolution in the setting of diagnosis and therapeutic fields AIM: To describe clinical, echocardiographic, microbiological, therapeutic and outcome characteristics of infective endocarditis in a Tunisian population. METHODS: The records of 135 patients admitted to adult cardiology department of la Rabta hospital between January 1981 and December 2011 were collected. The diagnosis of certain IE was retained according to modified Duke Criteria. RESULTS: The mean age of patients was 38.5 ± 16 years, with a male predominance (sex ratio: 1.4). IE affected native valves in 77% of cases, prosthetic valve in 15.5% of cases, congenital heart disease in 2% and pacemaker in 1.48% of patients. The portal of entry was identified in 43.7% of the patients, the oral origin was predominant. Blood cultures were positive in only 34% of patients. Causative microorganism was staphylococcus in 43.6%, streptococcus in 43.6% and negative bacill gram in 17.4% of patients. Echocardiography showed vegetation in 98% of patients, cardiac abscess in 23.7% of patients and valve mutilation in 17.7% of cases. Prosthesis dehiscence was present in 4.5% of cases. Complications were primarily hemodynamic (57%) followed by embolic events (34%). Surgery occurred in 57.7% of patients, it was early in 69% of cases. The indication was mainly hemodynamic and mixed in 70%of patients. Hospital mortality was 28% with predictor's factors: left heart (p=0.02), prosthesis (p <0.05), staphylococcus (p<0.005), heart failure (p<0.05) and neurological complications (p=0.04). CONCLUSION: According to our study, infective endocarditis has always touched a young population in Tunisia, rheumatic valve disease is still the predominant underlying heart disease and both streptococcus and staphylococcus are most frequently isolated. Mortality remains high despite considerable progress in terms of diagnosis and therapy.

[Determinants factors of hospital morbidity and mortality after reintervention of valve replacement]. / Facteurs déterminants dans la morbi-mortalité hospitaliére des réinterventions d un remplacement valvulaire.

BACKGROUND: Valve surgery involves valvular substitutes that expose to different types of complications that can lead to re subsequent interventions. AIM: was to identify the predictors factors of in-hospital morbidity and mortality of re interventions after valve replacement. METHODS: Retrospective study of 73 consecutive patients who underwent a re valve replacement between 1985 and 2010 in the Cardiovascular Surgical department of La Rabta hospital. RESULTS: The average age at further surgery was 44 years ( 15-80 years) and sex ratio of 0.87 . The average time between interventions was 10 years (3 days -33 years). Different etiologies were found prosthesis thrombosis (36.9% ). The overall hospital mortality was 36.9 % , 11 intraoperative deaths and 16 immediate postoperative deaths. CONCLUSION: The iterative intervention of valve replacement surgery is increasingly mastered by the surgical team. According to this study , the prognosis depends mainly on the patient preoperatively state, the cause of further surgery and its mode of occurrence.

[Is BNP assay useful for the diagnosis of acute dyspnea in emergencies departments?]. / Est-ce que le dosage du brain natriuretic peptide est utile dans le diagnostic de la dyspnée aiguë aux urgences?

BACKGROUND: It would be interesting to the emergency doctor to have at his disposal a helpful diagnostic tool like brain natriuretic peptide (BNP). Such assay is simple, available and reliable. AIMS: To report our experience on the role of BNP in the etiological diagnosis of acute dyspnea (AD) in emergency room (ER) and to assess the cost-effectiveness ratio of such diagnosis strategy. METHODS: A prospective study conducted in the ER of Rabta university teaching hospital of Tunis, from March 1st to June 20th 2010, involving 30 consecutive patients presenting to the emergency for AD. All patients underwent echocardiography in their acute phase and benefited from the dosage of BNP during the first 4 hours. The echocardiography parameters were collected by a single operator who was unaware of the results of the BNP dosage. RESULTS: The mean age of patients was 72.8years with a sex ratio of 1.5. AD was of orthopnea type in 9 cases and stage III NYHA dyspnea in the other patients. Clinical and radiological signs of left heart failure were noted in 30% of cases. Ultrasound data have objectified systolic dysfunction in 4 cases, diastolic in 3 cases and systolic plus diastolic in 10 cases. The BNP levels were below 100 pg/ml in 10 cases with pulmonary origin of the AD. A BNP level between 100 and 400 pg/ml was noted in 3 cases. In our study, the clinical probability of AHF prior to performing the test was estimated at 53% and estimated at 100% after the BNP assay. The BNP assay has reduced the length of stay in the emergency department 4 to 5 days and saved nearly 50% of the cost of care per patient. CONCLUSION: The BNP assay, has allowed us to confirm the AHF all cases. Given the prognostic value and economic benefit of this test we recommend its use in ER of our country.

Epidemiology and management of heart failure with reduced ejection fraction in a Tunisian university hospital.

INTRODUCTION: Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital. METHODS: This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017. RESULTS: The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20-40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004). CONCLUSION: This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis.

New onset heart failure with reduced ejection fraction management: single center, real-life Tunisian experience.

BACKGROUND: Heart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations. RESULTS: Our study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%. CONCLUSIONS: Our study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions.

[Results of surgical treatment of intracardiac total anomalous pulmonary venous return]. / Résultats du traitement chirurgical du retour veineux pulmonaire anormal total intracardiaque :à propos de 7 cas.

BACKGROUND: Total anomalous pulmonary venous return (TAPVR) has a rather low incidence (1-3%) of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. AIM: To report our results and long-term follow-up of surgical management of intracardiac TAPVR. METHODS: Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. RESULTS: The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. CONCLUSION: Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique.

Atrial natriuretic peptide and brain natriuretic peptide release in human essential hypertension.

Hypertension is associated with an increase in vasoactive peptides, but conflicting results are reported concerning their causes of elevation. In this study, cardiac vasodilator hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), and vasoconstrictor hormones (renin, aldosterone, cortisol, metanephrins) were determined in 36 hypertensive subjects (HT) without left ventricular hypertrophy (LVH), 19 healthy subjects without family hypertension (NTFN) and 35 healthy subjects with family hypertension (NTFH). Plasma levels of ANP and BNP were significantly higher (p<0.04) in HT subjects (28.1 +/- 6.1 and 22.7 +/- 6.8 pg/ml) compared to NTFN (13.4 +/- 3.3 and 6.1 +/- 1.5 pg/ml) and NTFH (12.5 +/- 1.4 and 7.2 +/- 1.3 pg/ml) subjects, respectively. No significant differences were observed in ANP and BNP concentrations between NTFN and NTFH. Measurement of vasoconstrictor hormones showed no significant differences between the three groups. Plasma ANP and BNP concentrations were significantly correlated in both HT (r=0.73; P<0.001), NTFN (r=0.71; P<0.002) and NTFH (r=0.53; P<0.003) subjects. ANP values were significantly related to systolic blood pressure (r=0.34; P<0.05) in the HT group while BNP values were not. The echocardiographic findings were not correlated with ANP or BNP in the HT patients. This suggests that natriuretic peptides increase is related to the blood pressure elevation rather than LVH to reduce detrimental high BP effects.

[Mitral stenosis a rare antology of diffuse pulmonary ossification]. / Le rétrécissement mitral cause rare d'ossification pulmonaire diffuse.

BACKGROUND: Diffuse pulmonary ossification is a rare entity with unknown pathogenesis. It presents with the formation of mature bone within the pulmonary parenchyma. Pulmonary ossification can be idiopathic or associated with diffuse and chronic lung disease, system disorders or heart disease essentially mitral stenosis. AIM: We report a case of a 49 year-old woman with long standing mitral stenosis. CASE: The patient had undergone a valve replacement with a mechanical prosthesis. She complains from dyspnea on exertion and dry cough. Frontal chest radiograph shows bibasilar confluent calcific areas of increased opacity. Computed tomography scans confirmed the presence of ossified acinar clusters. Other aetiologies of diffuse pulmonary ossification were eliminated by different complementary exams. CONCLUSION: Diffuse pulmonary ossification is slowly progressive. Patients are generally asymptomatic or complain from mild symptoms. Most cases are of diffuse pulmonary ossification are diagnosed during autopsy. Establishing a prognosis is difficult as few living cases are diagnosed.

Echocardiographic characteristics of cardiac involvement in Systemic lupus erythematosus.

INTRODUCTION: Echocardiography is a non invasive tool for the assessment of systemic lupus erythematesus (SLE) involvement . AIM OF STUDY: to investigate the cardiac involvement in patients diagnosed with SLE assessed by echocardiography and to study relationship between several factors and cardiac manifestation . METHODS: retrospective study of 76 patients with diagnosis of SLE between 2008 and 2017. All patients were asssesed by echocardiography .Patients were assigned into cardiac abnormalities group and non cardiac abnormmalties and compared to study relations between several factors and cardiac manifestation . RESULT: Cardiac involvement was found in echocardiography in 52% of patients (40 patients. Echocardiographic findings showed 12 cases ( 38 %) of pericardial effusion . Valvular abnormalities were observed in 19 cases (48 %), Myocardium was involved in 5 cases ( 12.5 %). there were no cases of myocarditis , High arterial pulmonary hypertension was reported in 4 cases (10%). Men were more vulnerable to cardiac involvement in lupus , there was signifiant relationship between disease duration and cardiac abnormalities (p 0.04 ), age was not associated significantly to echocardiographic abnormalites ,positif antiphospholipid antibodies(aPL+) was observed in higher frequency in cardiac involvement group with p<0.01 and especially in valvular anomalies Conclusion : Echocardiography should be routinely indicated for evaluation of cardiac involvement during SLE. These manifestations are most often moderate and asymptomatic. Pericardial effusion, and valvular involvement were the most frequent abnormalities.

[Late reinterventions after repair of common arterial trunk]. / Les reinterventions tardives apres reparation du tronc arteriel commun.

BACKGROUND: The common arterial trunk is a heart disease in witch a unique arterial trunk, with a unique ventriculo-arterial valve, exits from the ventricular mass and supply directly the coronary, the aortic and also the pulmonary arterial circulations. Its anatomic repair is now possible but necessitates the use of conduit in pulmonary position. AIM: To evaluate the incidence and the causes of late reinterventions after repair of common arterial trunk. METHODS: We retrospectively study the outcome of 17 patients who underwent repair of common arterial trunk between January 1983 and December 2006. The 15 early survivors were followed during a median period of 7 years (range 10 months and 13 years). RESULTS: Nine reinterventions were necessary in 8 patients. Only one conduit reintervention was necessary in the 8 patients. Freedom from conduit reintervention was 73% at 5 years and 33% at 10 years. Three reinterventions were performed in 2 patients for severe truncal valve incompetence, including repair in 2 cases and replacement in one case. Freedom from truncal valve reintervention was 67% at 10 years. CONCLUSION: Late reinterventions are inevitable after repair of common arterial trunk. The most common reasons are conduit stenosis and truncal valve incompetence.

Evolutive profile and prognosis factors of chronic heart failure in a Tunisan center.

BACKGROUND: Therapeutic approach of heart failure (HF) has evolved considerably to improve the prognosis that remains dark .The purpose of our study was to analyze the evolution of the  ejection fraction (FE) heart failure  and to identify predictors  factors of mortality and re-hospitalization. METHODS: Our study is prospective including 200 consecutive cases of HF patients with EF ≤ 40% during the period from 2012 to 2015. Clinical, para-clinical, evolultive  data were collected at admission and atb3 months. The main study  criteria is the occurrence of a major event:  cardiac death and or rehospitalization for HF. RESULTS: The mean age of  our patients was 56 + - 12. with male predominance.  Ischemic etiology was the main causes  (45%). All patients had  pharmacological treatment of HF , 88% patients were put on ACE inhibitors, 91% on beta-blockers(BB)  and 49% on spiranolactone, loop diuretics were prescribed in 95% of cases. The optimal dose was reached for the main molecules (IEC, BB and spiranolactone) only in  respectively  12%, 15% and 10% patients  . Myocardial revascularization was performed in 36 patients (40%). Among  the 45 patients with  valvulopathy   surgical treatment  was indicatetd for   _ patients(17%).  A  cardiac resynchronization theray   with defibrillator  was implanted in 30 patients, an automatic defibrillator without resynchronization was implanted   in 15 patients (7.5%). No patients  from our study had  a cardiac  transplantation or rehabilitation.Hospital and  3-months  mortality was   5% and 17.5% respectively, .Hospitalization rate was 36% and was highest in the first three months after discharge.  The multi-variable analysis  revealed four independent mortality factors:  diabetes,  EF , ischemic etiology, and TAPSE.  Age, stage IV dyspnea, atrial fibrillation , and SLG <-12.were independent predictors  factors of rehospitalization. CONCLUSION: is a serious  disease associated   with  poor prognosis despite advanced therapeutics.

Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial.

BACKGROUND: Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited. OBJECTIVE: The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. METHODS: A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. RESULTS: Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. CONCLUSIONS: This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. TRIAL REGISTRATION: ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX). REGISTERED REPORT IDENTIFIER: RR1-10.2196/8523.

[Q fever endocarditis: a case report]. / Endocardite infectieuse a coxiella burnetii. A propos d'un cas.

Do we bring back the observation of a patient aged of 42 years having a mitro-aortic valvulopathy who present since 3 months a level III dyspnea, a fever to 39 degrees C, a change of the general state and a splenomegaly. To the chest x-ray we note a pulmonary parenchymatous focus. Echocardiography puts in evidence a mitral illness to stenosis predominance and an aortic illness complicated of a graft bacterial with an abscess of the mitro-aortic trigone. Haemocultures were negative and the serology of the Rickettsia was positive. The diagnosis of infective endocarditis to Coxiella Burnetii is kept and is the patient put under Doxycycline 200 mg/j, Hydroxychloroquine 2 cp/j and Ofloxacine 400 mg/j. Will the two first antibiotics be pursued to the 18th month. The patient benefited, after 20 days of three antibiotics therapy, of a duplicate aortic and mitral replacement with simple following.

[Delays in acute myocardial infarction treatment: results of a multicenter study in the district of Tunis (Tunisia)]. / Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres. Résultats d'une étude multicentrique.

OBJECTIVE: We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year (from March 2000 to February 2001). METHOD: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender (OR = 2.3, p < 0.001), age (OR = 1.02, p < 0.01) and health insurance (OR = 1.5, p < 0.01). 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularisation of thrombolysis, 51% on men vs 31% on women (p < 0.01). The fatality rate was higher on women 14% vs 6.4% on men (p < 0.01) at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age (RR = 1.08, p < 0.001) and delay (2.56 p < 0.001) and tobacco smoking (RR = 2.83, p < 0.0001). CONCLUSION: This study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance.

[Secondary prevention of cardiovascular diseases: knowledge and practices of patients]. / Prevention secondaire des maladies cardiovasculaires: connaissances et pratiques des malades.

UNLABELLED: The aim of our study is to assess the degree of awareness and practices of patients with cardiovascular disease. METHOD: During October 2002-February 2003, we conducted a CAP study (Knowledge, attitudes, behaviors) at some outpatient clinic visit of Tunis District. Using a standardized questionnaire, investigators have collected demographic and personal data, informations about risk factor levels, knowledge and attitudinal characteristics related to risk factors for patients who satisfied the inclusion criteria. 443 patients have been interviewed (68.4% are men); 40% have more than 65 years old. Half of patients have never been schooled. Most of them have low socioeconomic level (38.8%) or middle one (56.0%). RESULTS: 66.9% of men have quit tobacco smoking and 19.5% still smoking 41.3% of patients have some difficulties to change their lifestyle. The difference is statically significant by educational and occupational levels. Almost 60% of them used to practice daily moderate physical activity, which was more frequent among men then women (p<0.01). During the last year, majority of patients has had checked their blood pressure (98%), glycaemia (94%) and cholesterolemia (94%). However, about 57% to 67% of patients knew if they have hypertension, diabetes or hypercholesterolemia. Most of patients are aware that healthy lifestyle can be important in preventing heart attacks and stroke and that control of blood pressure, cholesterolemia and glycaemia reduce recurrence of these attacks once they happened. CONCLUSION: CVDs prevention and control is facing the crucial question on lifestyle change and enhancing patients responsibility in their own health promotion.

[Evaluation by Doppler echocardiography of hemodynamic profil of mitral bileaflet prothesis. Report on 90 cases]. / Evaluation par echocardiographie Doppler du profil hemodynamique des protheses mitrales. A propos de 90 cas.

From 1981 to 1999 Mitral bileaflet prosthesis was implanted to 90 patients. Doppler echocardiography was performed for these patients between January and March 2002 with a mean deadline of 111 months after the intervention. 36 were women (40%) and 54 were men (60%) the mean age was 41 years (20 - 70 years) The mitral bileaflet prosthesis was a Saint Jude in 65 cases, Jyros 8 cases, Carbomédics 7 cases, Sorin Bicarbon 7 cases, Edwards Duromédics 2 cases et an ON-X in one case. The maximal transprosthetic gradient was 15.7 mm Hg +/- 5.06 (6.25 mm Hg). The mean transprosthetic gradient was 5.6 mm Hg +/- 1.07 (39.5 mmHg). The mean prosthesis functional area 2.37 cm2 +/- 0.44 (1.75 cm2 et 3.60 cm2). Maximal gradient, mean gradient and prosthesis functional area are independent from kind mitral bileaflet prosthesis and from the prosthesis size.

[Early and long term results of mitral valvuloplasty]. / Resultats precoce et lointain de la valvuloplastie mitrale.

46 patients underwent Carpentier's mitral valve repair from 1986 through 2000. There were 15 males and 31 females. The mean age was 30 years. The cause of mitral regurgitation was rheumatic in all cases. According to Carpentier's classification, type II was present in 44% of patients, type III in 16% and type II-III in 40%. Left ventricular dysfunction was present in 10.8% of patients. Immediate echec of mitral valve repair occurred in 2.2% of cases. With a mean follow up of 79.6 months, late mortality was 12.2%. The overall result was excellent or good in 52.5% of cases, fair in 21.4% and poor in 26.2%. Deterioration of the result occurred in 18 patients (44% p Predictive factors of poor early and late results were age more than 40 years and a type III mitral regurgitation.