[Tableau d'insuffisance cardiaque congestive révélant une myocardite lupique : cas clinique]. / Lupus myocarditis presenting as acute congestive heart failure : A case report.

Systemic lupus erythematosus (SLE or lupus) is a disease in which the immune system attacks healthy cells and tissues throughout the body. Lupus myocarditis is a life-threatening condition, observed clinically in 3-9 % of patients with SLE. We report the case of a patient followed for multisystem SLE, presenting with de novo heart failure with severe left ventricular dysfunction revealing lupus myocarditis.

[Association of a myxoma of the left atrium and a mitral stenosis : About a case]. / Association d'un myxome de l'oreillette gauche et d'un rétrécissement mitral : à propos d'un cas.

Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes.

[Rare case of incomplete Shone syndrome in adult man with marfanoid morphotype]. / Un cas rare de complexe de Shone incomplet chez un homme de 35 ans avec un morphotype marfanoïde et revue de la littérature.

Shone syndrome is a rare and complex congenital heart disease. It is characterized in its complete form, by a constellation of the four potentially obstructive lesions of the left heart side. Incomplete Shone's complex includes 2 or 3 of the characteristic lesions which, include a supravalvular mitral membrane, valvular mitral stenosis (MS) by a parachute mitral valve (PMV), subaortic stenosis and aortic coarctation (Coa). We describe here, the case of a 35-year-old man, hospitalized for chronic dyspnea and in whom, the diagnosis of incomplete Shone's complex is retained by echocardiographic analysis. Observed lesions include a parachute mitral valve responsible for mild regurgitation and moderate mitral stenosis, bicuspid aortic valve, and pseudo interruption of the aorta with dilatation of the ascending aorta and a patent ductus arteriosus. This case is the 2nd on 3942 patients in Drighil congenital heart disease registry.

Spontaneous calcific cerebral embolization revealing a calcified rheumatic mitral stenosis: a case report.

BACKGROUND: Cerebral cardiac embolism accounts for an increasing proportion of ischemic strokes and transient ischemic attacks. Calcified cerebral emboli are rare and mostly iatrogenic secondary to heart or aorta catheterization. However, spontaneous cerebral calcified embolism in the case of calcified aortic valve is very rare and there are less than 10 case reports in the literature. And a more interesting fact is that such an event, in the context of calcified mitral valve disease, has never been reported, at least to our knowledge. We are reporting a case of spontaneous calcified cerebral embolism revealing a calcified rheumatic mitral valve stenosis. CASE PRESENTATION: We report a case of a 59 year-old Moroccan patient, with a history of rheumatic fever at the age of 14 and no history of recent cardiac intervention or aortic/carotid manipulation, who was admitted to the emergency department after a transient ischemic attack. Physical examination at admission found normal blood pressure of 124/79 mmHg and heart rate of 90 bpm. A 12-lead electrocardiogram showed an atrial fibrillation, no other anomalies. Unenhanced cerebral computed tomography imaging was performed, revealing calcified material inside both middle cerebral arteries. Transthoracic echocardiography was performed, showing severe mitral leaflets calcification with a severe mitral stenosis, probably due to rheumatic heart disease. Cervical arteries Duplex was normal. A vitamin K antagonist (acenocoumarol) was prescribed, targeting an international normalized ratio of 2-3 and mitral valve replacement surgery was performed using mechanical prosthesis. Short- and long-term health, with a 1-year follow-up, were good and the patient did not experience any stroke. CONCLUSION: Spontaneous calcified cerebral emboli secondary to mitral valve leaflet calcifications is an extremely rare condition. Replacement of the valve is the only option to prevent recurrent emboli and outcomes are still to be determined.

Urothelial carcinoma associated with infective endocarditis due to a Leuconostoc Species: A rare case report.

Introduction: and importance: Leuconostoc is a genus of gram-positive bacteria, this type of bacteria, which can be found in green vegetables and are used in wine, cheese, and sugar production, is an uncommon cause of disease in human beings. Case report: We report the case of a 60 years old male, with a medical history of nasopharyngeal carcinoma treated by chemotherapy and radiotherapy. The patient was admitted for total hematuria and episodic fever for the last 2 months. blood test found an anemia at 5g/dl, hyperleukocytosis at 18,000/ml,The transthoracic echocardiography showed, moderate mitral regurgitation, severe mitral stenosis with a valve area of 1.5cm2, and a mobile vegetation measuring 14 × 6 mm on A2 part of the anterior mitral valve. Transesophageal echocardiography (TEE) showed a 16 × 8 mm mitral vegetation. An empirical antibiotic therapy then adapted to the antibiogram. Clinical discussion: our patient is at an extremely elevated risk for infective endocarditis. This case is interesting because the pathogenic bacterial species for IE are typically staphylococci and streptococci, Two similar cases of Leuconostoc spp endocarditis were found in the literature, effective therapy of penicillin-resistant group viridians streptococci with combination therapy, our team opted for empiric treatment with ceftriaxone associated to gentamycin. Conclusion: It is critical for clinicians to be aware of the many pathogenic organisms, including Leuconostoc species. It is also clear that a higher index of suspicion must be maintained in patients with multiple predisposing factors such as the patient in the case presented.

Prévalence des facteurs de risque cardiovasculaire et leur association avec les facteurs socio-économiques dans une population marocaine atteinte du syndrome coronarien aigu

Le but de la présente étude était d'évaluer la prévalence des facteurs de risque cardiovasculaires conventionnels et leur association avec des facteurs socio-économiques dans une population traitée pour un syndrome coronarien aigu, au département de car¬diologie du CHU Ibn Rochd de Casablanca au Maroc. Méthode : L'étude a été réalisée chez 199 patients consécutifs au cours de la phase aiguë d'un syndrome coronarien aigu. Les critères d'inclusion étaient l'ad¬mission dans les 24 heures après le début de la dou¬leur thoracique. Le facteur de risque cardiovasculaire conventionnel le plus courant chez ces patients était essentiellement le tabagisme, suivi de l'hypertension artérielle et du diabète de type II. Résultats : La prévalence de l'hypertension et du diabète était plus élevée chez les femmes atteintes du syndrome coronarien aigu que chez les hommes. Cette différence s'est également maintenue après ajustement en fonction de l'âge. Une fréquence plus élevée d'individus avec un stress au travail faible et modéré que des individus présentant des niveaux de stress au travail élevés a été observée. Cependant, les femmes qui souffraient d'un syndrome corona¬rien aigu avaient un niveau de stress au travail plus élevé que les hommes. Cette différence statistique a disparu lorsque l'âge a été utilisé comme covariant. Il n'y avait pas de différence statistique dans l'acti¬vité physique liée au travail entre les hommes et les femmes. De plus, il n'y avait aucune association entre le niveau de stress au travail, l'activité physique liée au travail et les facteurs de risque cardiovasculaires conventionnels. Conclusion : Les facteurs de risque conventionnels les plus répandus chez les patients atteints du syn¬drome coronarien aigu inclus dans l'étude étaient le tabagisme actuel, le diabète et l'hypertension. Les femmes présentaient des niveaux de stress au travail plus élevés que les hommes. Cependant, les facteurs socioéconomiques n'étaient pas associés à la préva¬lence des facteurs de risque cardiovasculaires conven¬tionnels chez les hommes et les femmes

[Pulmonary arterial hypertension and porto-caval fistula in a 17 year old patient]. / Hypertension artérielle pulmonaire et fistule porto-cave découverte chez un jeune de 17 ans.

The authors report the case of a 17 year old patient with severe pulmonary arterial hypertension accompanied with a congenital porto-caval shunt. This patient had been admitted with dyspnoea on exertion with signs of pulmonary arterial hypertension on clinical examination. Echocardiography revealed a systolic pulmonary arterial pressure of 80 mmHg with no left heart anomaly or intracardiac shunt. Pulmonary investigations, as well as immunology, clotting, liver function and retroviral serology were all negative. A routine abdominal ultrasound showed a 10 mm proximal porto-caval fistula with no sign of portal hypertension. This case shows that anomalies of the portal system can cause pulmonary arterial hypertension even in the absence of any symptoms suggestive of hepatic disorder.

[Right intracardiac thrombus in Behçet's disease]. / Thrombus intracardiaques droits au cours de la maladie de Behçet.

The authors report the clinical history of a 22-year-old woman, followed for Behçet's disease, who presented a prolonged fever for two months associated with oral and genital ulcerations. There was an inflammatory syndrome, papillary oedema without brain injury. Echocardiography revealed moderate pericardial effusion and voluminous thrombosis of right atria and right ventricle. Chest computed tomography showed a lung infarction without thrombosis of pulmonary artery. The antiphospholipid antibodies were negatives. The treatment was based on corticotherapy and anticoagulation with a good outcome. In Behçet disease, cardiac involvement manifestations as pericardial, myocardial or endocardial lesions. This case underlines the rarity of cardiac thrombosis in Behçet disease.

[Study of variations in preload on the new echocardiography parameters of diastolic function in health subjects]. / Etude des variations de précharge sur les nouveaux paramètres échocardiographiques de la fonction diastolique chez le sujet sain.

The standard Doppler indices of transmitral filling are changed by variations in preload, relaxation and left ventricular compliance. Recent work in the literature suggests that the new parameters of diastolic function [mitral flux propagation speed in colour TM. (Vp) and tissue Doppler mitral ring velocities (Ea)] are independent of loading conditions. The objective of this work was to study the effect of modifications in the preload on Vp and Ea in normal subjects. Therefore, we have studied various Doppler echocardiographic measurements performed at rest, during a Trendelenberg manoeuvre at 60 degrees, and after sublingual administration of trinitrate in 25 healthy young (2 +/- 8 years) male volunteers. The end diastolic volume increased from 126 +/- 25 ml in the resting state to 145 +/- 24 ml during the Trendelenberg (p = 0.009) then decreased after trinitrate to 121 +/- 28 ml. The peak of the E wave increased from 88 +/- 12 cm/s in the resting state to 90 +/- 15 cm/s during the Trendelenberg and decreased to 70 +/- 11 cm/s after trinitrate (p < 0.0001). The peak Ea annular velocities of the septal and lateral walls were 22 +/- 4 cm/s and 15 +/- 1.6 cm/s in the resting state, without variation during the Trendelenberg (22 +/- 5 cm/s and 15 +/- 2 cm/s) but with a significant reduction after trinitrate to 19 +/- 5 cm/s and 13 +/- 2 cm/s (p = 0.02 and p = 0.002). In contrast, no significant variation was noted in Vp (60 +/- 14 cm/s in the resting state, 62 +/- 12 cm/s during the Trendelenberg and 59 +/- 14 cm/s after trinitrate). We conclude that Vp is not significantly affected by preload whereas Ea is not independent of the loading conditions.