[Permanent cardiac pacing: about 234 patients]. / La stimulation cardiaque permanente : à propos de 234 patients.

BACKGROUND: Permanent cardiac pacing remains the only effective treatment for chronic, symptomatic bradycardia. In recent years, the role of implantable pacing devices has expanded substantially. AIM: To compare the situation of patients with critical brady arrhythmias before and after pacing focusing on indication for pacemaker implantation, frequency of re intervention and early and late complications. METHODS: Retrospective study performed over 24 years between 1984 and 2007 at the department of cardiology of Farhat Hached hospital. A total of 234 patients were included, and the database was formed by the patients' files and the protocols of implantation. RESULTS: The mean age of patients was 69.5 years. The most frequently reported signs and symptoms before implantation of pace maker were dizzy spells and syncope respectively in 53% and 29.1% of patients. Among the electrocardiographic alterations leading to an indication of pacemaker implantation, atrio-ventricular blocks were the most numerous at 74.4% followed by sinus node disease at 17.1%. Early complications were represented essentially by haematoma and infection of the pocket of pacemaker respectively at 2.9% for each one. After a mean follow up of 6.8 years, 88 patients (45.3%) still free of symptoms. Late complications include lead dislodgement and pacemaker syndrome at 2% for each one. CONCLUSION: The results of our study demonstrates that even the rate of complications following pacemaker implantation is not high, the follow-up of patients should be fast, complete, safe, and clear, and should include sufficient documentation.

Echinococcosis of the heart: clinical and echocardiographic features in 12 patients.

UNLABELLED: We describe the clinical and echocardiographic features in 12 patients with hydatid cyst of the heart who were screened between 1985 and 2001. Presenting symptoms have a wide variability but the main symptom was precordial pain. The electrocardiogram was always abnormal and showed T wave inversion in 8 cases, ST depression in 5 cases, incomplete right bundle-branch block in one case and atrial fibrillation in one case. Transthoracic echocardiography and transoesophageal echocardiography constitute the imaging procedure of choice for the diagnosis of cardiac hydatid cyst with a high sensibility, specificity. Computed tomography (CT) was performed in all patients and confirmed the echocardiographic data. MRI was performed in one patient with right atrium hydatid cyst location and confirmed the echocardiographic data. CONCLUSION: In the presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst, the diagnosis of cardiac echinococcosis is possible.TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcus disease in other intra- or extrathoracic locations.

[Epidemiologic features of myocardial infarction in young patients]. / Caractéristiques épidémiologiques de l'infarctus chez le sujet jeune.

Acute myocardial infarction (AMI) in persons under the age of 45 years is uncommon. To determine the clinical features in young patients presenting with AMI, we include 38 patients with mean age 35 years who survive from myocardial infarction. This disease is almost associated with cardiovascular risk factors, the most common of which are tobacco abuse (90%) and diabetes (20%). The coronary arteries are most often normal (40%) or single vessel (33%). In hospital complications are the same as in the older adult but the prognosis seems to be better.

[Surgically treated chronic aortic insufficiency: prognostic value of preoperative echocardiography]. / Insuffisance aortique chronique opérée: valeur pronostique des données échocardiographiques préopératoires.

Between March 1979 and December 1998, 38 patients with isolated chronic aortic insufficiency underwent aortic valve replacement. The aim of this study is to determine whether preoperative echocardiography parameters are useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. The global survival is 92% in one year and 89% in ten years. We conclude that on end systolic left ventricle diameter < 55 mm has good prognosis (p = 0.019) and there is a strong correlation between preoperative end systolic and post operative end systolic diameter an end diastolic left ventricular diameter > 70 mm and a left ventricular fractional shortening < 25% weren't predictive of a poor prognosis.

[Right atrium angiosarcoma disclosed by alveolar hemorrhage]. / Angiosarcome de l'oreillette droite révélé par une hemorragie alvéolaire.

UNLABELLED: Cardiac angiosarcoma represents a primary cardiac malignancy tumor whose early diagnosis is difficult because of its non specific clinical presentation. We present the case of a 57 years old patient with medium abundance hemoptysis. The chest X ray film and CT scan showed bilateral pulmonary infiltrate without cardiac anomaly. Abdominal echography showed disseminated hepatic tumoral lesions. A transthoracic echocardiography made after apparition of heart failure symptoms found a right atrium cardiac tumor. The hepatic lesion biopsy showed angiosarcoma. CONCLUSION: In presence of uncommon systemic symptoms like diffuse pulmonary lesions associated with cardiac anomaly, the diagnosis of angiosarcoma should be included.

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis.

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.

[Feasibility of transesophageal echocardiography during balloon mitral valvulotomy]. / Echographie transoesophagienne multiplan durant la dilatation mitrale percutanée.

The purpose of this study was to demonstrate the utility and feasibility of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). 40 patients were included with symptomatic rheumatic mitral valve stenosis with mean age of 31 years. Transoesophageal echocardiographic monitoring allowed an immediate detection of mitral insufficiency in 10 patients. This latter was moderate in eight cases and severe in two cases indicating to stop the procedure. The addition of on-line TEE during PBMV facilitate and confirm the success of the procedure and detect complications.

[Cardiovascular manifestations of Kawasaki syndrome. Value of echocardiography in diagnosis and progression]. / Manifestations cardiovasculaires du syndrome de Kawasaki. Apport de l'échocardiographie dans le diagnostic et l'évolution.

Seven children with suspected Kawasaki disease were studied by echocardiogram. Coronary abnormalities occurred in all patients, associated with: thrombosis (2 patients) small pericardial effusion (2 patients) poor ventricular function (2 patients), moderate mitral regurgitation (2 patients). Patients received treatment with intravenous gamma globulin, aspirin, and anticoagulant. Echocardiogram abnormalities disappeared between 1 and 26 months after the onset of the disease; only persist coronary hyperechogenecity in 6 patients.

[Cardiac tamponade revealing systemic scleroderma]. / Une tamponnade cardiaque révélatrice d'une sclérodermie systémique.

The frequency of pericardial involvement in Systemic Sclerosis (SSc) is high but usually was asymptomatic and cardiac tamponnade was exceptional. We report a case of systemic sclerosis (scleroderma) revealed by cardiac tamponnade. This case illustrate the value of transthoracic echocardiography in the diagnosis of cardiac tamponnade in systémic sclerosis.

[Cardiopericardial echinococcosis]. / Echinococcose cardiopéricardique.

UNLABELLED: Cardiac hydatid cysts are rare and represent 0.5 to 2% off all hydatid cyst in human. We describe clinical and echographic features in 12 patients with cardiac echinococcosis, admitted between 1992 and 2001. Average age was 40 years (16-60 years). The cysts were located in the left ventricle wall (3 patients), right ventricle wall (3 patients) right atrium (3 patients) and pericardial cavity (3 patients). Cardiac Hydatid cyst diagnosis was established by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in all cases. Computed tomography and magnetic resonance imaging confirmed echographic finding. All patients were operated. The operation finding confirmed the imaging data. Only one patient died in the post operative period. No recurrence or associated complication were reported in the late follow up. CONCLUSION: In presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst the diagnosis of cardiac echinococcosis is possible. TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcosis diseases in other intra or extrathoracic location.

[Candida albicans prosthetic valve endocarditis. Two cases]. / Endocardite infectieuse à Candida albicans sur prothèse. A propos de deux cas.

TWO CASES: Candida albicans prosthetic valve endocarditis (PVE) is a rare entity with serious complications. We report two cases of Candida albicans PVE, confirmed by culture of the prosthetic valve. The first patient died twenty days after surgery with cerebral bleeding secondary to multiple mycotic aneurysms, the second patient was still alive eight months following a Saint-Jude aortic valve replacement and prolonged antifungal therapy. The difficulty of diagnosis and management are discussed.

[Value of early systematic transoesophageal ultrasonography after mitral valve replacement by Saint-Jude prosthesis]. / L'apport de l'échographie transoesophagienne précoce systématique après remplacement valvulaire mitral par une prothese Saint-Jude-Médical.

The aim of this study was to assess the value of the routine multiplane transoesophageal echocardiography (TEE) in the early postoperative period after mitral valve replacement with a Saint Jude Médical (SJM) mechanical prosthesis. This prospective work enrolled 56 patients who have been operated between September 1999 and September 2001, all these patients had a multiplan TEE after 14.7 days (8-29 days) of post-operative. The effect of peri-prosthetic leaks was 59%. They were always minimal and asymptomatic. 68% of them disappeared at the late exam. An asymptomatic intermittent blockage of an leaflet had been noted in one patient. It appears to us today indispensable to achieve a systematic TEE in the early post operative period after mitral valve replacement. This exam remains little aggressive and comfortably supportable by the patient in look of information brought.