[Immediate results of repeat percutaneous mitral valvuloplasty]. / Résultats immédiats de la redilatation mitrale percutanée.

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy. However, this technique is costly, is not devoid of complication and success is not guaranteed. Indications of an attempted redo percutaneous mitral valvuloplasty (redo-PMV) are not well established. Hence the idea to study the immediate results of (re-PMV). PURPOSE OF WORK: The purpose of this study is to evaluate the immediate results of the re-PMV in patients with mitral restenosis and analyze the different clinical and laboratory findings to determine predictors of success of re-PMV to better selection of candidates for a new attempt PMV. METHODS: Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon succeeding a successful initial procedure, collected in the cardiology department of Habib Thameur hospital of Tunis between 1996 and 2011, in which we identified the data of clinical and paraclinical examinations. RESULTS: The mean age of patients was 43 ± 11 years [23; 63]. Of the population, 87.5% were female (five men and 35 women). The average time between the two procedures was 8 ± 4 years [1; 15]. The immediate procedural success defined by a mitral valve area greater or equal to 1.5 cm(2) and a grade less than or equal to 2 mitral regurgitation was obtained in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in three patients (7.5%). A cerebrovascular stroke occurred in one patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and an overall score of Padial greater than 10 were retained as predictors of failure. More the overall score of Wilkins is high (>8), more it is predictive of failure. The two components of the Wilkins score: valvular mobility and subvalvular apparatus (SVA) and the parameter of the redesign of the SVA score of Padial considered separately are also predictive of failure. Only a left atrial area less than or equal to 25 cm(2) was linked to high risk of severe MR. CONCLUSION: Redo percutaneous mitral valvuloplasty is a therapeutic alternative to surgery that is effective and promising interesting immediate results. Analysis of clinical and mainly echographic parameters is useful for predicting the success of the gesture, which will allow a better selection of candidates for re-PMV.

[Contribution of Doppler echocardiography in the diagnosis of arrhythmogenic right ventricular dysplasia]. / Apport de l'échocardiographie Doppler dans le diagnostic de la dysplasie arythmogène du ventricule droit.

The arrhythmogenic right ventricular dysplasia (ARVD) is a rare heart muscle disorder, occurring typically in young adults. The diagnosis remains difficult. The aim of our study was to evaluate the contribution of Doppler echocardiography in the diagnosis and screening for ARVD. Eighteen patients, followed in our cardiology department for ARVD and 10 "witnesses" in good condition were evaluated by echocardiography. We have essentially clarified the dimensions of the RV, its kinetics segmental, Doppler tricuspid flow, the study of movement of the tricuspid annulus in M-mode and tissue Doppler. We have compared the results of echocardiography at those of MRI and RV angiography. In our series, pathological measurement of the RV was found in all patients. No one of the control group had expansion of the RV. Twelve of our patients had abnormal wall motion. The displacement of the tricuspid annulus is reduced both in septal and lateral position. In tissue Doppler, Ea/Aa was lower than in healthy subjects in 15 cases in the lateral position and 16 cases in septal position. ETT is superior to MRI and RV angiography in the diagnosis of localized forms. The family survey, conducted in 38 parents of eight consenting families allowed to screen seven subjects. All these patients had abnormal Doppler echocardiography. Doppler echocardiography is a reliable and efficient investigation for the diagnosis of ARVD. It remains on the first intention to review a suspected ARVD.