Cardiac hydatid cyst in the interventricular septum: A literature review.

Human hydatidosis occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. This article is a review of all of the literature related to hydatid cyst in the interventricular septum included in the PubMed database. Forty-five cases reported between 1964 and 2019 were identified.

[Left ventricular non-compaction: What should be known!] / La non-compaction du ventricule gauche : ce qu'il faut savoir !

Isolated non-compaction of the left ventricle (NCVG) is a rare congenital cardiomyopathy resulting from the shutdown of normal embryogenesis of the myocardium. Its main feature is the existence of many deep heart-related ventricular trabeculations, generally located at the level of the apex of the left ventricle. Diagnosis is based on echocardiography and magnetic resonance imaging (MRI), and may be difficult in the atypical forms. The clinical presentation and the prognosis are very variable. Familial forms are not rare, ordering a family screening.

[Results of percutaneous mitral balloon commissurotomy in pregnant women about 12 cases]. / Résultats de la dilatation mitrale percutanée chez la femme enceinte à propos de 12 cas.

INTRODUCTION: Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable. AIM OF THE STUDY: The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment. PATIENTS AND METHODS: It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years. RESULTS: Mean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cm2 averaged to 2±0.35cm2. Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58±64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy. CONCLUSION: The effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.

[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.

[Management of cardiac arrhythmias during pregnancy]. / La prise en charge thérapeutique des troubles du rythme cardiaque au cours de la grossesse.

INTRODUCTION: Pregnancy can precipitate or exacerbate cardiac arrhythmias. Management of those arrhythmias is not very different from that in non-pregnant women. OBJECTIVE: In this review we tried to specify factors which favour arrhythmias in pregnant women and to show their specific management. METHODS: We carried out a search through PubMed using as keywords: pregnancy, cardiac arrhythmias, antiarrhythmics. RESULTS: Hemodynamic perturbations, direct electrophysiological effects of hormones and underlying heart disease are potential factors that can promote arrhythmias in pregnancy. Usually, no drug therapy is needed for the management of supraventricular or ventricular premature beats but potential promoting factors should be eliminated. In paroxysmal supraventricular tachycardia, vagal maneuvers should be tried firstly. Adenosine could be used if vagal maneuvers are ineffective. In pregnant women with atrial fibrillation, the goal of treatment is the conversion to sinus rhythm or the control of ventricular rate. Ventricular arrhythmias are usually uncommon during pregnancy and often occur in the absence of structural heart disease and are responsive to drug therapy. Symptomatic bradycardia rarely complicates pregnancy and its management does not differ from that in non-pregnant women.

[Thyroid ectopic tumour in the right ventricle of the heart]. / Tumeur thyroïdienne ectopique dans le ventricule droit du cœur.

The intracardiac ectopic thyroid tumour is rare. We report the case of a woman who was admitted for exertional dyspnea. The echocardiography revealed an obstructive tumor in the right ventricular outflow tract. Histological examination of the removed tumour showed the ectopic follicular thyroid tissue.

[Intramural hematoma of the thoracic aorta: Medical treatment or surgery?]. / Hématome intramural de l'aorte thoracique : traitement médical ou chirurgie ?

Intramural hematoma (IMH) of the aorta is an uncommon entity. This disease shares many characteristics with acute aortic dissection. Treatment of IMH remains controversial. We report the case of a 58 years old man with hypertension disease who was admitted in emergency department with suspicion of acute aortic dissection. Transoesophageal echocardiography showed IMH involving the descending aorta which spread afterwards to the ascending aorta. Patient was treated medically and echocardiographic follow-up showed that aortic hematoma remains stable. Two years later, patient is alive and the last TEE reveals disappearance of hematoma in ascending aorta and decrease of it in descending aorta.

[Peripartum cardiomyopathy]. / La cardiomyopathie du péripartum.

Peripartum cardiomyopathy is a rare and under recognized form of dilated cardiomyopathy, defined as a heart failure in the last month of pregnancy or in the first five months post-partum with absence of determinable cause for cardiac failure and absence of demonstrable heart disease. The incidence of peripartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancy. Advanced maternal age, multiparity, twin births, preeclampsia and black race are known risk factors. The etiology of peripartum cardiomyopathy remains unknown but viral, autoimmune or idiopathic myocarditis are highly suggested. The clinical presentation on patients with peripartum cardiomyopathy is similar to that of patients with systolic heart failure. The treatment is based on drugs for sympyomatic control. Studies in graeter populations are need to determine the role of immunosupressive treatment. About half patients of peripartum cardiomyopathy recover. The left ventricular ejection fraction and the left ventricular end-diastolic diameter are statistically significant prognostic factors. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The place of dobutamine stress test in counseling the patients who desire pregnancy must be more studied.

[Behcet disease: uncommon cause of myocardial infarction]. / Maladie de Behçet: cause rare d'inarctus du myocarde.

A 25-year-old man who was known to have Behçet's syndrome and who has no coronary risk factors suffered an acute anterior wall myocardial infarction which was complicated by a ventricular fibrillation. The diagnosis of Behçet's syndrome was based on recurrent thrombophlebitis, genital and oral aphtoses, posterior uveitis, positive pathergy test and HLAB51. About 20 cases of myocardial infarction were reported in the literature but the etiopathogeny, the causal relationship and the treatment are yet unknown.

[Correlation between aortic atherosclerosis at transesophageal echocardiography and coronary atherosclerosis]. / Corrélations entre l'athérosclérose aortique à l'échocardiographie transoesophagienne et l'athérosclérose coronaire.

The aim of this study was to test the relationship between atherosclerotic plaques in the thoracic aorta detected by transesophageal echocardiography and coronary artery disease detected by angiography. A prospective study was carried out in 103 patients who underwent coronary angiography. All patients underwent transesophageal echocardiography with imaging of the thoracic aorta. Aortic intimal changes were classified in 4 grades. The detection of aortic atheroma plaques was the strongest predictor of coronary artery disease. The presence of aortic plaques on transesophageal study had a sensitivity of 97.6% and a specificity of 80% for angiographically proved obstructive coronary artery disease. The positive predictive value of aortic plaque for obstructive coronary artery disease was 95.3% and the negative predictive value was 88.9%. Compared to the other segments, the detection of atherosclerotic plaque in the descending aorta has the highest sensitivity but the specificity was the highest in the ascending aorta. With older age and in women the specificity decreased, while the sensitivity increased.

[Assessment of pure isolated mitral valve insufficiency by Doppler echocardiography]. / Quantification des insuffisances mitrales pures isolees par l'echodoppler cardiaque.

Taking 33 patients having pure MI as a material, the authors find a correlation between regurgitation fraction obtained by calculation of outputs estimated by Touch's method and angiographic values. There is a statistically significant differences (P < 0.001) between regurgitation fraction of grade I to II and grade II to III MI. The ratio mitral integral time velocity (ITV) to Aortic (ITV) is an important semi-quantitative assessment of pure MI. In fact, a ratio > 1.3 identify important degree of MI with 82% sensitivity and 93% specificity. The authors estimate that there is a correlation between the ratio of regurgitant jet surface to left atrial surface found in TEE and their degree of MI in angiography with a significant difference (P < 0.001) between the ratio of grade I to II and grade II to III MI in angiography. A ratio higher than 40% allow to identify grade III MI at minimum.

[Endocavitary implantation of a permanent pacemaker in the contralateral side of right pneumonectomy: a case report]. / Implantation endocavitaire d'un stimulateur cardiaque définitif du côté controlatéral à une pneumonectomie droite: à propos d'une observation.

The definitive endocardial stimulation is easy to install, allows a stable position of the leads, and a satisfactory stimulation thresholds for a long period. The epicardial approach is reserved for some rare indications including infectious contexts. The endocardial approach has been considered for a 67 years man with a complete AV block and an atrial fibrillation. This patient had undergone a right pneumonectomy 15 years before. A VVIR pacemaker has been implanted successfully by an internal jugular vein approach, and connected to a passively fixed unipolar lead. Because of the right ventricle deformation which made it unrecognizable, even by angiography means, we had to face major difficulties to position the lead. The epicardial approach should be considered even if a direct unique lung controlateral approach is easier than homolateral, because it allows us a quick ventricular access under the view control.

[Place of definitive cardiac stimulation in cardiomyopathies and atrial arrhythmia]. / Place de la stimulation cardiaque definitive au cours des cardiomyopathies et des arythmies atriales.

Definitive cardiac stimulation ralatually used for brady cardia are going to be in the third millennium the specific therapy of arrhythmia and cardiomyopathy. In the last 10 years, may progress occur in the use of cardiac stimulation as hemodynamic therapy of obstructions hypertrophic and dilated cardiomyopathies resistant to conventional medical treatment. Moreover auricular stimulation present antiarrhythmic effects in some atrial arrhythmias as auricular fibrillations auricular diseases and atypical flutters. It confirmed by prospective multicentric randomized trials cardiac stimulation may represent in the future a good physiopathologic and efficient treatment free from the side effects of drugs that remain partially active. These perspectives needs to be modulated by the known and acceptable risks of a definitive cardiac stimulation.

[Infectious enterococcal endocarditis associated with Laubry and Pezzi syndrome]. / Endocardite infectieuse a enterocoque sur syndrome de Laubry et Pezzi.

Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocarditis risk. Authors report a case of an 18 years old young girl presenting an enterococcus infectious endocarditis associated to Laubry and Pezzi syndrome. Initial course is not favourable requiring a surgical treatment in the acute stage. Bacterial endocarditis combined with Laubry and Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoring factor is present.

[Dilated cardiomyopathy secondary to acromegaly]. / Cardiomyopathie dilatée secondaire à une acromégalie.

In acromegaly, dilated cardiomyopathy is rare. Indeed, arterial hypertension, coronary artery disease and hypertrophic cardiomyopathy are more common. The authors report a case of a 42-years-old man with dyspnea (class III NYHA) and palpitations. The cardiac echography showed a dilated cardiomyopathy. The investigations revealed an acromegaly as an etiology. Diagnosis was based on patient morphotype, a high level of growth hormone (GH) and a pituitary adenoma detected by magnetic resonance imagery. This case is characterized by the absence of arterial hypertension and hypertrophic cardiomyopathy. The coronary angiography was normal. Consequently, in this particular case, dilated cardiomyopathy seems specific to acromegaly.