Impact of Arterial Hypertension on Left Atrial Size and Function.

An increase in left atrial (LA) size in patients with arterial hypertension (AHT) has long been known to be associated with worse cardiovascular morbidity and mortality contributes to various complications, including atrial arrhythmias, stroke, and heart failure. The aim of our study was to evaluate the impact of arterial hypertension (AHT) on the LA size and function. This cross-sectional investigation included one hundred patients with essential hypertension without valvular or structural heart disease and atrial fibrillation. All recruits had a transthoracic echocardiography. LA volumes were measured by area-length method in transthoracic echocardiography at different cardiac cycle times. The indices of LA function were calculated: the reservoir function (total emptying fraction, total emptying volume, and expansion index), the conduit function (passive emptying fraction and passive emptying volume), and the pump function (active emptying fraction and active emptying volume). For all statistical tests, a p value ≤0.05 (represents the degree of significance) is considered statistically significant. In univariate analysis, LA was dilated in 9% of patients. The LA reservoir function and the pump function were increased, respectively, in 85% and 82% of patients. LA conduit function was impaired in 80% of patients. In bivariate analysis, the most powerful factors for this repercussion were diabetes (LA volume MAX dilated in nondiabetic patients (p = 0.037)), obesity (the reservoir function was impaired in obese patients (p = 0.015)), and antihypertensive drugs (the reservoir function was impaired in patients who take beta blockers (p = 0.023); the LA pump function was significantly impaired in patients treated with calcium antagonists (p = 0.012)). This study proved the impact of AHT on the LA size and function. Further investigations are necessary to evaluate the potential predictive value of LA remodeling in hypertensive patients like speckle tracking imaging.

Acute coronary syndrome with non ST segment elevation myocardial infarction revealing anomalous connection of the left anterior descending artery.

The occurrence of an acute coronary syndrome (ACS) with an anomalous connection of coronary artery (ANOCOR) identified as a culprit artery is very rare. This association may lead in some anatomical forms to a delay in coronary reperfusion. We report the clinical case of a patient admitted for high-risk Non ST elevation myocardial infarction (NSTEMI) in whom coronary angiography accidentally discovers an anomalous connection of the left coronary network from the right anterior. In light of this case and a review of literature, we discuss the peculiarities of these anomalous connections.

[Atheromatous coronary ectasia]. / Athérome coronaire éctasiant.

Coronary ectasias are relatively rare and poorly known pathologies. In adults they are caused most often by atheromas. These anomalies can expose to intracoronary thrombotic risk due to blood stasis. They are most often associated with stenosing lesions which may affect the prognosis. We here report three observations of patients hospitalized for acute coronary syndrome associated with ST elevation and mega coronary appearance detected on coronarography and conduct a review of the literature on this type of lesions.

[Fabry disease: about an uncommon case]. / Maladie de Fabry: à propos d'un cas atypique.

We here report the case of a 60-year old patient with congestive heart failure due to Fabry disease-related cardiopathy. This study has offered the opportunity to perform a literature review on cardiopathy related to this disease as well as to highlight the features of cardiac manifestation in Fabry disease.

[Ventricular septal defects: anatomic, clinical, therapeutic and prognostic aspects. 44 cases]. / Communications interventriculaires: aspects anatomocliniques, thérapeutiques et évolutifs. A propos de 44 observations.

OBJECTIVES: The aim of this study is to analyze epidemiologic, anatomic, clinical and prognostic aspects of ventricular septal defect (VSD) in the pediatric population in Morocco. METHODS: This retrospective descriptive study included 44 consecutive patients admitted to the cardiology B department of Rabat University Hospital Center from January 2000 through March 2003. The inclusion criteria were: VSD, isolated or associated with other left-right shunt defects, diagnosed by transthoracic echocardiography, and hospitalized in the service. RESULTS: VSD accounted for 10.6% of the congenital cardiac diseases hospitalized in our department. Patients' mean age was 2.25 +/- 2.6 years; the consanguinity rate was 29%. The primary clinical symptoms were dominated by failure to gain weight (84%), exertional dyspnea (82%), and repeated bronchitis (72%). Early complications were infundibular stenosis (4 cases), aortic regurgitation (3 cases), and infectious endocarditis (1 case). Nine children had other abnormalities, including 6 with trisomy 21. Echocardiography showed that membranous defects were by far the most common type (88%). All patients received symptomatic medical treatment. Only 31.7% (n=14) had surgery: 11.3% (n=5) to close the hole (corrective) and 20.4% (n=9) for pulmonary artery (palliative) banding. After two years of follow-up, those with surgical correction were all doing well. CONCLUSION: Surgically closing the VSD is the best way to avoid irreversible pulmonary arterial hypertension; banding should be only a temporary measure while awaiting corrective surgery.