Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report

Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.

Atrioventricular Septal Defect with Intact Interatrial Septum. Case Report

In atrioventricular septal defect (AVSD), anatomical lesions usually are an ostium primum atrio-septal defect;a common atrioventricular valve, an inlet ventricular septal defect (VSD). It is most often associated with major chromosomal abnormalities. It is the most common congenital disease in Down syndrome. Our case was an infant with a Down syndrome who was admitted for a dyspnea (stage 3 in New York Heart Association classification) and tachycardia. The diagnosis was made by a transthoracic echocardiography. It showed a rare variety of atrioventricular septal defect without an atrial septal defect. The child was treated successfully with one patch technic and no recurrence was noted.

Pre-Rupture Aneurysm of the Juxta and Sub-Renal Abdominal Aorta in Early Pregnancy: A Case Report

Aneurysm of the abdominal aorta is the result of a weakening of the arterial wall and corresponds to abnormal dilatations of the arteries defined as an increase ≥ 50% of the arterial diameter compared to the normal segments. A long asymptomatic, abdominal aortic aneurysm can be a catastrophic maternal-fetal situation due to the high risk of rupture induced by pregnancy. A rare association between aneurysm and pregnancy poses a problem of diagnosis and standardized management. The lack of knowledge of this condition regularly leads to a delay in management, which is a source of excess mortality. We report the case of a patient with a progressive pregnancy of 12 weeks of amenorrhea who presented with a large sub renal abdominal aortic aneurysm with thrombosis and fissuring in order to discuss the diagnostic and management aspects of this association.

Surgical Treatment of Tetralogy of Fallot with Pulmonary Valve Agenesis in a 22 Years Old Patient

Agenesis of pulmonary valve is a rare variant and severe form of Tetralogy of Fallot (ToF). The evolution is usually marked by respiratory and cardiac failure at early age, which needs early surgical correction. Uncorrected treatment of Tetralogy of Fallot diagnosed at adult age is infrequent and only few studies have been described. We present here a rare case of a 22 years old patient who presented with dyspnea since childhood. Subsequent investigations allowed diagnosis of treatment of Tetralogy of Fallot with agenesis of the pulmonary valve. Following the assessment, the patient underwent a surgical repair and the recovery was uneventful. The management of treatment of Tetralogy of Fallot with pulmonary valve agenesis in adult period remains complex, requiring different surgical techniques.

The Configuration of the Femoral Arterial Bifurcation’s Influence on Its Atherogenesis

Several theories point to the influence of the geometry of femoral arterial bifurcation in the formation and evolution of atherosclerosis plaques at the level of common, superficial and deep femoral arteries. The objective of this study is to correlate the degrees of calcifications of the femoral tripod with different morphological parameters, namely conicity, tortuosity, proximal and distal diameters of the arteries and angles between the common femoral artery (CFA) and the superficial femoral artery (SFA) and the profound femoral artery (PFA) and the superficial femoral artery. The results showed that only the tortuosity of the common femoral artery influences the formation of atherosclerosis plaque. These results allow us to predict the degree of calcification of the femoral tripod based on the tortuosity of the common femoral artery.

Sclerotherapy for Varicose Veins of the Lower Limbs

Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18;72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.