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.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Mortality of Children with Mechanical Valve Prostheses at the CUOMO Cardio-Pediatric Center of University National Hospital of Fann (Dakar)

Introduction: Mechanical valve replacement in pediatric age is a dreaded but sometimes inevitable surgery. The purpose of this study was to determine the mortality of children with mechanical valve prostheses in the short, medium and long term. Patients and Methods: This was a retrospective and descriptive study conducted at the CUOMO cardio-pediatric center at Teaching National Hospital of Fann between January 1st, 2017 and December 31st, 2021. We included, children whose age is less than or equal to 16 years of age and who have benefited from a mechanical valve replacement and with a follow-up period of more than 6 months post-operative in the CUOMO cardio-pediatric center. Patients whose age at the time of surgery was over 16 years were excluded;patients who have benefited from bioprosthesis or valvular plastic surgery alone;as well as patients for whom a follow-up of more than 6 months was not found. Statistical analyses were carried out using the SPSS (Statistical Package for Social Science) software version 18 to calculate averages and percentages. Results: We included 85 patients. The average age was 12.84 ± 2.52 years. The male gender predominated with a sex ratio of 1.65. Dyspnea was found in 96.47% of children. Pure mitral regurgitation was the most common valve disease found in 67.06%. Rheumatic etiology was noted in 87.06% of cases. Mono valve replacement was performed in 84.71% of patients and double valve replacement in 15.3% of cases. Major mechanical complications were reported in 8 patients including 5 severe aortic mismatch cases. Hemorrhagic complications were observed in 4 patients requiring surgery. Hemodynamic complications were dominated by right ventricle dysfunction in 14 patients. Supraventricular rhythm disorders were present in 11 patients and one case of ventricular tachycardia. We found six cases of infectious endocarditis. Eight deaths were recorded with a mortality rate of 5.88%. Significant predictors of mortality were stage IV dyspnea of NYHA and preoperative overall heart failure. Conclusion: Our study showed good results in terms of short-, medium- and long-term mortality. Complications related to mechanical valve prostheses are not negligible, hence a rigorous lifetime monitoring after surgery.