Cardiac Tamponade: Epidemioclinical, Therapeutic and Evolutionary Aspects at the University Hospital of Brazzaville

Objectives: Contribute to improving the management of cardiac tamponade in Congo. Background: Cardiac tamponade is an acute or subacute compression of the heart chambers by pericardial effusion responsible for uncertain prognosis for patients. The objective of this study is to help improve the management of patients with cardiac tamponade. Patients and Methods: We conducted a retrospective and descriptive study at the University Hospital of Brazzaville, from January 2015 to December 31, 2019. Included were all patients hospitalized for cardiac tamponade. Epidemioclinical, therapeutic and evolutionary data were analyzed. Results: An overall of 14 patients were divided into 9 men (64.2%) and 5 women (35.7%), i.e. a sex ratio of 1.8. The mean age of patients was 34.2 ± 15.1 years old (18 years to 64). The most represented comorbidity was hypertension (n = 2;14.3%). The most frequent clinical sign was dyspnea (n = 14;100%). The ECG showed diffuse and concordant repolarization disturbances (n = 14;100%), sinus tachycardia (n = 13;92.8%), microvoltage (n = 12;85.7%). Cardiomegaly was constant (n = 14;100%). In terms of transthoracic ultrasound, we found: diastolic compression of the right ventricle (RV) (n = 12;85.7%), dilation of the inferior vena cava (IVC) (n = 12;85.7%). Treatment consisted of crystalloid vascular filling in all patients, pericardial puncture (n = 7;50%), surgical drainage (n = 12;85.7%), anti-tuberculosis drugs (n = 11;78, 6%), antimitotics could be administered in one case (n = 1;7.2%). Two cases of death were recorded, i.e. 14.3%. Conclusion: Cardiac tamponade, although it is a rare condition, remains a serious pathology and difficult to manage in our context.

Peri-Annular and Septal Abscesses in Infectious Endocarditis. About 3 Cases Observed at the University Hospital of Brazzaville

Infectious endocarditis (IE) is a relatively rare but serious condition. We report 3 cases of infectious endocarditis complicated by peri-annular and/or septal abscess. The patients aged 24, 25 and 28 were all male. Global heart failure was observed in 2 cases. Atrioventricular block was noted in 2 cases (complete syncopation: 1 time;2nd degree Mobitz 2 1 time). Transthoracic echocardiography made it possible to diagnose abscess in all cases (aortic and septal peri-annulus: once, septal only: twice). The aortic insufficiency was grade 2 in all cases, mitral insufficiency grade 2 in 1. The front door was found once, with a dental location. Blood cultures were negative in all cases. A bi-probabilistic antibiotic therapy made it possible to control the infectious process in all the patients. Cardiac surgery, indicated in all cases, was performed in 1 case, consisting of flattening the abscesses and then placing a pacemaker in the patient with complete syncopal atrioventricular block. The outcome of all patients was favorable. Return to permanent sinus rhythm, associated with complete left bundle branch block, was noted at the 4th year of development in the pacemaker wearer. The other 2 patients are still awaiting medical evacuation.