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.

Epidemiological, Clinical and Angiographic Profile of Chronic Coronary Syndromes in the Catheterization Room. Single-Centre Study Carried Out in the Cardiology Department of the Chu Aristide Le Dantec in Dakar (Senegal)

Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1st, 2018 to December 31st, 2019) in the Cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclusion: Our study shows that screening for chronic coronary disease should be done especially in diabetics, elderly subjects and those with previous angioplasty taking into account symptoms and pretest probability to avoid unnecessary invasive procedures.

Epidemiological, Clinical and Etiological Profile of Rhythmic Emergencies at the University Hospital of Brazzaville, Republic of Congo

Objectives: To describe the epidemiological, clinical and etiological aspects of rhythmic emergencies at the University Hospital of Brazzaville. Patients and Methods: This was a retrospective descriptive study conducted in the cardiology and internal medicine department of the University Hospital of Brazzaville from January 1, 2014 to June 30, 2016. Were included, all patients admitted for a severe rhythm disorder diagnosed on the surface electrocardiogram. Rhythmic emergency was defined as a severe rhythm disorder of abrupt onset and required rapid management. Data entry and analysis were performed with Epi Info software version 3.5.1. Results: During the study period, 2269 patients were hospitalized, including 138 for a rhythmic emergency. The frequency of rhythmic emergencies was 6.1%. The patients were divided into 76 women and 62 men (sex ratio = 0.81). The mean age of the patients was 63.1 ± 16.9 years (extremes: 17 and 91 years). The socio-economic level was low for 103 patients (74.6%), medium for 26 (17.7%), and high for nine (6.6%). The average time to consultation was 13.7 ± 12.3 days. On admission, the signs were: heart failure (103 cases;74.6%) including 22 acute cases;dyspnea (94 cases;68%);palpitations (38 cases;27.5%);functional impotence (13 cases;9.4%);collapse (nine cases;6.5%);chest pain (two cases;1.4%). The type of rhythmic emergency was: rapid atrial fibrillation (103 cases;74.6%), ventricular tachycardia (14 cases;10.1%), junctional tachycardia (10 cases;7.2%), rapid atrial flutter (10 cases;7.2%), tachysystole (one case;0.7%). The context of occurrence was: hypokalemia (8 cases;5.8%), drunkenness (two cases;1.4%), acute gastroenteritis (one case;0.7%). Cardiovascular risk factors were: hypertension (62 cases;45.2%), smoking (17 cases;12.1%), dyslipidemia (12 cases;8.7%), diabetes (11 cases;8%), obesity (10 cases;7.2%). Underlying heart disease was: dilated cardiomyopathy (40 cases;29%), hypertensive cardiomyopathy (26 cases;18.8%), valvulopathy (24 cases;17.4%). Ischemic heart disease, chronic pulmonary heart disease, and cardiothyreosis were noted equally (n = 5;3.6%). No heart disease was noted in 24 patients (17.4%). Conclusion: Rhythmic emergencies are frequent in Brazzaville. They are dominated by atrial fibrillation and often occur on heart disease.

Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer Coronary Artery Disease Patients

Background: Fractional flow reserve (FFR)-guided interventions, though proved to be safe, continue to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. 7.7%;and PCI 32.4% vs. 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. The rate of 2-year major adverse cardiovascular events (MACE) was 0.9%. Conclusion: This study supports the use of FFR in determining treatment strategy in ACS or CCS patients with low MACE. Resting FFR value of <0.87 may be an alternative to intracoronary nitroglycerine/adenosine/Nikorandil-induced FFR in predicting positive FFR particularly in hemodynamically unstable patients, and who are intolerant to hyperemic drugs.

Preoperative Cardiovascular Risk Assessment Prior Non Cardiac Surgery: A Case Series of Patients Undergoing Urological Surgery in Ngaoundere, Cameroon

Background and objective: Preoperative cardiovascular risk control is critical to reducing the frequency of perioperative cardiovascular events and improving the survival and quality of life of surgical patients. This study aimed at assessing preoperative cardiovascular of patients undergoing urological surgery in Ngaoundere, Cameroon. Methodology: A cross-sectional study was carried at the urological surgery department of the Ngaoundere Islamic Clinic. Participants’ sociodemographic, clinical and biological data were collected and analyzed using Sphinx V5 software. Results: A total of 58 patients were included in the study. Their mean age was 61.33 ± 16.16 years. The most represented age group was the one over 70 years (34.50%). In total, 50 (86.20%) patients had low risk surgical procedures and 20 (34.5%) patients had poor functional capacity. Lee score was calculated for all patients with low functional capacity. Of these patients, 17 (85%) had a low risk of cardiovascular events. Conclusion: The present study reveals a low preoperative cardiovascular risk in urological surgery in Ngaoundere, Cameroon;however, this observation does not exclude the need of systematic evaluation of preoperative cardiovascular risk for better prevention of postoperative complications, in surgical setting in our context.

Right Atrium Myxoma in an 11-Year-Old Girl in Guinea

The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11-year-old girl weighing 22 kg, admitted for exertional dyspnea, dry cough, palpitations, hepatitis, abdominal bloating, fever evolving for more than 9 months without a history of known cardiovascular disease;referral from a pulmonology department for cardiomegaly and right pleurisy. At cardiac auscultation, the rhythm was irregularly fast at 130 beats without added noise with a blood pressure of 110/65 mmhg. In the lungs, there was silence and a decrease in vocal vibrations at the right base, SaO2 at 70%. Elsewhere a thoracic collateral venous circulation was visible. Electrocardiogram recorded rapid atrial fibrillation at 134 cycles. The cardiac ultrasound concluded that there was a mobile mass in the right atrium prolapsing in the right ventricle measuring 25 mm × 18.9 mm suggesting a myxoma. The myxoma of the right atrium is of a rare localization with a polymorphic clinical manifestation. It should be diagnosed as early as possible to avoid the occurrence of dreaded complications. Its management is surgical.

Assessment of Left Ventricular Torsion in Hypertensive Patients

Background: Hypertension has important effects on left ventricle and its early detection helps to avoid the cardiac complications. LV Twist in systole helps in storing potential energy during diastole;LV untwist releases this energy. Speckle tracking echocardiography (STE) is angle-independent so it allows a more detailed evaluation of myocardial deformation. Objective: This work aimed to assess the left ventricular torsion by speckle tracking in hypertensive patients. Patients and Methods: The study was applied on 40 hypertensive patients and 20 age and sex matched control groups;all had speckle tracking echocardiography of the LV, and the basal and apical rotation were measured to assess the LV torsion. The 18 segments of LV strain were assessed and the net LV global longitudinal strain was calculated and demonstrated as bull's eye figure. Results: Hypertensive patients had higher mean values of both apical rotation and left ventricular twist than control group by a highly significant value (9.76 ± 4.98 vs 4.03 ± 2.15, P value 0.001) and (15.25 ± 4.10 vs 9.90 ± 1.47, P value 0.001) respectively. Hypertensive patients had a higher basal rotation than controls but did not reach a significant value (-6.01 ± 3.25 vs -5.52 ± 2.63, P value 0.558). On the contrary, the global LV longitudinal strain was lower in hypertensive patients than control but did not reach a significant value (-18.48 ± 3.94 VS -19.48 ± 3.57, P value 0.341). Conclusion:Hypertension affects myocardial structure and its systolic and diastolic functions;the left ventricular twist is an essential component of the systolic function that increases in hypertension as an early compensation for the systolic impairment. The detection of these changes achieved accurately by 2-D speckle tracking, can help in monitoring the treatment modalities of the patients for a better direction of treatment and thus, prevent further deterioration.

Assessment of LV Function in Children with Wilson’s Disease: Speckle Tracking Imaging Study

Background and Objective: Wilson’s disease is a genetic disorder of copper metabolism that affects liver and other organs including heart. In early stages of myocardial affection, the left ventricle (LV) appears apparently normal when evaluated by traditional two-dimensional (2D) echocardiography. The aim of this study was to detect subclinical LV dysfunction in children with Wilson’s disease using 2D speckle tracking echocardiography. Patients and Methods: Twenty children with Wilson’s disease were compared with age- and sex-matched 20 healthy children. All subjects were evaluated by traditional 2D echocardiography and speckle tracking echocardiography. Results: There were no significant differences between patients and controls regarding conventional echo parameters except for lower E mitral flow and E' annular septal peak velocity in patient group. The regional peak longitudinal strain of apical 4 chamber view was -17.8% ± 4.2% in patients and -20.1% ± 2.3 % in control subjects (P = 0.043), and for apical 2 chambers view, it was -20.1%± 3.6% in patients and -22.6% ± 3.4% in control subjects (P = 0.034) and it was -18% ± 3.5% in patients and -20.5% ± 3.2% in control subjects (P = 0.025) in apical long axis view. The global peak longitudinal strain was also lower in patients than control group (18.3% ± 3.2%, and 20.85% ± 2.4%) respectively (P = 0.014). There were no significant differences between both groups regarding circumferential and radial strains (P > 0.05). Conclusions: Despite apparently normal LV systolic function, the children with Wilson’s disease demonstrated significantly lower peak longitudinal strain as an indicator for early affection of LV systolic function.

Atrial Fibrillation during Cerebral Infarction in Brazzaville: Frequency and Predictive Factors

In order to contribute to the improvement of brain infarction management in Brazzaville, a cross-sectional and analytical study with prospective data collection was conducted in the cardiology and neurology departments of the Brazzaville University Hospital, from February 1 to July 31, 2018. It included patients hospitalized for cerebral infarction confirmed with imaging, and having done an etiological assessment with at least one electrocardiogram at rest and one of long duration. Among these 138 patients included, 11 had atrial fibrillation, equaling?a frequency of 7.9%. The mean age of AF patients was 71 ± 8.8 years. The cardiovascular risk factors found were hypertension in eight cases (72.7%), diabetes in five cases (45.5%), abdominal obesity in four cases (36.4%). AF was permanent in 10 cases (91%), and paroxysmal in one case (9%). It was valvular in three cases (27.3%) and non-valvular in eight cases (72.7%). The cardiopathy involved was hypertensive in seven cases (63.6%), ischemic and valvular in two cases each. The CHA2DS2-VASc score, calculated in eight patients, was an average of 2.2, and ≥2 in more than 80% of patients;HAS-BLED score of 2.4 on average was ≥?3 in more than 72% of patients. Digoxin was prescribed in seven cases (63.6%) and an anti-vitamin K in eight cases (72.7%). In multivariate analysis, age (OR = 20.10, p = 0.023), arterial hypertension (OR = 23.82, p = 0.011), and dyslipidemia (OR = 2.03, p = 0.032) were the predictive factors found. AF is infrequent during brain infarction in Brazzaville. This systematic research raises the problem of age in our context.

The Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Dysfunction in Patients with Coronary Artery Disease Assessed by Strain Rate Imaging

Introduction: Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Unfortunately, the treatment strategies of regional myocardial diastolic dysfunction in patients with CAD have not been well characterized and benefit of percutaneous coronary intervention (PCI) as a treatment strategy is not clear. So the present study aimed to assess the effects of PCI on regional and global left ventricular diastolic dysfunction in patients with CAD assessed by strain rate (SR) imaging. Methods: Thirty adult symptomatic patients with coronary artery disease that underwent coronary angiography and candidate for PCI on left anterior descending artery were enrolled to our study. Echocardiographic findings and early diastolic SR were measured before and 48 hours after PCI. Results: Mean age of the patients was 59.9 ± 8.3 years. Most of the left ventricular diastolic parameters showed significant difference before and after elective PCI;while mitral E velocity, DT, E/A and pulmonary vein flow before and after PCI did not show significant difference assessed by statically test. Also before PCI, mean (SD) of peak early diastolic SR in ischemic regions (1.89 ± 0.22) was smaller than of non-ischemic regions (2.53 ± 0.26) while after PCI this parameter became similar in ischemic regions (2.55 ± 0.27) and non-ischemic regions (2.55 ± 0.26). Conclusion: Most of the left ventricular diastolic parameters improved after PCI in CAD patients. Also regional myocardial relaxation as measured by peak early diastolic SR (ESR) in the ischemic segments improved significantly compared with that in non-ischemic segments.

Appraisal of Five Clinical Guidelines for the Management of Hypertension in Andean Countries and Europe

There is global concern on the methodological limitations, transferability and effectiveness of clinical practice guidelines (CPGs) for chronic non-communicable diseases, particularly for hypertension. Bolivia, Ecuador and Peru have regularly produced CPGs;however no formal assessment has been done on their contents, transferability and effectiveness. The past decade saw significant migration from Andean countries to Europe. Knowing how European CPGs compare with those produced in Andean countries is necessary to recommend future changes targeted to the migrant population. A systematic search of CPGs was done on indexed databases and non-indexed publications. Recognized and approved CPGs were identified by technical officers in the Ministries of Health of the respective countries. The guidelines of the European Society of hypertension and four selected CPGs from the Andean countries were assessed by two independent evaluators using the “Agree II instrument for assessing clinical practice guidelines, AGREE II Consortium, May 2009”. Comparison of the CPGs is based on the six domain scores provided by the Agree II instrument. The overall score of CPGs ranged from 1.85 to 2.94 of 6 maximum possible. The European CPG scored highest in 3 of 6 domains compared, most notably in rigor of development. Average domain scores for clarity of presentation (0.84) and scope and purpose (0.64) were highest scores for applicability (0.30). Stakeholder involvement (0.28) and rigor of development (0.17) were the lowest. The CPGs assessed appear to fail meeting the standards of quality and pertinence. They show a progressive worsening from domains declaring good intentions of being clear, to those which measure their hard aspects and implications.

Use of Beta-Blocker in Acute ST-Elevation Myocardial Infarction

This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.

Inter Atrial Communication in Adults: About 5 Cases in Guinea

Inter auricular communication (AIC) is the most common congenital heart disease after aortic bicuspid disease with an incidence of 5%?-?10% in children and 30%?-?40% in adults. It represents 6% to 10% of congenital heart defects with septal defect. Inter auricular communications (AIC) are the most common cardiac malformations in adults. This was a retrospective study of 5 cases of inter-auricular communication discovered in adulthood in the cardiology department of the Ignace Deen National Hospital between 01 November 2018 and 31 May 2019. The diagnosis was made by the Cardiac Doppler ultrasound. During the study period,?5 cases of AIC were registered at the cardiac department Ignace Deen. The average age of our patients was 51.8 years with extremes of 20 and 70 years. This average age is comparable to that of the literature that reports most develop symptoms after 40 years. In this study, male dominance was noted with 60% versus 40% of female cases. The evolution was marked by a death case of 20% who had AIC associated with an?inter ventricularcommunication (CIV) with signs of global heart failure and four cases had a favorable evolution or 80%.

The Impact of the Morphologic Characteristics of Type B Aortic Dissection in the Acute Phase on the Aortic Enlargement in the Late Stage

Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. Methods: A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Results: A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354);TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable. Conclusions: In patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.

Pulmonary Embolism in Hospitalization in the Department of Cardiology of Gabriel Toure University Hospital

Objective: The aim of this study was to describe the epidemiological, clinical and Para clinical characteristics in patients hospitalized for pulmonary embolism in the cardiology department of Gabriel Toure University Hospital. Methodology: It was a retrospective and descriptive study from January 2011 to December 2014 and involved all patients hospitalized during the study period. Results: The study included 21 patients out of 1738 hospitalized patients, with a prevalence of 1.21%. The mean age was 38.57 years with extreme ages of 18 and 64 years. The sex ratio was 0.40. Risk factors found in the study were oral contraception (19.05%), overweight (19.05%), smoking (14.28%), HIV (4.76%) and heart failure (4, 76%). 61.90% (n = 13) had isolated pulmonary embolism, 38.09% (n = 8) had venous thrombosis and pulmonary embolism association. Through the chest angio-CT, 28.57% of obstructions were located at the left branch of the pulmonary artery, 9.52% at the right branch and 61.90% were bilateral obstructions. Four deaths were recorded, all in a context of massive pulmonary embolism, with a fatality rate of 19.05%. Conclusion: Pulmonary embolism is a serious and common disease, often difficult to diagnose. It is a cardiovascular emergency and requires immediate and adequate care.

Effects of Voluntary Apnea on Haemodynamic Responses during Groundwork Techniques of Judo

Context: Several studies were conducted on physiology of apnea in scuba diving. No survey has been reported in fighting sports. Objective: To evaluate cardiovascular variations misled by voluntary apnea during groundwork techniques of judo training. Methods: The temporal evolution of heart rate and modifications of the blood pressure have been investigated during cross sectional and experimental study. A total of 28 Congolese judoists took part in the study. The voluntary apnea was achieved by a judoist to try to carry out two kinds of groundwork (hon-gesagatame and kamishiho-gatame). According to the case, Student t test and analysis of variance were used for comparing data. Multivariate analysis was used to evaluate the effect of “type of groundwork technique × category of weight”. Results: Between 0 and 3 seconds, tachycardia has been observed during the static groundwork techniques and then bradycardia occurred to 3 - 9 seconds for the dynamic groundwork techniques : +6.8% of the rest frequency versus -9.4% for hon-gesa;+4.9% versus -13.7% for kami-shiho. Thereafter, it followed a fluctuation of heart rate of 9 - 15 seconds. Beyond, a stagnation was noted for hongesa, whereas a minimal increase (<5%) for kami-shiho. In relation to the systolic arterial pressure, a meaningful rise was recovered: +46.5% (hon-gesa) versus +50.1% (kami-shiho) in static exercise;+43.4% (hon-gesa) versus +43.3% (kami-shiho) in dynamic exercise. The report was similar for the diastolic arterial pressure: +31.5% (hon-gesa) versus 30.0% (kami-shiho) in static exercise;+20.3% (hon-gesa) versus +23.8% (kami-shiho) in dynamic exercise. Conclusion: The apnea consecutive to the hindrance of an exit groundwork technique to judo drags bradycardia increased while exercise realized static posture, and a rise of the arterial pressure.

Safety, Handling and Electrical Performances of Bradycardia Leads in Acute Conditions: Results from the FINE Registry

Background: Beflex is an active fixation atrial and ventricular lead with a retractable screw;X-Fine is a passive fixation ventricular lead. These two bradycardia lead models were evaluated in the FINE study, an observational prospective trial conducted in France and Spain. Methods: Patients enlisted for pacemaker or defibrillator implants were enrolled. The primary objective was to assess acute dislodgement rates at the 3-month follow-up visit. Safety and electrical performances of the leads were assessed in acute conditions at implant and at the follow-up visit up to three months later. A handling questionnaire was submitted to implanting investigators immediately after implant. Results: A total of 2254 patients were enrolled in 95 centers;investigators implanted 1153 active atrial leads, mainly in the right atrium;1021 active right ventricular leads, mainly in the septum and 712 passive right ventricular leads, mainly in the apex. After a mean follow-up of 54.9 ± 37.6 days, dislodgement rates were 1.0% and 1.6% for atrial and ventricular active, and 3.2% for ventricular passive leads. No unexpected adverse reactions were observed during the course of the study and the electrical performances at implant and follow-up visits remained within normal ranges. Overall, most investigators (84%) rated leads’ handling as superior (better or best) to what observed with other bradycardia leads. Conclusion: Different bradycardia leads showed a dislodgement rate of 1.0% and 1.6% for atrial and ventricular active leads, and 3.2% for ventricular passive leads, at 3-month follow-up. Acute safety and electrical performances were within expected ranges and very good handling performances were observed.

Modified Ross Procedure for a Young Woman with a Root Abscess on a Bicuspid Aortic Valve: Report of a Case

A 19-year-old woman with a bicuspid aortic valve was admitted because of active infective endocarditis with a root abscess. Four weeks of antibiotic therapy achieved negative blood cultures and normalized inflammatory signs;however, echocardiography revealed severe aortic regurgitation through an abscess cavity located at the root. The modified Ross procedure, in which the pulmonary autograft was reinforced with a prosthetic graft to prevent postoperative annular dilation, was successfully performed. The postoperative clinical course was uneventful, and echocardiography performed at 1 year showed trivial aortic regurgitation. Selection of homograft may benefit young woman who wishes to bear children, and covering pulmonary autograft by a prosthetic graft in order to prevent annular dilatation of autograft in patient with bicuspid aortic valve, may be allowed only under negative infection sign.

Amiodarone Therapy for Cardiac Arrhythmias: Is It Associated with the Development of Cancers?

Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.

Optimal Adiposity Measurement and Risk Stratification in Established Ischaemic Stroke

Background: Prevention strategies post-stroke should target risk factor reduction which includes consideration of weight, diet and lipoprotein profiles. Limited data informs the optimal adiposity measurement post-stroke to target those at highest recurrent risk. This study aims to identify adiposity measurement/s post-stroke that best predict cardiovascular and co-morbid risk. Subjects and Methods: 142 stroke patients (100 males, 42 females;mean age 63 years) participated. Adiposity and metabolic profiles included BMI, waist circumference, waist to height ratio (WHR), triglyceride levels and hypertriglyceridemic waist. The predictive ability of these measures with indices of cardiovascular risk (Cardiovascular Risk Score) and co-morbidity (Charlson’s co-morbidity index) were examined. Results: In hierarchical multiple regression models, age and gender controlled, waist (p = 0.002), triglyceride levels (p = 0.006), BMI and WHR (p = 0.014), uniquely and significantly contributed to the variance in cardiovascular risk, in their models. Only one combination of measures (waist and triglyceride levels) improved the predictive ability of waist in cardiovascular risk stratification (p = 0.001). In men, waist (p = 0.013) and in women triglyceride levels (p = 0.012) performed as the best predictors of cardiovascular risk respectively. No combination of measures was superior to triglyceride levels in women or waist circumference measures in men in predicting cardiovascular risk. With Charlson’s co-morbidity index as the dependent variable, triglyceride levels significantly contributed to variance of the model with age and gender influences controlled (p = 0.047). No combination of measures improved the predictive ability of triglyceride levels for co-morbidity. Conclusion: Waist circumference and triglyceride levels should form a minimum dataset for adiposity when considering cardiovascular and comorbid risk post-stroke.