Selma Charfeddine

Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre

BACKGROUND Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available. AIM To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia. METHODS This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013. Data on baseline characteristics, potential aetiology, treatment strategies and discharge outcomes were collected from medical records. RESULTS There were 959 patients with a significant valvular heart disease (mean age 53±17years; female/male ratio 0.57). Valvular heart disease was native in 77% of patients. Mitral stenosis was the most frequent lesion (44.1%), followed by multiple valve disease (22.3%). Rheumatic origin (66.6%) was the most frequent aetiology, followed by degenerative (17.2%) or ischaemic (8.1%) causes, endocarditis (1.4%) and congenital (0.9%) causes. Native valve disease was severe in 589 patients (61.4%). Percutaneous mitral balloon valvuloplasty was performed in 36.9% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 446 (75.7%) patients. Only 161 (36.1%) patients were finally operated. Postoperative mortality was 13.6% for all valvular heart diseases. CONCLUSION This retrospective study has shown that the main cause of valvular heart disease in Tunisia is rheumatic fever. Mitral stenosis and multiple valve disease are the most frequent valvular heart diseases in Tunisia. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease.

0359: Percutaneous balloon mitral commissurotomy in children and young adults with rheumatic mitral stenosis

Objective To determine the efficacy and the safety of percutaneous balloonmitral commissurotomy (PBMC) in young patients (aged under 18 years – olds) with rheumatic mitral stenosis and to compare these results with those of adult patients. Patients and Methods Percutaneous transvenous mitral commissurotomy (PTMC) using the Inoue technique was performed in 480 patients with rheumatic mitral stenosisbetween 1998 and 2013. 41 were aged under 18 years – old (group 1). The other 439 patients (group 2) had a mean age of 34±11.9 years. All patients were assessed clinically. An echocardiography was performed before and after the procedure. Results Mean age in group 1 was 15±2.95 years (range 8 to 18) with a women predominance (73.2% vs. 26.8%.). In group 1, there was a significant increase of the mean mitral valve area index (MVAI) (0.84±0.24 vs 1.78±0.39cm2, p Conclusion Despite a high rate of restenosis, PBMC is very effective and safe in children, and consider that it should be the procedure of choice for young patients with symptomatic rheumatic mitral stenosis.

0293: Predictors of major cardiovascular events during unprotected left main PCI

Introduction PCI has become increasingly practiced in left main stenosis (LMS). The purpose of this study was to determine predictors of mid term major cardiovascular events in 110 cases of unprotected left main PCI. Methods Clinical and angiographic data were collected retrospectively for all patients with LMS, admitted to the cardiology center of Sfax between 2002 and 2013 and for which urgent or scheduled percutaneous revascularization was performed. The occurrence of cardiovascular events, or MACCE: death, MI, heart failure, angina or stroke recurrence was assessed at 12 months. Results During the study period, 110 patients underwent an unprotected LM PCI. These patients were predominantly male (72.7%). The death rate intra – hospital was 4.5% and 12 months mortality was 3.6%. 31 patients (28.2%) had nonfatal events during follow up. The clinical presentation at admission and diabetes were MACCE predictors at 12 months (p=0.04 and 0.05 successively). The distal LM location with bifurcation involvement, the multivessel disease associated and a high Syntax score> 32 are predictors of the occurrence of MACCE in the medium term (p=0,03; p=0001; and p=0001 successively). The type and length of the stent used in the LMS are also predictors of the occurrence of MACCE (49.1% for BMS versus 9.8% for DES, p Conclusion The unprotected LM PCI became promising thanks to developpemet of angioplasty techniques and equipement especially intracoronary imaging.