Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developin...Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.展开更多
Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and techn...Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training. Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome. Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako. Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome. Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%. Sex-ratio was 2.10. Mean age of patients was 58.5 ± 11.39 years. ST elevation acute coronary syndrome was the most common indication with 63.92% of cases. High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases. Coronary angiography was pathological in 91.70% of cases (n = 548). Patients with lesions of anterior interventricular artery were 73.73% of cases. Tritruncal lesions accounted for 40.63% of cases. Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome. Anterior interventricular artery is most often the culprit lesion for our patients.展开更多
Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been...Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been known and described for many years and have led to the description of cardio-renal syndrome. The objective of this study was to determine the frequency;to describe the clinical, etiological and prognostic aspects of acute renal failure in patients hospitalized for chronic congestive heart failure. Method: This was a descriptive retrospective study from January 2, 2018 to December 31, 2022. Included in this study were all the complete records of patients hospitalized for chronic congestive heart failure with serum creatinine ≥120 μmol/I. We’re not included in this study, incomplete files, records of patients hospitalized for other pathologies, records of patients hospitalized for chronic congestive heart failure with normal renal function. Our study variables were qualitative and quantitative divided into clinical, paraclinical and prognostic data. Our data were analyzed using the EPI-info 7.2.2.6 software. Data entry and presentation were carried out using Word, Excel and PowerPoint from the 2016 Office Pack. Results: We collected 830 files of which 114 met our selection criteria, a frequency of 13.73%. The mean age of the patients was 47 ± 19 years. The F/M sex ratio was 1.23. The dominant etiologies were hypertension followed by diabetes with respectively 60.5% and 23.7%. Toxic factors including tobacco accounted for 7.9% of cases. Dyspnea accounted for 86.8%. Most of our patients were grade 3 or 36% based on systolic blood pressure on admission with an average of 164.16 ± 33.95 mmHg and an average diastolic blood pressure of 93.24 ± 20.40 mmHg. Biologically, the serum creatinine revealed a high frequency of 201 - 400 μmol/l (33% of cases) with an average value of 586.49 ± 631.44 μmol/l with the extremes 2.960 and 2448.68 μmol/I. Anemia was moderate in 34.2% of cases. Cardiac ultrasound was performed on 81 patients, the results of which showed dilated cardiomyopathy in 48.2% of cases. Renal ultrasound was performed only by 18 patients, renal suffering was found with 8.8%. Almost all (92.11%) of the patients had an acute renal failure of functional origin. More than half (65.80%) of our patients were at risk. Diuretics were the most prescribed antihypertensives with 87.71% followed by ACE inhibitors 78.94%. The average length of hospitalization was 13.81 ± 7.66 days with extremes of 24 hours and 41 days. Conclusion:The association of acute renal failure and chronic congestive heart failure is a frequent situation. The diagnostic approach must be guided by the context and the data of a meticulous examination supplemented by an appropriate paraclinical assessment. Kidney renal failure is mostly functional.展开更多
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 co...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, 1<sup>st</sup>, 2018 to December 31<sup>st</sup>, 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.展开更多
Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hype...Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hypertensive emergencies in the cardiology department of the Ignace Deen National Hospital. Methods: This was a longitudinal descriptive study of patients admitted to the cardiology department of the Ignace Deen National Hospital for hypertensive emergencies, over a period of six (6) months from 1 October 2020 to 31 March 2021. Results: Among the 638 patients admitted to the cardiology department during the study period, 102 cases of hypertensive emergencies were identified, representing a frequency of 15.99%. The mean age of the patients was 56.65 ± 13.33 years, with extremes of 23 and 90 years, and the sex ratio was 1.91 in favour of men. The associated cardiovascular risk factors were: age (76.47%), smoking (41.18%), sedentary lifestyle (31.37%), obesity (16.67%), dyslipidaemia (12.75%), diabetes (11.76%) and excessive alcohol consumption (11.76%). The various clinical pictures found were: acute pulmonary oedema 39 cases (38.23%), acute coronary syndrome 31 cases (30.39%), stroke 17 cases (16.67%), hypertensive encephalopathy 11 cases (10.78%), acute renal failure 3 cases (2.94%) and aortic dissection 1 case (0.98%). The drugs used on admission were calcium antagonists (Nicardipine 10mg) in 58 cases (56.86%), diuretics (Furosemide 20mg) in 44 cases (43.13%), nitrates (Risordan 20mg) in 39 cases (38.23%) and beta-blockers in 31 cases (30.39%). In terms of outcome, 88 (86.27%) patients had improved. However, 12 (11.76%) deaths were recorded. Conclusion: Hypertensive emergencies are a worrying condition with a high prevalence in the cardiology department of the Ignace Deen National Hospital.展开更多
Context: Heart failure (HF) is a common pathology requiring many types of treatments, including therapeutic education, which has demonstrated a major benefit in terms of reducing re-hospitalization and mortality from ...Context: Heart failure (HF) is a common pathology requiring many types of treatments, including therapeutic education, which has demonstrated a major benefit in terms of reducing re-hospitalization and mortality from HF or all other causes. Objective: The aim of this study was to evaluate the contribution of therapeutic education (TPE) in patients with heart failure. Methodology: This was a single-centre, interventional, non-randomized, before-and-after type study. It focused on hospitalized heart failure patients aged 18 and over. We evaluated the effect of TPE on therapeutic compliance, knowledge, practical attitudes, patient perceptions and quality of life. Results: Our study included 41 patients prior to therapeutic education: 17 men (41%) and 24 women (59%). The mean age was 54.7 ± 16.2 years. After the TPE sessions we evaluated 32 patients: The patients with good compliance increased from 75% to 90.63%, and patients with a low level of compliance (90.6%) decreased to 34.4%. An increase in the number of patients who had an attitude adapted to not exceeding the recommended amount of salt (6 before TPE and 22 after TPE), as well as in the number of patients who had an attitude adapted to physical activity (12 before TPE and 16 after TPE). There was also an increase in the number of patients who were confident about the outcome of their disease (12 before TPE and 16 after TPE), and a decrease in those who were hopeless (8 before TPE and 5 after TPE), an improvement in the quality of life score (45.03 before TPE and 15.78 after TPE). Conclusion: This study shows the beneficial effect of therapeutic education in patients hospitalized for heart failure in improving their level of knowledge, compliance with treatment, lifestyle habits and quality of life.展开更多
Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in t...Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.展开更多
Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Me...Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Methods: This was a retrospective and descriptive study that took place from January 1, 2011 to December 31, 2017. The records of patients with cyanotic congenital heart disease in the “B” surgery department of Point G University Hospital were collected. Patients operated on for cyanotic congenital heart disease were included in this study. Non-operated patients were not included. Results: The records of 17 patients operated on for cyanotic congenital heart disease were retained. The average age of patients at the time of surgery was 5.18 years with extremes of 2 and 18 years. Boys were in the majority with 59%, i.e. a sex ratio of 1.42. Patients resided in Bamako in 82% of cases. Inbreeding was found in 35.3%. Eighty-eight percent of children were born at term and 94% had up-to-date vaccination status. The average duration of patient follow-up between diagnosis and surgical management was 5 years with extremes of 2 years and 12 years. Tetralogy of Fallot regular form was the most represented heart disease. Conclusion: Cyanogenic congenital heart disease remains the most frequent congenital pathologies in our country. They most often affect male children. Consanguinity is the most common etiological factor found. Tetralogy of Fallot regular form remains the most common.展开更多
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six...Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.展开更多
Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in deve...Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.展开更多
Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitte...Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.展开更多
Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure r...Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.展开更多
<div style="text-align:justify;"> <strong>Objective</strong>: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the card...<div style="text-align:justify;"> <strong>Objective</strong>: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the cardiology department (USIC) of the G-spot hospital in Bamako,<span "=""> Mali. <b>Materials and Methods</b></span><span "="">: This was a descriptive cross-sectional study from January 1, 2018 to April 30, 2019 that included all patients admitted to the USIC during this period. Each patient benefited from individual data support with systematic recording of socio-demographic, clinical, complementary and therapeutic data and analyzed with the SOFTWARE SPSS 20.0 French version. <b>Results</b>: The study involved 40 patients out of 311 patients hospitalized in USIC, representing a hospital frequency of 12.86%. Males were the most affected (60%) with a sex ratio of 1.50. The modal class was 41</span> - 60 years with extremes at 18 years and 89 years. Cardiovascular risk factors were dominated by HTA (27.50%), diabetes and tobacco, each with 22.50%. The general signs were tachycardia (90%), oxygen desaturation (77.50%), impregnable blood pressure (62.50%), agitation (52.50%) and an oliguria (70%). At the electrocardiogram the rhythm was sinus (80%), it was an atrial fibrillation (15%), a ventricular tachycardia (10%) and signs of coronary ischemia (necrosis in 35% and ST over shifted in 20% of cases). At cardiac doppler ultrasound,the left ventricle was dilated (50%), the right cavities dilated (30%), segmental kinetic disorder (40%), the left ventricular systolic function (FEVG) impaired (75%) and valve disease (10%). Biology noted hyper-creatinemia (65%), hyper-glycemia (12.50%), anemia and hyponatremia with 20% frequency each. Among etiology,<span "=""> ischemic heart disease accounted for 57.50% followed by pulmonary embolism 20%, dilated valve cardiomyopathy 7.50% and chronic pulmonary heart 2.50%. The trend in the majority of cases was unfavorable with 60% of deaths. Chronic pulmonary heart and pulmonary embolism were the deadliest with a frequency of 100% and 87.50% respectively. <b>Conclusion</b>: Cardiogenic shock is an infrequent condition with a high mortality of a prognosis. Ischemic heart disease is the most common etiology of the disease</span>. </div>展开更多
<strong>Introduction</strong>: Venous thromboembolic disease (VTED), associating deep vein thrombosis and pulmonary embolism, represents a major public health issue. The objective of our work is to correla...<strong>Introduction</strong>: Venous thromboembolic disease (VTED), associating deep vein thrombosis and pulmonary embolism, represents a major public health issue. The objective of our work is to correlate confirmed VTED with clinical probability scores using elements of interview and clinical examination. <strong>Methods:</strong> This was a retrospective study from January 1, 2012 to October 27, 2013. Venous thromboembolic disease was diagnosed by lower limb venous Doppler ultrasound for deep vein thrombosis and thoracic CT angiography for pulmonary embolism. <strong>Results:</strong> Our series included 74 cases of venous thromboembolic disease including 42 cases of deep vein thrombosis and 29 cases of pulmonary embolism. The average age was 48.5 ± 15.9 years. The sex ratio was 0.72. The patients came from the outpatient clinic in 67.57% of cases. The Wells score for pulmonary embolism showed excellent performance in the “Surgery/Cancer” subgroup where the low probability was zero. The revised Geneva score for pulmonary embolism, showing the same proportions of low (14.2%) and intermediate (85.7%) probability, did not discriminate the subgroup of patients with underlying heart disease from the one from a surgical or carcinological environment. <strong>Conclusion:</strong> Clinical probability scores are more suitable in surgical and oncological settings than in medical settings.展开更多
Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are perfor...Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.展开更多
Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University ...Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University Center in Bamako—Mali. Methodology: It was a descriptive cross-sectional study from January 2010 to February 2017 in the CHU Point G cardiology department, including all patients hospitalized during this period. Results: Of 6912 hospitalized patients, 23 patients were concerned by aortic dissection. The prevalence of aortic dissection was 0.33%. The most affected age group was 50 - 69 (43.5%) of patients. The predominance was male with a sex ratio of 4.75. The cardiovascular risk factors were high blood pressure (73.9%) and smoking (60.9%). The major functional signs were chest pain (65.2%) and dyspnea (65.2%). Asphygmy (56.5%) and breath of aortic insufficiency (60.9%) were the dominant physical signs. The electrocardiogram recorded sinus tachycardia with 86.9% of patients. The radiographic of the frontal thorax showed mediastina widening (73.9%). At echocardiography, dilatation of the ascending aorta was described with 73.9% and the intimal veil (47.8%). Pericardial effusion was observed with 26.1% of patients. In the thoracic angioscan, the aortic dissection gave 43.5% for type A and 56.5% for type B. The aneurysm of the aorta was abdominal with 21.7%, ascending portion (13.0%) and descending with 8.7%. Complications were dominated by heart failure (47.8%) and aneurysm of the aorta (34.8%). The lethality was 52.2%. Conclusion: Aortic dissection is a medical and surgical emergency with poor prediction.展开更多
<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of th...<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of the University Hospital Center (CHU) Point G in Bamako-Mali. <strong>Methodology:</strong> This was an analytical study from January 01, 2018 to December 31, 2018 in the CHU Point G cardiology department, including all patients hospitalized during this period. <strong>Results:</strong> Of 1379 hospitalized patients, 19 patients were concerned by pulmonary embolism of the young person. The prevalence of pulmonary embolism of the young person was 1.37%. The most affected age group was 21 - 30 (47.4%) of patients. The predominance was female (89.47%) with a gender ratio of 0.11 in favour of women. The average age in the series was 29.79 years with extremes of 16 years and 40 years. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1%, respectively. The dominant signs were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Pulmonary embolism was unlikely in 60.52% according to the Geneva and Wells score simplified. At the thoracic angioscanner, the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients;in 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) and left ventricular dilation (40%). Hyper leucocytosis (47.4%), anemia and low prothrombin rate (TP) (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI (Pulmonary Embolism Severity Index) score. The average hospital stay was 10 days. Hospital mortality was 10.5%. <strong>Conclusion:</strong> The pulmonary embolism of the young person is a frequent, serious and multifactorial pathology and the female sex is most affected especially during peri partum periods, hence the need for preventive measures. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation review in our context.展开更多
Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019,&...Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, </span><span style="font-family:Verdana;">which</span><span style="font-family:Verdana;"> has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the COVID-19 pandemic and 42</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-size:10pt;font-family:""></span><span style="font-family:Verdana;">06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the Covid-19 pandemic and 27</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.展开更多
Few studies have been conducted on hypertension among youth in Mali?hence the interest of our study aimed to clarify certain aspects what are not taken account yet in previous studies.?Objective: Determine the clinica...Few studies have been conducted on hypertension among youth in Mali?hence the interest of our study aimed to clarify certain aspects what are not taken account yet in previous studies.?Objective: Determine the clinical and para-clinical characteristics of hypertension among 18 to 35 years old young people.?Methods:?This cross-sectional and retrospective study of 24 months from January 1st, 2009 to December 31st, 2010?in the cardiology department of the Gabriel Touré UTH.?Results:?We identified 132 cases during the study period out of 2146 cases of hypertension with a prevalence of 6.1%. The female gender represented 81.8%, with a sex ratio of 45.59, 1% of patients had an unknown family history of hypertension. The age group of 31 to 35 years accounted for 43.9%. The circumstances of discovery were dominated by exertional dyspnea (37.9%). Body mass index was normal in 45.5% of patients. The higher BMI was more common in female patients with 39.39% (p?= 0.045). In the sample,53% of patients had a systolic blood pressure between 140?and 159 mmHg and 38.6% had diastolic blood pressure ≥ 110 mmHg with no significant difference (p?> 0.5). The high creatinine level was found in 18.18% of our patients. The ECG?found?84.6%?of left ventricular hypertrophy among cavitary hypertrophies. The echocardiography has found cavitary?dilatation in 40.04% of cases;it concerned the left ventricle in 25.71%. Also 18.57% of our patients had impaired left ventricular systolic function. Among the complications found in our patients, kidney failure led with 56%.?Conclusion:?Hypertension is not a rare event among young population even with a normal body mass index. It is often discovered during complications that can be dreadful.展开更多
文摘Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.
文摘Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training. Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome. Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako. Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome. Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%. Sex-ratio was 2.10. Mean age of patients was 58.5 ± 11.39 years. ST elevation acute coronary syndrome was the most common indication with 63.92% of cases. High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases. Coronary angiography was pathological in 91.70% of cases (n = 548). Patients with lesions of anterior interventricular artery were 73.73% of cases. Tritruncal lesions accounted for 40.63% of cases. Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome. Anterior interventricular artery is most often the culprit lesion for our patients.
文摘Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been known and described for many years and have led to the description of cardio-renal syndrome. The objective of this study was to determine the frequency;to describe the clinical, etiological and prognostic aspects of acute renal failure in patients hospitalized for chronic congestive heart failure. Method: This was a descriptive retrospective study from January 2, 2018 to December 31, 2022. Included in this study were all the complete records of patients hospitalized for chronic congestive heart failure with serum creatinine ≥120 μmol/I. We’re not included in this study, incomplete files, records of patients hospitalized for other pathologies, records of patients hospitalized for chronic congestive heart failure with normal renal function. Our study variables were qualitative and quantitative divided into clinical, paraclinical and prognostic data. Our data were analyzed using the EPI-info 7.2.2.6 software. Data entry and presentation were carried out using Word, Excel and PowerPoint from the 2016 Office Pack. Results: We collected 830 files of which 114 met our selection criteria, a frequency of 13.73%. The mean age of the patients was 47 ± 19 years. The F/M sex ratio was 1.23. The dominant etiologies were hypertension followed by diabetes with respectively 60.5% and 23.7%. Toxic factors including tobacco accounted for 7.9% of cases. Dyspnea accounted for 86.8%. Most of our patients were grade 3 or 36% based on systolic blood pressure on admission with an average of 164.16 ± 33.95 mmHg and an average diastolic blood pressure of 93.24 ± 20.40 mmHg. Biologically, the serum creatinine revealed a high frequency of 201 - 400 μmol/l (33% of cases) with an average value of 586.49 ± 631.44 μmol/l with the extremes 2.960 and 2448.68 μmol/I. Anemia was moderate in 34.2% of cases. Cardiac ultrasound was performed on 81 patients, the results of which showed dilated cardiomyopathy in 48.2% of cases. Renal ultrasound was performed only by 18 patients, renal suffering was found with 8.8%. Almost all (92.11%) of the patients had an acute renal failure of functional origin. More than half (65.80%) of our patients were at risk. Diuretics were the most prescribed antihypertensives with 87.71% followed by ACE inhibitors 78.94%. The average length of hospitalization was 13.81 ± 7.66 days with extremes of 24 hours and 41 days. Conclusion:The association of acute renal failure and chronic congestive heart failure is a frequent situation. The diagnostic approach must be guided by the context and the data of a meticulous examination supplemented by an appropriate paraclinical assessment. Kidney renal failure is mostly functional.
文摘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, 1<sup>st</sup>, 2018 to December 31<sup>st</sup>, 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.
文摘Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hypertensive emergencies in the cardiology department of the Ignace Deen National Hospital. Methods: This was a longitudinal descriptive study of patients admitted to the cardiology department of the Ignace Deen National Hospital for hypertensive emergencies, over a period of six (6) months from 1 October 2020 to 31 March 2021. Results: Among the 638 patients admitted to the cardiology department during the study period, 102 cases of hypertensive emergencies were identified, representing a frequency of 15.99%. The mean age of the patients was 56.65 ± 13.33 years, with extremes of 23 and 90 years, and the sex ratio was 1.91 in favour of men. The associated cardiovascular risk factors were: age (76.47%), smoking (41.18%), sedentary lifestyle (31.37%), obesity (16.67%), dyslipidaemia (12.75%), diabetes (11.76%) and excessive alcohol consumption (11.76%). The various clinical pictures found were: acute pulmonary oedema 39 cases (38.23%), acute coronary syndrome 31 cases (30.39%), stroke 17 cases (16.67%), hypertensive encephalopathy 11 cases (10.78%), acute renal failure 3 cases (2.94%) and aortic dissection 1 case (0.98%). The drugs used on admission were calcium antagonists (Nicardipine 10mg) in 58 cases (56.86%), diuretics (Furosemide 20mg) in 44 cases (43.13%), nitrates (Risordan 20mg) in 39 cases (38.23%) and beta-blockers in 31 cases (30.39%). In terms of outcome, 88 (86.27%) patients had improved. However, 12 (11.76%) deaths were recorded. Conclusion: Hypertensive emergencies are a worrying condition with a high prevalence in the cardiology department of the Ignace Deen National Hospital.
文摘Context: Heart failure (HF) is a common pathology requiring many types of treatments, including therapeutic education, which has demonstrated a major benefit in terms of reducing re-hospitalization and mortality from HF or all other causes. Objective: The aim of this study was to evaluate the contribution of therapeutic education (TPE) in patients with heart failure. Methodology: This was a single-centre, interventional, non-randomized, before-and-after type study. It focused on hospitalized heart failure patients aged 18 and over. We evaluated the effect of TPE on therapeutic compliance, knowledge, practical attitudes, patient perceptions and quality of life. Results: Our study included 41 patients prior to therapeutic education: 17 men (41%) and 24 women (59%). The mean age was 54.7 ± 16.2 years. After the TPE sessions we evaluated 32 patients: The patients with good compliance increased from 75% to 90.63%, and patients with a low level of compliance (90.6%) decreased to 34.4%. An increase in the number of patients who had an attitude adapted to not exceeding the recommended amount of salt (6 before TPE and 22 after TPE), as well as in the number of patients who had an attitude adapted to physical activity (12 before TPE and 16 after TPE). There was also an increase in the number of patients who were confident about the outcome of their disease (12 before TPE and 16 after TPE), and a decrease in those who were hopeless (8 before TPE and 5 after TPE), an improvement in the quality of life score (45.03 before TPE and 15.78 after TPE). Conclusion: This study shows the beneficial effect of therapeutic education in patients hospitalized for heart failure in improving their level of knowledge, compliance with treatment, lifestyle habits and quality of life.
文摘Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.
文摘Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Methods: This was a retrospective and descriptive study that took place from January 1, 2011 to December 31, 2017. The records of patients with cyanotic congenital heart disease in the “B” surgery department of Point G University Hospital were collected. Patients operated on for cyanotic congenital heart disease were included in this study. Non-operated patients were not included. Results: The records of 17 patients operated on for cyanotic congenital heart disease were retained. The average age of patients at the time of surgery was 5.18 years with extremes of 2 and 18 years. Boys were in the majority with 59%, i.e. a sex ratio of 1.42. Patients resided in Bamako in 82% of cases. Inbreeding was found in 35.3%. Eighty-eight percent of children were born at term and 94% had up-to-date vaccination status. The average duration of patient follow-up between diagnosis and surgical management was 5 years with extremes of 2 years and 12 years. Tetralogy of Fallot regular form was the most represented heart disease. Conclusion: Cyanogenic congenital heart disease remains the most frequent congenital pathologies in our country. They most often affect male children. Consanguinity is the most common etiological factor found. Tetralogy of Fallot regular form remains the most common.
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.
文摘Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.
文摘Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.
文摘Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.
文摘<div style="text-align:justify;"> <strong>Objective</strong>: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the cardiology department (USIC) of the G-spot hospital in Bamako,<span "=""> Mali. <b>Materials and Methods</b></span><span "="">: This was a descriptive cross-sectional study from January 1, 2018 to April 30, 2019 that included all patients admitted to the USIC during this period. Each patient benefited from individual data support with systematic recording of socio-demographic, clinical, complementary and therapeutic data and analyzed with the SOFTWARE SPSS 20.0 French version. <b>Results</b>: The study involved 40 patients out of 311 patients hospitalized in USIC, representing a hospital frequency of 12.86%. Males were the most affected (60%) with a sex ratio of 1.50. The modal class was 41</span> - 60 years with extremes at 18 years and 89 years. Cardiovascular risk factors were dominated by HTA (27.50%), diabetes and tobacco, each with 22.50%. The general signs were tachycardia (90%), oxygen desaturation (77.50%), impregnable blood pressure (62.50%), agitation (52.50%) and an oliguria (70%). At the electrocardiogram the rhythm was sinus (80%), it was an atrial fibrillation (15%), a ventricular tachycardia (10%) and signs of coronary ischemia (necrosis in 35% and ST over shifted in 20% of cases). At cardiac doppler ultrasound,the left ventricle was dilated (50%), the right cavities dilated (30%), segmental kinetic disorder (40%), the left ventricular systolic function (FEVG) impaired (75%) and valve disease (10%). Biology noted hyper-creatinemia (65%), hyper-glycemia (12.50%), anemia and hyponatremia with 20% frequency each. Among etiology,<span "=""> ischemic heart disease accounted for 57.50% followed by pulmonary embolism 20%, dilated valve cardiomyopathy 7.50% and chronic pulmonary heart 2.50%. The trend in the majority of cases was unfavorable with 60% of deaths. Chronic pulmonary heart and pulmonary embolism were the deadliest with a frequency of 100% and 87.50% respectively. <b>Conclusion</b>: Cardiogenic shock is an infrequent condition with a high mortality of a prognosis. Ischemic heart disease is the most common etiology of the disease</span>. </div>
文摘<strong>Introduction</strong>: Venous thromboembolic disease (VTED), associating deep vein thrombosis and pulmonary embolism, represents a major public health issue. The objective of our work is to correlate confirmed VTED with clinical probability scores using elements of interview and clinical examination. <strong>Methods:</strong> This was a retrospective study from January 1, 2012 to October 27, 2013. Venous thromboembolic disease was diagnosed by lower limb venous Doppler ultrasound for deep vein thrombosis and thoracic CT angiography for pulmonary embolism. <strong>Results:</strong> Our series included 74 cases of venous thromboembolic disease including 42 cases of deep vein thrombosis and 29 cases of pulmonary embolism. The average age was 48.5 ± 15.9 years. The sex ratio was 0.72. The patients came from the outpatient clinic in 67.57% of cases. The Wells score for pulmonary embolism showed excellent performance in the “Surgery/Cancer” subgroup where the low probability was zero. The revised Geneva score for pulmonary embolism, showing the same proportions of low (14.2%) and intermediate (85.7%) probability, did not discriminate the subgroup of patients with underlying heart disease from the one from a surgical or carcinological environment. <strong>Conclusion:</strong> Clinical probability scores are more suitable in surgical and oncological settings than in medical settings.
基金The study was approved by Research Ethics Committee at the Faculty of Medicine Ain Shams University(FWA 000017585).Approval No.FMASU M D 65/2019.
文摘Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.
文摘Objective: The work aimed at describing an epidemioclinical, therapeutic and evolutionary characteristics of patients hospitalized for aortic dissection in the cardiology department in Point “G” Hospital University Center in Bamako—Mali. Methodology: It was a descriptive cross-sectional study from January 2010 to February 2017 in the CHU Point G cardiology department, including all patients hospitalized during this period. Results: Of 6912 hospitalized patients, 23 patients were concerned by aortic dissection. The prevalence of aortic dissection was 0.33%. The most affected age group was 50 - 69 (43.5%) of patients. The predominance was male with a sex ratio of 4.75. The cardiovascular risk factors were high blood pressure (73.9%) and smoking (60.9%). The major functional signs were chest pain (65.2%) and dyspnea (65.2%). Asphygmy (56.5%) and breath of aortic insufficiency (60.9%) were the dominant physical signs. The electrocardiogram recorded sinus tachycardia with 86.9% of patients. The radiographic of the frontal thorax showed mediastina widening (73.9%). At echocardiography, dilatation of the ascending aorta was described with 73.9% and the intimal veil (47.8%). Pericardial effusion was observed with 26.1% of patients. In the thoracic angioscan, the aortic dissection gave 43.5% for type A and 56.5% for type B. The aneurysm of the aorta was abdominal with 21.7%, ascending portion (13.0%) and descending with 8.7%. Complications were dominated by heart failure (47.8%) and aneurysm of the aorta (34.8%). The lethality was 52.2%. Conclusion: Aortic dissection is a medical and surgical emergency with poor prediction.
文摘<strong>Objective:</strong> The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of the University Hospital Center (CHU) Point G in Bamako-Mali. <strong>Methodology:</strong> This was an analytical study from January 01, 2018 to December 31, 2018 in the CHU Point G cardiology department, including all patients hospitalized during this period. <strong>Results:</strong> Of 1379 hospitalized patients, 19 patients were concerned by pulmonary embolism of the young person. The prevalence of pulmonary embolism of the young person was 1.37%. The most affected age group was 21 - 30 (47.4%) of patients. The predominance was female (89.47%) with a gender ratio of 0.11 in favour of women. The average age in the series was 29.79 years with extremes of 16 years and 40 years. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1%, respectively. The dominant signs were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Pulmonary embolism was unlikely in 60.52% according to the Geneva and Wells score simplified. At the thoracic angioscanner, the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients;in 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) and left ventricular dilation (40%). Hyper leucocytosis (47.4%), anemia and low prothrombin rate (TP) (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI (Pulmonary Embolism Severity Index) score. The average hospital stay was 10 days. Hospital mortality was 10.5%. <strong>Conclusion:</strong> The pulmonary embolism of the young person is a frequent, serious and multifactorial pathology and the female sex is most affected especially during peri partum periods, hence the need for preventive measures. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation review in our context.
文摘Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, </span><span style="font-family:Verdana;">which</span><span style="font-family:Verdana;"> has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the COVID-19 pandemic and 42</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-size:10pt;font-family:""></span><span style="font-family:Verdana;">06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">30 min before the Covid-19 pandemic and 27</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.
文摘Few studies have been conducted on hypertension among youth in Mali?hence the interest of our study aimed to clarify certain aspects what are not taken account yet in previous studies.?Objective: Determine the clinical and para-clinical characteristics of hypertension among 18 to 35 years old young people.?Methods:?This cross-sectional and retrospective study of 24 months from January 1st, 2009 to December 31st, 2010?in the cardiology department of the Gabriel Touré UTH.?Results:?We identified 132 cases during the study period out of 2146 cases of hypertension with a prevalence of 6.1%. The female gender represented 81.8%, with a sex ratio of 45.59, 1% of patients had an unknown family history of hypertension. The age group of 31 to 35 years accounted for 43.9%. The circumstances of discovery were dominated by exertional dyspnea (37.9%). Body mass index was normal in 45.5% of patients. The higher BMI was more common in female patients with 39.39% (p?= 0.045). In the sample,53% of patients had a systolic blood pressure between 140?and 159 mmHg and 38.6% had diastolic blood pressure ≥ 110 mmHg with no significant difference (p?> 0.5). The high creatinine level was found in 18.18% of our patients. The ECG?found?84.6%?of left ventricular hypertrophy among cavitary hypertrophies. The echocardiography has found cavitary?dilatation in 40.04% of cases;it concerned the left ventricle in 25.71%. Also 18.57% of our patients had impaired left ventricular systolic function. Among the complications found in our patients, kidney failure led with 56%.?Conclusion:?Hypertension is not a rare event among young population even with a normal body mass index. It is often discovered during complications that can be dreadful.
