Introduction Percutaneous pulmonary valve implantation (PPVI) with self-expanding valves, such as the VENUS P, has expanded treatment options for patients with large RVOT anatomies. However, concerns persist regarding valve durability and subclinical leaflet abnormalities, including hypoattenuated leaflet thickening (HALT) and reduced leaflet motion (HAM) (Fig. 1). The incidence and clinical impact of these findings after PPVI remain poorly defined. Methods Baseline, post-procedural and 6 months follow-up data were prospectively analyzed for 51 patients who underwent PPVI with Venus-P (Jan 2022–Dec 2025). At 6-month follow-up, all patients underwent cardiac CT to assess the presence of leaflet abnormalities (HALT and HAM). Results Of the 51 patients 49% were male with a mean age of 40.1±14.5 years. Thirty-seven patients had Tetralogy of Fallot. The main indication for percutaneous pulmonary valve implantation was pulmonary regurgitation (98%) associated with right heart chamber dilation.The median valve diameter was 34mm (IQR: 32–36); At 6-month follow-up, HALT was detected in 25 patients (49%), whereas HAM was observed in 7 patients (13.7%). HAM was associated with impaired leaflet motion without any significant increase in transvalvular gradients on echocardiography. RVOT Vmax values were comparable between the two groups (no HALT versus HALT/HAM) at all time points(after PPVI T1: 1.64 vs 1.55, P=0.459; at 6 months T2: 1.69 vs 1.76, P=0.467). Conclusion In this cohort of patients undergoing PPVI with VENUS P valves HALT was a frequent finding at 6-month follow-up, whereas HAM was less common and not associated with hemodynamic valve deterioration on echocardiography. And there were no statistically significant differences between the two groups. These findings suggest that, although subclinical leaflet abnormalities are common after PPVI, their short-term clinical impact appears limited.
Introduction: The aim of our study was to analyze the epidemiological, diagnostic, and therapeutic aspects of digestive abdominal emergencies, as well as the factors associated with postoperative complications. Methodology: This was a retrospective cross-sectional study with descriptive and analytical aims, conducted over a one-year period (August 1, 2022 – July 31, 2023). All patients over 15 years of age presenting with a digestive abdominal emergency were included. Results: We collected data from 272 patients. The mean age was 39 years (± 17.3), and the male-to-female ratio was 2:1. The mean time to consultation was 120 hours ± 447.7 (5 days). Appendiceal pathology (44.5%), generalized acute peritonitis (17.3%), and acute intestinal obstruction (16.2%) were the most frequently observed pathologies. Surgical treatment was performed in 86% of cases, with midline laparotomy being the most frequently used approach (92%). The mean waiting time for surgery was 45.0 ± 112.3 hours (2 days). Medical treatment was administered to 11.4% of patients, and instrumental treatment was indicated in 2.57%. The operative morbidity rate was 19.6% (n=46), and surgical site infection was the main postoperative complication (n=23). The overall mortality rate was 2.7% (n=7). Factors associated with the occurrence of complications were WHO performance status (p = 0.004), hemoglobin level (p = 0.015), acute bowel obstruction (p = 0.049), and generalized acute peritonitis (p = 0.030). Conclusion: Digestive surgical emergencies pose a public health problem with significant morbidity and mortality due to diagnostic and therapeutic delays. This study should help improve the quality of care and postoperative outcomes. Keywords: digestive emergency, epidemiology, prognostic factors, Senegal.
Introduction Percutaneous pulmonary valve implantation (PPVI) with self-expanding devices such as the Venus P-valve has expanded treatment options for patients with large ventricular outflow tracts (RVOT). However, the impact of PPVI on right ventricular (RV) pulmonary arterial coupling remains incompletely understood. The TAPSE/PAPS ratio has emerged as a simple, non-invasive surrogate of RV coupling and may provide insights into RV adaptation following intervention. Methods We conducted a longitudinal analysis of 77 patients undergoing PPVI with the Venus P-valve, evaluating echocardiographic parameters at three time points: baseline (T0), early post-procedural (T1), and 6-month follow-up (T2). Key parameters included tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PAPS), and the TAPSE/PAPS ratio. Paired comparisons between time points were performed to assess temporal changes. Results Of the 77 patients (mean age: 39.9±14.7 years), 45 were male, and 52 had Tetralogy of Fallot. After the PPVI a significant reduction in TAPSE was observed (T0 vs T1: −2.6mm; P<0.001), which persisted at 6 months (T0 vs T2: −3.2mm; P<0.001), with no further significant change between T1 and T2 (P=0.215). Conversely, PAPS showed a significant decrease both acutely (−3.5mmHg; P=0.007) and over time (T1 vs T2: −1.8mmHg; P=0.011), resulting in an overall reduction of −5.3mmHg at follow-up (P<0.001). Despite these changes, the TAPSE/PAPS ratio remained stable across all time points (T0 vs T1: P=0.482; T0 vs T2: P=0.741), with a non-significant trend toward improvement at 6months (P=0.064). Conclusion PPVI with the Venus P-valve is associated with acute RV unloading, reflected by a reduction in TAPSE, and a progressive decrease in pulmonary pressures. The preservation of the TAPSE/PAPS ratio suggests maintained RV–pulmonary arterial coupling despite changes in individual parameters. These findings support the concept of adaptive RV remodeling following PPVI and highlight the relevance of coupling indices in the longitudinal assessment of RV function.
AIM:To describe the epidemiological, diagnostic, therapeutic, and outcome aspects of pediatric neuromyelitis optica spectrum disorders (NMOSD) in Dakar, Senegal. METHODS:We conducted a multicenter retrospective and prospective study including patients with pediatric-onset NMOSD (<18 years) diagnosed according to the 2015 Wingerchuk criteria. RESULTS:Over 7 years and 3 months, 8 children (7 females) were included, with a median age at symptom onset of 13.5 years (range 8-17). The main neurological manifestations during the disease course were myelitis (7/8), optic neuritis (5/8), and area postrema syndrome (4/8). Brain magnetic resonance imaging revealed nonspecific white matter abnormalities in 2 patients. Anti-aquaporin 4 antibodies were positive in 6 patients. Cerebrospinal fluid analysis, performed in 4 patients, showed lymphocytic pleocytosis in 2 of them (72 and 17 cells/mm3). All patients received prednisone; 7 also received azathioprine. After a median follow-up of 26.5 months, the mean Expanded Disability Status Scale was 4.44. Six patients had a relapsing-remitting course, with a median time to second relapse of 3 months (range 2-6). CONCLUSION:This preliminary study highlights the clinical heterogeneity, female predominance, and frequent AQP4-IgG positivity of pediatric NMOSD in Senegal, broadly comparable to international cohorts. However, diagnostic delays, limited access to intensive therapies, and significant disability were observed, underscoring regional disparities in treatment and prognosis and the need for earlier diagnosis and improved access to effective therapies to optimize outcomes in sub-Saharan Africa.
