Les techniques d'imagerie nucléaire, telles que la scintigraphie myocardique au MIBI et la TEP-18FDG, offrent des informations précises sur la perfusion, la fonction contractile et les processus métaboliques du muscle cardiaque. Ces examens isotopiques ont ouvert de nouvelles perspectives pour la prise en charge individualisée des patients atteints de cardiopathies ischémiques, en guidant les choix thérapeutiques, qu'il s'agisse de revascularisation coronaire, de thérapie médicamenteuse ou d'autres modalités de traitement. Ce travail a pour objectif de déterminer l'apport des examens isotopiques dans l'étude de la viabilité myocardique et de démontrer l'impact des résultats de ces modalités d'imagerie sur la décision de prise en charge thérapeutique et sur le pronostic des patients à moyen terme. Il s'agit d'une étude prospective à visée descriptive et analytique menée auprès de 40 patients chez qui une étude de la viabilité myocardique a été indiquée. Tous les patients ont bénéficié d'explorations isotopiques et de coronarographies réalisées dans les services de médecine nucléaire et de cardiologie au CHU Sahloul de Sousse sur une période de 18 mois entre janvier 2022 et juin 2023. La scintigraphie de viabilité myocardique avait conclu à un pourcentage de 62,5 % de territoires de myocarde non viables versus 37,5 % de territoires de myocarde hibernants. Ces résultats concordaient parfaitement avec ceux retrouvés par la TEP-TDM au 18FDG qui a été faite chez 10 patients parmi 40, amenant à conclure que la valeur diagnostique de la scintigraphie myocardique de viabilité est comparable à celle de l'imagerie métabolique. Aussi, la scintigraphie myocardique s'est révélée être un outil très fiable qui affectait considérablement la décision thérapeutique. En effet, selon les résultats fournis, la revascularisation a été indiquée chez 40 % des patients présentant un myocarde viable et le traitement médical chez tous les patients ayant un myocarde non viable. Durant le suivi sur une période de 13,3 ± 2,8 mois, on a noté une amélioration significative de la FEVG dans le groupe des patients présentant un myocarde hibernant et traités par revascularisation par rapport à ceux traités médicalement (p = 0,02). En plus, le groupe des non viables a eu un taux de décès (12 %) supérieur à celui du groupe viable (6,7 %). Les taux de survie étaient par conséquent meilleurs chez le groupe de patients présentant des lésions viables.

Coronary artery birth defect is an uncommon heart disease. Its incidence is 1% among congenital heart diseases, it is largely underestimated because some forms are asymptomatic. The natural evolution of this pathology depends on the type of coronary birth defect, indeed it is favorable in forms of the multiple ostium type or if there is a birth variation in front of the adequate Valsalva sinus, and appalling in the case of birth of the left coronary artery from the pulmonary artery. To describe clinical and epidemiological particularities of birth defects of coronary arteries with multiple ostia. Between 1998 and 2022, 33 cases of multiple ostium coronary artery birth defects were identified in our department. Were analyzed retrospectively: the presence or absence of underlying congenital heart disease, clinical expression with the circumstances of discovery, ECG, chest X-ray, transthoracic echocardiography (TTE) and coronary angiography data. The average age was 57 years (from 33 to 72 years), there was a male predominance (63.63%). None of the patients had underlying congenital heart disease. In our series 28 patients (84.84%) had at least one cardiovascular risk factor. The circumstances of discovery of coronary birth defects were: stable angina in 33.4% of cases, NSTEMI in 45.5%, STEMI in 3% cases and heart failure in 3% cases, isolated exertional dyspnea in 3% of cases. In 12.1% of patients, the discovery was fortuitous. The contribution of chest X-ray was limited, showing cardiomegaly without specificity in 30.3% of patients. The ECG performed in all patients showing repolarization disorders related to the culprit artery affected. The TTE performed in all patients showed left ventricular dilation in 36.36% of cases. The ejection fraction was reduced in 36.36% of patients. On coronary angiography, the multiple ostia were: 2 ostia at the level of the antero-left sinus from which the LAD and the CX are born and an ostium from which the RCA is born, all the patients in our series had atheromatous involvement associated with the presence of at least one artery the seat of a tight stenosis which explains the symptomatology. Multiple ostium coronary birth defects are usually asymptomatic and discovered incidentally. ALCAPA and the birth from the opposite sinus are the most prone to clinical manifestations.

Drug eluting coronary stents (DES)have been shown to be effective and cost effective in treating complex lesions such as long lesions in coronary artery disease. Very long DES will reduce the number of stents used and will cover diffuse coronary lesions. This was a retrospective study including 105 patients who had implanted at least one DES (40 mm or more in length)from 2015 to 2020. We included 105 patients. The mean age was 63.6 ± 9.4 years. We noted a male predominance(81 men). The most common CV RF were as follows: Htn: 59%, dyslepidemia: 51.4%, diabetes: 47.7%, tobacco: 44.8%. The most reported antecedents were: 46.7% known coronary artery patients of which 27.6% were stented. Ischemic stroke was present in 6.7% of patients. The most frequent clinical presentation were chronic coronary syndrome (CCS)(41.9%), followed by NSTEMI (28.6%). On admission 4.9% had an acute edema of lungs on admission, 24.6% of patients had a glycemia greater than 9.9 mmol/l. At TTE 8.8% of patients had LVEF < 40%. On coronary angiography, the most coronary status was twin-cell (44.8%). The left coronary trunk was reached in 5.7%. Several coronary arteries were stented by long stents, the most frequent of which were the RCA(46.7%), and the LAD in 39%. Coronary lesions were: thrombotic in 10.5%; in 21.9% they were bifurcation lesions, and CTO in 9.5%. The long stent covered the ostium of the coronary arteries 8.6%. The mean length of stents were 47.26mm(from 40 to49 mm). Balloon predilation was performed in 75.2% and post-dilation was performed in 88.6%. In 18.1% of the cases the long stents overlapped with short stens. All procedures by long stents were performed successfully except in 2 cases where the thrombotic load was significant. The final TIMI flux was 3 in 98% of the cases. Patients of our study had more Htn and dyslepidemia. The most frequent clinical presentation was CCS. Long DES provide complete coverage of diffuse coronary lesions.

Persistent ductus arteriosus (PDA) is defined by the persistence of the DA beyond the first 3 months of life. Natural closure normally occurs 24 to 48 hours after birth. Discovery is rare in adulthood. This was a retrospective study of patients with PDA discovered in adulthood and who underwent percutaneous closures (PC) of PDA. Patients were collected over a period from 2009 to 2018. Eleven PC of PDA in adults were performed. The average age of discovery of PDA was 22 years. While the average age for percutaneous treatment was 25 years (18 to 33 years). There was a female predominance (9 women). All the patients were symptomatic. The circumstances of discovery of PDA were as follows: NYHA stage II dyspnea in 9 patients and bronchopulmonary infections in 2 patients. On the chest x-ray, 4 patients had cardiomegaly. On ECG, 10 patients had a left axis. Six patients had electrical LVH. On TTE, the left cavities were dilated in 10 patients. The pulmonary artery (PA) was dilated in 3 patients. LVEF was preserved in 100% of cases. At the TTE the averaged channel diameter was 5.2 mm (from 3 to 8 mm). The maximum average gradient between the aorta and the PA was 78.6 mmHg. The average SPAP was 32.5 mmHg. There were 4 patients who had PAH. No other heart disease was associated. The most common type of PDA was type A (8 patients). The average size of the prosthesis (amplatzer) put in was 8/7 mm. The 11 PDAs were closed successfully, without immediate complications. Angiographic and TTE in the KT room showed minimal residual shunt in 4 patients, and eliminated an aortic and pulmonary obstacle. In the short-term (3 months), all patients were asymptomatic. On TTE LV measurements normalized, SPAP were normal, all prostheses were in place, and there is no residual shunt. The duration of follow-up was 26 months. PDA is a common congenital heart disease. It can remain asymptomatic for a long time and does not appear until adulthood. PC is the treatment of choice.

Percutaneous angioplasty, has become the elective treatment for coarctation of the aorta(CoA) in adulthood. However, many complications can occur in the short,and long term like Htn,recoarctation(reCoA)and aneurysm formation. This was a retrospective, mono-centric and descriptive study of patients with CoA in whom percutaneous dilation was performed. Patients were collected from our Cardiology department over a period from2013 to2019. Twenty three percutaneous dilations of CoA were performed. The average age of percutaneous treatment was 30 years (6 to 51 years).There was a female predominance(12 girls).The most common circumstance of dicovery of CoA was Htn (17 cases).which was unbalanced under treatment in14 patients. The site of CoA was isthmic in 20 cases. Aortic valve was bicuspid in 5 cases. Grade II aortic insufficiency was noted in5 cases. Percutaneous dilation was performed on native CoA in 15 cases and on reCoA in 8 cases. Dilation was performed by a balloon alone in 11cases (including all reCoA).9 patients underwent balloon dilation and stent placement. The size of the balloon used was on average 12 × 30 mm. The average size of stent was14 × 36 mm. Gradient between ascending and descending aorta averaged increased from 48 mmhg (15 to 90 mmhg) before dilation to 10 mmhg (0 to 25 mmhg)after dilation. The result was satisfactory with fingerprinting taken in 21 cases. No immediate complications were noted in all cases. Regular monitoring of BP (self-measurement) has shown that BP has balanced in 13 patients after 1month.ReCoA occurred in 10 patients after an average of 3 years indicating percutaneous re-dilation in 7 cases and surgical treatment in the other cases. 2 patients developed an aortic aneurysm at the exit of the stent at 4 years of follow-up. CoA is not a simple narrowing of the aortic isthmus, but rather an arterial disease. In adults, the treatment of coarctations and localized recoarctations essentially involves percutaneous dilation

Cirrhotic cardiomyopathy(CMC)currently appears as a particular clinical entity occurring during cirrhosis,which is characterized by a constellation of structural,functional, and electrophysiological cardiac abnormalities.Its diagnosis is mainly based on TTE, whose recent advances have led to a paradigm shift in the analysis of cardiac function. This is a cross-sectional study of patients followed for cirrhosis during the period from 9/1/16 to 5/31/17.Each patient benefited from a clinical examination, an ECG and a cardiac ultrasound: conventional, tissue doppler as well as a 2D Strain study.The diagnosis of CMC was made in the presence of systolic (DS) and/or diastolic (DD) dysfunction. We included 76 patients with an average age of 54 years [18-79 years] and a sex M/F ratio of 1.4.In 46%,cirrhosis was viral. It was classified CHILD PUGH B in 44.7%. The median MELD score was 11.25 patients (32.9%) were decompensated in the edemato-ascitic mode.QT interval was prolonged in 43.5%.Based on the 2005 consensus diagnostic criteria, DS and DD were present in 5.3% and 51.3%of cirrhotics, respectively. The prevalence of CMC was 53.9%.In addition, the 2D Strain study revealed DS in 13.1%.DD was noted in 32.9% according to the tissue doppler parameters. Based on these data, the prevalence of CMC was 40.8%. The agreement between the consensus definition of CMC and that based on new echocardiographic techniques was moderate (kappa index = 0.585; P < 0.001). In multivariate analysis, 3 independent predictors of CMC were identified, namely:age (OR 1.05; 95% CI: 1.003–1.103; P < 0.039),female gender (OR 3.006; 95% CI:1.029-8.778;P = 0.044) and the CHILD PUGH score ≥ 9 (OR 4.363; 95% CI:1.328–14.331; P = 0.015). Our study has shown that CMC is a common condition, affecting older, female patients with advanced hepatoptathy. TTE in particular 2D strain,could be a promising method for diagnosing this entity, especially by detecting a SD not diagnosed by conventional TTE.

Ventricular Septal Defect(VSD)is the most common congenital heart disease in children.A minority require closure to avoid complications. Surgical approach is the gold standard.Even if results of surgical closure of VSD are satisfactory, it is associated with complications and inherent risks of sternotomy. Today, Percutaneous Closure(PC)of VSD has become a valuable tool in place of surgery in some cases. This was a retrospective, mono-centric and descriptive study of patients with a VSD in whom a PCVSD was performed. Patients were collected from our Cardiology department over a period from2014 to 2018. Twelve PCVSD were performed. The median age of discovery of VSD was 4 months (2 months to 33 years).The average age of PC was 8 years(2 to 33 years), with a female predominance(8 girls).VSD were perimembranous in 6 cases, and trabecular in the others. The VSD was unique in all cases. The diameter of the VSD was on average 5.7 mm(4 to 13 mm). Left cavities were dilated in 9 patients. Pulmonary artery was dilated in 3 cases. The VSD was restrictive in 11cases.The prosthesis size was(on average 5/5 mm),the largest was 6/6 mm. The type of prosthesis used was ADO II in 11cases,and ADO I in 1case.The 12 VSD were successfully closed. A transient AVB occurred immediately after the closure of a trabecular VSD.A minimal residual shunt was present immediately after closure in 9 cases. After a month all patients were asymptomatic, a residual shunt persisted in 7 cases. SPAP remained stable in all cases and were reduced for the child who initially had PAH. Left cavities remained dilated in the 9patients.1 year after PC, all patients were asymptomatic. A residual shunt was noted in 4 cases. Only 5 patients retained moderate dilation of the left cavities.2patients were put on ACE inhibitor. The follow-up was 2.5 years. PCVSD is a promising alternative to surgery. The results of our study are encouraging despite the small sample size and the absence of a surgical control group

Résumé Introduction Malgré l’habileté et l’expérience de l’opérateur dans la fermeture percutanée de canal artériel persistant (CAP), des complications peuvent survenir lors de la procédure de fermeture percutanée. Pour pallier à ces complications, le choix du dispositif doit être adapté à chaque patient. Objectif : Rapporter l’expérience du service de cardiologie dans la fermeture percutanée de CAP et de déterminer les facteurs influençant le choix de la prothèse. Méthodes : Notre étude a inclus les patients porteurs d’un CAP et hospitalisés en vue d’une procédure de fermeture percutanée, de Septembre 2003 à Juin 2016. Résultats : Cent cinquante-trois patients successifs ont été inclus dans l’étude. La fermeture percutanée a été récusée chez 9 patients. Le CAP a été fermé avec succès chez 140 patients. Des complications sont survenues chez 11 patients. Il s’agit de 3 cas de migration du dispositif, 4 cas de protrusion du dispositif dans l’isthme aortique, 3 cas de protrusion dans l’artère pulmonaire et un hématome inguinal dans un cas. Trois facteurs prédictifs de survenue des complications : un âge inférieur à 2 ans, un canal tubulaire de type C et un ratio diamètre canal/poids > 0,95. Un shunt résiduel minime a été constaté à la fin de la procédure chez 22,85% des patients. Les facteurs prédictifs de shunt résiduel sont : un âge inférieur à 2 ans, un diamètre pulmonaire du CAP plus large, la présence d’une hypertension artérielle pulmonaire et un canal tubulaire de type C. Conclusion : Le choix de la prothèse dépens essentiellement de l’âge, du poids et de l’anatomie du canal.

Rheumatic mitral stenosis (MS) is one of the most common valvulopathies in north Africa. Among her circumstances of discovery,pregnancy. Percutaneous mitral dilatation (PMD) is currently the treatment of choice for tight MS. To describe the short-term results of PMD performed for pregnant women with tight MS. This is a retrospective study of 8 pregnant women with a tight MS hospitalized in our Cardiology Department between 2012 and 2018 for PMD. For each patient, clinical, echocardiographic(TTE), and hemodynamic data were analyzed before and after PMD. There were 8 patients with an average age of 28.5 years (from 25 to 37). Two patients were known to have a MS and had previous PMD. All patients consulted for NYHA stage III dyspnea. At the ECG: 6 were in sinus rhythm. TTE pre-dilatation showed: an average mitral surface area at 1.1 cm 2 ,the average transmitral gradient was on average 12.05 mmHg. There was a bi-commissure fusion of the mitral valve in 6 patients. Mitral insufficiency (MI) was: minimal in 2 cases and moderate in 1 case, 5 patients had pulmonary arterial hypertension with mean SPAP at 43.2 mmHg. The right cavities were dilated in two women. The result of PMD was satisfactory in all patients. MI worsened one grade in one patient, and two grades in another, while a MI was newly created in one case. A transition to atrial fibrillation was noted in 1 patient who was well tolerated. TTE control immediately after PMD in the catheterization room showed: an average mitral area of 1.9 cm 2 (1.4 to 2.4 cm 2 ) so an improvement of more than 50% in the initial mitral area. The average transmitral gradient became 4.67 mmHg. Both commissures were completely opened in 7 patients. Dyspnea became class I in one patient while the others became asymptomatic. All patients delivered at term. The newborns were all in good health. PMD is still the treatment of choice in pregnant women with symptomatic MS if the anatomy of the valve allows it.

Rheumatic mitral stenosis (MS) is a common valvulopathy in Tunisia. When tight, percutaneous mitral dilatation (PMD)is the treatment of choice in young subjects with favorable valvular anatomy. Describe clinical and echocardiographic features of patients with tight MS before and after short, medium and long-term of PMD. This is a retrospective, monocentrique, and a descriptive study of patients in our cardiology department between 2012 and 2018 who were hospitalized for PMD with MS. Ninety patients were identified. Age of discovery of MS:35 years(10 to 66),female predominance(68.88%)of which 8 were pregnant. TTE pre-dilatation showed: a mean mitral area (MA) at 1 cm 2 , the Average Transmitral Gradient (ATG) was 11.3 mmHg. Bi-commissural fusion in76.7%; Mitral insufficiency(MI) was minimal: 55.6%.75 patients had PAH with an average SPAP at 43.2 mmHg. The right cavities (RC) were dilated in 20%. After PMD success in 93.3%. Incidents were worsening of MI in 7 cases, newly created MI in 14 cases, pericardial effusion in 2 patients. TTE immediately after PMD showed: MA at 1.79 cm 2 (1.2 to 2.4 cm 2 ): an improvement of more than 50% in the initial MA. ATG became 5.46 mmHg, an average decrease of 4.8 mmHg. MI was not created or worsened in 76.6%. Both commissures were completely open in 65.5%. After 6 months of PMD: 60.7% of patients became asymptomatic, 31.1% remained dyspnea. Two patients had ischemic stroke. TTE at 6 months showed MA at 1.7cm 2 , SPAP decreased in all patients, PAH (which was present before PMD) disappeared in 38.9%.RC are no longer dilated in 14 patients. In the long term 33,3% remained asymptomatic, 54.8% developed dyspnea, 36.7% developed AF. The duration of surveillance was 5.5 years on average. Mitral restenosis was observed on 5 years after PMD in 55.7%. The attitude was to make a new PMD in 24.5%and a mitral valve replacement (MVR) for the other patients. PMD has a place in the treatment of MS but it should not be at the expense of MVR which has well its indications.

The birth anomaly of the coronary arteries is an infrequent cardiac malformation. Its incidence is 1% among congenital heart disease, it is largely underestimated because some forms are asymptomatic. The natural evolution of this pathology depends on the type of the CBA. Between 1998 and 2017, 82 cases of birth defects of the coronary arteries were identified in the department. Retrospectively analyzed were the presence or absence of congenital heart disease, clinical presentation with the circumstances of discovery, ECG, chest X-ray, TTE, and coronary angiography data. The average age was 44.16 years, there was male predominance (63.41%). Only 10 patients had underlying congenital heart disease. Among the patients, 68.29% had at least one cardiovascular risk factor. The circumstances in which coronary birth defects were discovered were: stable angina in 21.95% of cases, acute coronary syndrome without ST in 36.6%, acute coronary syndrome with ST in 12.9% of cases and heart failure in 13.41% of cases, syncope in 1.21%. In 8.43% of patients, the discovery was fortuitous. Chest x-ray was limited, showing cardiomegaly with no specificity in 31.7% of patients. The ETT performed in all patients showed an EF low in 36.58%. At the coronary angiography, 73 patients (89.02%) had aortic birth defects distributed as follows: 31.7% with multiple ostia, 28.04% had an abnormal birth of the right or left coronary of the opposite sinus, 11 patients or 13.41% had an abnormal birth of the RC or LC from the non-coronal posterior sinus, and finally 10 cases or 12.19% of cases had a birth variation compared to the adequate valsalva sinus. Three patients had an unclassified birth defect. Nine patients have a left coronary nascent pulmonary artery. Coronary birth defects constitute a wide variety of abnormalities with very diverse clinical expressions. The birth of the left coronary from the pulmonary artery and the birth from the opposite sinus are the most productive of clinical manifestations.

In patients with left main coronary artery (LMCA) stenosis, PCI with drug-eluting stents may be an acceptable alternative to CABG. However, data from African subcontinent are lacking. We sought to evaluate trends in treatment strategies of LMCA disease over time in Sahloul University Hospital and to compare early and long-term adverse outcomes of each therapeutic option. From 2005 to 2016, 260 patients with unprotected LMCA were included. In total, 102 patients underwent Surgery, 109 patients underwent PCI and 49 patients were medically treated. Over time, the proportion of patients treated with PCI rather than CABG increased substantially. Patients treated with PCI had more anterior ST-segment elevation myocardial infarction (MI) and cardiogenic shock at presentation compared to CABG group. More patients treated with CABG had multivessel disease, more distal LMCA bifurcation and higher SYNTAX scores. All the other baseline variables were similar. After a follow-up of 39 ± 26 months in PCI group and 52 ± 38 months in CABG group, there were no differences between PCI and CABG, at the adjusted analysis, in the rate of myocardial infarction (MI) (HR: 1.75; 95%, CI: 0.55 to 5.50; P = 0.33), cerebrovascular accidents (CVA) (P = 0.69), and the composite of MACCE (HR: 1.04; 95% CI: 0.59 to 1.83; P = 0.88). Compared to PCI group, CABG group has a higher all-cause mortality (P = 0.017) driven exclusively by an elevated incidence of operative mortality (13.7% vs. 6.4%; HR: 0.08; 95% CI: 0.017 to 0.43; P = 0.003). Nevertheless, long-term advantage of CABG over PCI was the less need for repeated revascularization (HR: 3.1; 95% CI: 1.26 to 8.12; P = 0.014). Medically treated patients produced a four–year all cause death rate of 44%. Revascularization therapy of LMCA stenosis have evolved remarkably over the last decade in our faculty. PCI and CABG show comparable safety. However, repeat revascularization is more common after PCI.

Les personnes diabétiques âgées représentent une fraction importante et croissante des personnes âgées et des diabétiques. La principale cause de décès chez les diabétiques est représentée par les maladies cardiovasculaires. Le but de notre travail était d’étudier les aspects cliniques des complications dégénératives du diabétique du sujet âgé. Il s’agissait d’une étude rétrospective descriptive qui s’est déroulée sur une période d’une année (2016). Elle a porté sur 100 patients diabétiques âgés de 65 ans et plus, admis au service de médecine interne par les biais des urgences du CHU Maamouri Nabeul. L’âge moyen a été de 69,4 ± 13 ans (extrêmes : 65 à 87 ans), avec prédominance masculine (SR = 1,27). La durée moyenne d’évolution du diabète a été estimée à 5,25 ± 3,9 ans (extrêmes : 1 à 10 ans). Le motif d’hospitalisation le plus fréquent a été un déséquilibre du diabète dans 60 %. La microangiopathie est présente dans 40 % des cas et a été dominée par la neuropathie (50 %). La rétinopathie et la néphropathie diabétique ont été notées respectivement dans 22,5 % et 12,5 % des cas. Les complications macrovasculaires ont été présentes chez 28 % des patients et a intéressé les trois principaux lits vasculaires avec comme expression clinique les accidents vasculaires cérébraux (39,28 %), les coronaropathies (32,14 %) et l’artériopathie oblitérante des membres inférieurs (28,57 %). La prévention des complications dégénératives notamment des macroangiopathies chez le sujet âgé diabétique reste une priorité. Les sujets âgés présentent de nombreuses complications et comorbidités qu’il est nécessaire de dépister systématiquement pour améliorer la qualité des soins.

Les AVC sont fréquents et graves. Ils constituent la 3e cause de mortalité dans le monde. Le diabète est non seulement un facteur de risque majeur d’AVC, dont il multiplie le risque de survenue par 1,5 à 3, mais aussi un facteur de mauvais pronostic. Le but de cette étude a été d’étudier les accidents vasculaires cérébraux chez les sujets âgés diabétiques. Étude descriptive, rétrospective portant sur 62 patients âgés de plus de 65 ans hospitalisés au service de médecine interne par le biais des urgences au CHU Maâmouri Nabeul Tunisie durant l’année 2016. L’âge moyen a été de 70,11 ± 13,5 ans avec une nette prédominance masculine (SR = 1,38). Les antécédents de nos patients sont essentiellement l’hypertension artérielle (70,97%), le tabagisme (35,48%) et la dyslipidémie (35,48%). Le diabète type 2 était présent dans 48,39% des cas. Le déficit moteur a été le principal motif de consultation dans 80,64% des cas; 9,68% de nos patients ont présenté une altération de l’état de conscience dés l’admission. Une hyperglycémie initiale a été notée chez 77,42% des patients. Le diagnostic d’AVC ischémique a été retenu dans 77,42%. La durée moyenne de séjour a été de 6,17 ± 4,64 jours. L’évolution a été marquée par des séquelles neurologiques dans 88,7%% des cas. La mortalité a été de 12,9%. L’HTA, le tabagisme, la dyslipidémie, l’obésité (22,58%), la néphropathie diabétique (16,13%) ont été les facteurs de risque associés au diabète. L’AVC du sujet âgé diabétique est une pathologie grave, de pronostic sévère.

Les sujets âgés (SA) diabétiques consultent fréquemment les urgences pour des accidents aigus d’étiologies diverses pouvant mettre en jeu le pronostic vital. Le but de notre travail a été d’analyser les caractéristiques épidémiologiques, cliniques et de dégager les facteurs pronostiques des SA diabétiques admis à la SAUV pour une pathologie médicale. Étude rétrospective s’étalant sur 72 mois, incluant 588 SA diabétiques admis à la SAUV pour une pathologie médicale. L’âge moyen de nos patients a été de 69,98 ± 19,3 ans avec prédominance masculine. L’ancienneté du diabète a été en moyenne de 14 ± 6 ans. Le diabète type 2 a été présent dans 63,6 %. Les antécédents ont été dominés par la pathologie cardiovasculaire (67,24 %), presque la moitié de nos patients avaient une insuffisance rénale (48,97 %) ; 32,65 % de notre population étaient tabagiques. Les troubles de la conscience (57,1 %) et la dyspnée (46,9 %) ont été les principaux motifs de consultation. Le tableau clinique a été grave d’emblée dans 34,7 % ; 48,97 % ont présenté des signes d’insuffisance respiratoire aiguë, 22,44 % ont été en état de choc. Dans notre série, les étiologies ont été dominées par les pathologies cardiaques 40,81 % et métaboliques 26,53 %. Le décès a été noté dans 42,85 %. Au terme de notre étude, nous avons retenu comme facteurs de mauvais pronostic : ancienneté du diabète ≥ 10 ans, comorbidité ≥ 2, IGSA > 8, CGS ≤ 8, assistance ventilatoire et recours aux drogues vaso-actives. La prise en charge des SA diabétiques nécessite une démarche diagnostique et thérapeutique adaptée à la pathologie en cause et à son retentissement.

Background: Atrial septal defect (ASD) is often an isolated disease, but its association with other abnormalities can make diagnosis challenging. Careful analysis of simple complementary exams can help precise anatomical diagnosis ensuring suitable treatment. The aim of this article is to report, from a case report and literature review, diagnostic challenges and the contribution of simple complementary exams, such as chest X-ray, for the diagnostic orientation of an ASD associated with peripheral pulmonary artery stenosis, as well as therapeutic particularities. Case report: We report the case of a girl born in 2007, with history of dyspnoea and recurrent bronchitis in whom a loud systolic murmur was detected fortuitously at the age of 2 years. Her clinical examination was otherwise normal. The electrocardiogram recorded sinus rhythm, incomplete right bundle branch block, and right ventricular hypertrophy. Chest X-ray showed moderate cardiomegaly and hypervascularity of the left lung field contrasting with reduced blood flow to the right lung. Doppler echocardiography revealed a wide ostium secundum ASD, right chamber volume overload and right pulmonary artery stenosis. The latter was confirmed by CT angiography and right cardiac catheterization.  The patient underwent percutaneous right pulmonary artery dilation with stent placement. Control chest X-ray noted bilateral hypervascularity of the lung. The ASD was closed percutaneously one year later. The outcome was uneventful. Conclusion: The combination of ASD with pulmonary artery stenosis limits pulmonary hyperflow. In our case, this stenosis was tight and sat on the right branch of the pulmonary artery reducing significantly blood flow to the ipsilateral lung. Careful chest X-ray analysis may suggest diagnosis, which can be confirmed by ultrasounds and if necessary, by further examination, allowing treatment adaptation. To our knowledge, this association is very rare and no similar case has been reported.

Le diabète est une maladie silencieuse, indolore. Son évolution se fait vers les complications métaboliques et surtout dégénératives, lesquelles sont aussi indolores. Cette absence de douleur est en partie responsable de la gravité évolutive des lésions. Parmi ces complications, la plus redoutée reste le pied diabétique. Le but de notre étude est d’étudier les caractéristiques épidémiologiques et cliniques du pied diabétique du sujet âgé. Étude descriptive, rétrospective portant sur 460 diabétiques âgés de plus de 65 ans consultant les urgences de traumatologie du CHU Maamouri Nabeul Tunisie durant une période de 4 ans (2014–2017) pour pied diabétique. L’âge moyen de nos malades a été de 68 ± 13,8 ans, avec prédominance masculine. Le diabète insulinonécessitant a été noté dans 30 % des cas. La durée moyenne d’évolution du diabète a été de 9,46 ± 4,3 ans. Le diabète était mal-équilibré dans 82,6 % des cas. Un niveau socioéconomique bas a été noté dans 89,13 % des cas ; 60,87 % des patients ont des antécédents de lésion du pied. Les lésions les plus fréquente ont été : mal perforant plantaire (50 %), phlegmon (41,3 %), gangrène (30 %), nécrose ischémique (8,7 %). Le point de départ des lésions a été des infections cutanées dans plus que la moitié des cas. L’atteinte du pied est polyfactorielle et les divers éléments en cause agissent de façon synergique. Une lésion minime du pied chez un sujet âgé diabétique peu mettre en joue le pronostic fonctionnel et probablement vital du patient.