INTRODUCTION:Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term outcomes of patients with SCAD. METHODS:A national wide, 25-year (since 2000), study with prospective (since 2017) inclusions of patients presenting for ACS with documented SCAD. Primary endpoint was in-hospital and long term major adverse cardiac and cerebrovascular events (MACCE). RESULTS:87 patients. Mean age 47.5±11 years, 71% female, 84% had no or only one conventional cardiovascular risk factor. Pregnancy-associated (P-SCAD) accounted for 9%. ST-segment elevation myocardial infarction and cardiogenic shock were described in 51% and 7%. 101 SCAD lesions (60% type 1, 37% type 2 and 3% type 3) were noted. Left anterior descending was the most affected vessel (72%), multivessel involvement was observed in 26% and severe tortuosities were reported in 38%. Conservative strategy was possible in 84% of patients; among them 15% required subsequent urgent clinically driven revascularization. Coronary angiography and percutaneous interventions were associated with five major complications of which one was fatal. Six in-hospital deaths were reported (7%), 4 of them were P-SCAD. After 16-month median follow-up, overall major events and mortality rates were 17% and 9% respectively. Two SCAD recurrences were reported. CONCLUSIONS:SCAD affected a middle-aged, predominantly female population, with no or few conventional risk factors. In-hospital mortality was high especially in P-SCAD. Coronary angiography and interventions for SCAD were associated with frequent complications, and a conservative management should be preferred when possible.

heart failure in peripheral arterial disease in 4 patients (1.3%) and valvular heart disease in 1 patient. Patients with at least one cardiovascular comorbidity had significantly more severe forms of covid 19 compared to patients without comorbidities (46% vs 16% p <0.05). All deaths occurred in patients with cardiovascular co-morbidities Conclusion: Cardiovascular comorbidities are common in hospitalized patients with COVID 19 dominated by hypertension and ischemic heart disease. Cardiovascular comrobidities have a pejorative impact on the prognosis of... Background: Central blood pressure is superior to office blood pressure measurements in predicting cardiovascular end organ damage. Conclusion: Therapy based on SPC of Valsartan/amlodipine was effective in providing extensive BP control (office and central BP). for a of 36 Independent follow were identified by multivariate logistic regression. Results : A total of 116 patients were included. 41,1% were treated with DES, 23,3% with DEB and 8,6 % with POBA. 12,9% underwent CABG and 13,8% received MT only. During follow-up, 37,9% of patients had at least one MACE. The mean delay to the occurrence of the first MACE is 15 months. [95% CI 1,2 – 6,8]; p=0,008) and the absence of post-dilatation after ISR angioplasty (OR 1,32; [95% CI 1,0 – 1,35]; p=0,04). Conclusion : Determining of these factors is important in order to improve ISR angioplasty outcomes. The a ratio of 1.3. the risk increase in pulse and respectively). in pulse between two types of therapy which are internal electric shock (IES) and anti-tachycardia pacing (ATP)leading to reduction of severe ventricular arrythmia. Despite the implementation of DAI either in primary or secondary prevention, several studies have predefined scores identifying patients who can really benefit from this treatment. Method: Our study is a descriptive and analytical cohort including 80 patients implanted in the cardiology department of the Habib Thameur hospital from January2010to June2019. Data on mortality and its causes were collected from medical records. We looked for predictors of mortality. Results: Males were predominant (92%) in our population. Ischemic During a follow-up of 55 we ischemic of infectious endocarditis, case of electrical In multivariate analysis, the of inappropriate therapies(p=0.008), ischemic heart disease(p=0.066) and Conclusion: In our study we identified three predictor factors of mortality which are ischemic heart disease, inappropriate with SaO2 <= 90%, LVEF <= 50%, and redo surgery. At 06 months follow-up, the functional gain in the overall population was significant (p <0.001) (table). However, the improvement in the functional status of group 1 patients was not significant. Ultrasound data showed a significant decrease in Right atrium area from 28.6 ± 7.4 cm² to 22.1 ± 5.2 cm² (p <0.001), right ventrivular diameter from 41 ± 5 , 8 to 31.4 ± 7.1 mm (p <0.001) and systolic PAP from 46.3 ± 14.1 mmHg to 33.3 ± 7.3 mmHg (p <0.001 ). We also note an improvement in right systolic function in our series. Conclusion: are a strongly in The diagnostic and therapeutic management of these patients requires specialized human skills and a well-equipped technical platform within the framework of specialized functional units. have them during follow up. It was found that only the PACS was significantly lower in the population having had these two complications (7.2 ± 2.9 vs 9.4 ± 4.1, p = 0.049). There was no significant difference between the two compared groups according PALS and left atrium area. The analysis of the ROC curve (PACS vs stroke and / or AF) objected that patients with a PACS value less than 10% have a significantly higher incidence of stroke and AF (89% vs 61%, p = 0.03) with a sensitivity of 50% and a specificity of 74% (AUC= 0.65). In our study, we did not find an independent predictor of the onset of stroke and / or AF in the follow-up of an asymptomatic patient with severe or moderate MS: PACS <10% (p = 0.06; OR = 1.18; 95% CI: [0.9-1.14]) and PALS <25 (p = 0.11; OR = 1.06; 95% CI: [0.9-1.14]). Conclusion: Our study demonstrated that the lower values of left atrial strain can be a predictor of AF and or stroke. re-examination, we identified patients who had shown an improvement of the LVEF to reach a LVEF > 40%. Results : In all, 223 patients were enrolled in the study, based on initial LVEF, 87 (39%) patients were classified as having HFrEF. Among patients with reduced LVEF (mean age: 66.1; gender ratio: 1.55), 13.8% (12 patients) had shown an improvement of LVEF and then considered to have HFiEF and 86.2% (75 patients) had a persistent HFrEF.patients with HFiEF younger (mean age: 58.5 vs 67.7; p= 0.04), more recent onset of heart failure (de Novo HF: 22.9%; p=0.01) (25% vs 56%; 0.04). of HTA and AF were similar (HTA :41.7% vs 52%; 0.5 ; AF: 16.7% vs 28% ; 0.4). All patients with HFiEF were treated with guideline-directed HF medical therapy. some The immediately onset of AVB was the only factor significantly correlated with the patient’s pacemaker dependency (p = 0.041). Conclusion : This study highlights the need for regular and prolonged rhythmic monitoring of cardiac surgery patients because a conductive disorder may occur late. and the cerebral veins in 1 patient. Superficial venous thrombosis was present in 20.8% of cases. Arterial involvement was present in 11.1% of patients. It included pulmonary artery aneurysms in 8 cases and occlusion of the central retinal artery in one patient. Other associated systemic manifestations were: skin and mucous membrane disorders (100%), articular (34.7%), ophthalmological (29.2%), neurological (27.8%) and cardiac involvement in 7 patients. Treatment was based on long term curative anticoagulation (70%), corticosteroid therapy (50%) and immunosuppressants (21%). Embolization was performed in two patients with good results. Conclusion : Our study illustrates the frequency and the polymorphism of vascular involvement in BD. The diagnosis of acute myocarditis the use of multiple diagnostic tests. The aim of this study is to evaluate the correlation between transthoracic echocardiography (TTE) and cardiac MRI (CMR) findings in acute myocarditis. our Left ventricular ejection fraction (LVEF) in 84% of cases. Three patients had a reduced LVEF.Two patients had a mid-range LVEF. Wall motion abnormalities (WMA) were in fourteen patients: segmental hypokinesia in nine patients, akinesia in four patients and only one case of global median follow-up of55months, 233 appropriate shock (87.3%) and 34 inappropriate shock (12.7%) were recorded. The incidence density of IEC was2.06 shocks/patient-year at one year,0.99shock/patient-year at 3 years and 0.50 shock/patient-year at 5 years. For appropriate shock (CEIA) this incidence density was1.72shock/patient-year at one year, 0.98shock/ patient-year at 3 years and0.42 shock/patient-year at 5 years. Spearman’s correlation coefficient is -1, which is in favor of decreasing this incidence density over time. For inappropriate shocks (CEII), this incidence density was0.33shock/ patient-year at one year,0.02shock/patient-year at3 years and0.09shock/patient-year at 5 years Spearman’s correlation coefficient is not significantly nonzero, which is in favor of a tendency towards stability as a function of time. We found that the incidence density of total IEC was decreasing over time. This decrease concerned the CEIA while the incidence density of CEII was stable during follow-up. A total of 174 patients (75 males and 99 females) this with a mean of 36.8 ± - 65]. Of the study population, 12.6 % underweight (male, 2.7%; female, 20.2 %), 30.5 % as normal weight (male, 49.3 %; female, 16.2 %), 31.0% overweight 36 %; female, 27.3 %) and 25.9% as obese (male, female, 36.4%). The mean BMI was 26.3±5.8 Kg/m2 extremes of 14.5 and 41.2 Kg/m2. Conclusion: In our study, hydration with bicarbonate serum has not shown any benefit in preventing Contrast induced nephropathy compared to hydration with physiological saline. A multi-center observational study is needed to confirm our results. Background : The occurrence of death in a young adult remains an event experienced as dramatic for the family as well as society and doctors. Sudden death at any age constitutes a medico-legal barrier to burial. Methods : We performed a retrospective study using autopsy data from the Department of forensic Medicine in Farhat Hached hospital. A review of all autopsies performed for 17 years was done. In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden cardiac death in persons aged between 18 and 35 years. Results : We collected 120 cases of sudden cardiac death during the studied period. The mean age of the studied population was 26.3 years. SCD is significantly more prevalent in young males. General etiologic categories include heritable and acquired cardiomyopathies and arrhythmia syndromes (30%), structural congenital heart diseases (12.4 %), coronary abnormalities (14.6 %) and other abnormalities. Conclusion : The evaluation of the young victims of SCD and their relatives is an effective strategy for the detection of familiar cardiovascular. Introduction : Sudden cardiac death (SCD) is defined as the unexpected natural death of a cardiovascular cause in any circumstance and at any age. Although SCD in the elderly is not exceptional, publications in this area are rare. Our study aimed to highlight the epidemic peculiarities of sudden cardiac death in elderly people in the center of Tunisia. Methods: We conducted a retrospective study over a period of 4 years (2017- 2020) on all cases of sudden cardiac death of the elderly subject (age over 60 years) autopsied in the Department of Forensic Medicine in the Hospital of Kairouan. Results: During the study period, 71 cases were recorded. The age of the decea

Objective: Management of hypertension requires a good adherence to treatment for a successful antihypertensive long-term therapy. Purpose: The aim of our study was to identify the factors associated with poor adherence to treatment in the elderly. Design and method: We conducted a descriptive study including 101 Tunisian hypertensive treated subjects, aged 65 years and over, followed on outpatient basis between November and December 2019. Adherence to treatment was evaluated using EvalOBs, a visual scale of adherence to antihypertensive treatment. Results: Median age was 73 and sex ratio 0.57. Our patients were completely dependent in 4% of cases and among those aged 80 and over, 68.2% were frail. Adherence to treatment was satisfactory in 75.2% of cases. Patients forgot to take their antihypertensive treatment the day of the consultation in 51% of cases and 33% had a medication breakdown since the last consultation. Seventeen per cent of the patients have been away from their treatment because of memory disorder and 7%missed their treatment because some days they feel that the treatment is doing more harm than good. In multivariate analysis, the factors associated with poor adherence to treatment were: male (OR = 11,774; p = 0.013), patient smoker (OR = 0,167; p = 0,02), medication break-down (OR = 0253; p = 0,006) and forgetting the treatment the day of the consultation (OR = 0,159; p = 0,047). Conclusions: Detection of the risk of non-adherence and therapeutic education are necessary to improve the adherence to antihypertensive treatment. The education must be focused on male and smokers and a better medication supply is needed.

Hydatidosis remains an endemic disease in some regions of the world, such as Tunisia. The liver and the lungs are the most common sites in adults. Mediastinal and pericardial hydatid cysts are very rare even in endemic areas and true incidence has not been described in the literature. We report the case of a 74-year-old woman with clinical, biological and electrocardiographic features of acute myocardial infraction. Two-dimensional echocardiography and detailed imaging revealed a mediastinal and pericardial hydatid cyst. The particularity of the clinical presentation, the complementary investigations as well as the management and follow-up of the patient are discussed. This case is of great interest since the rarity of concomitant hydatid cyst in two uncommon localizations: mediastinum and pericardium, and the unusual incidental discovery during a myocardial infarction.

Alveolar hemorrhage (AH) is a heterogeneous clinical syndrome with a high mortality rate, characterized by extensive bleeding into the alveolar spaces. AH secondary to systemic thrombolysis treatment in the setting of acute myocardial infarction is an uncom-mon complication, but potentially fatal and can lead to acute respiratory failure. This entity is rarely reported in the literature. We report two cases of acute AH after intravenous throm-bolysis for acute myocardial infarction, which could contribute to the literature on the subject, and discuss the risk factors as well as the clinical and radiological findings support-ing the diagnosis. We overview also the rare previous published case reports in this context, and we contrast our findings with those reported in the literature.

Primary hyperoxaluria (PH) type 1 is a rare hereditary metabolic disorder resulting in accumulation of calcium oxalate in several organs, including the heart. Cardiac oxalosis in PH is poorly described in the medical literature. We report the case of a 42-year-old woman diagnosed with primary hyperoxaluria type 1 and end-stage renal failure who presented with syncope related to a paroxysmal third-degree atrioventricular block. The patient benefited from the implantation of a dual chamber pacemaker with a good outcome. Conduction blocks in case of primary hyperoxaluria type 1 are exceptional; in fact, less than five reports have previously been published in the medical literature. With this case, we would like to highlight the need for regular and careful monitoring of cardiac status in patients treated for primary oxalosis, especially when renal function is impaired.

BACKGROUND:Behçet's disease (BD) is a multisystemic vasculiti where cardiac involvement is not common. Previous studies have shown that the incidence of ventricular arrhythmia and sudden cardiac death (SCD) is higher in patients with BD than in the healthy population. Among various possible explanations, autonomic nervous system (ANS) dysfunction has been suggested. Few studies have evaluated ANS function in patients with BD, and the results obtained are controversial.OBJECTIVE:We aimed to assess cardiac autonomic function by heart rate variability (HRV) in patients with BD; to evaluate circadian changes in HRV; and to study the relationship between HRV parameters and disease parameters.METHODS:Thirty-six patients with Behçet's disease (median age 42 years, 28 men) and 36 age- and sex-matched healthy volunteers were included. HRV analyses were performed in the time and frequency domains for the entire 24-hour period and for the daytime and nighttime periods. BD activity was studied with Behcet's disease current activity form (BDCAF).RESULTS:Patients with BD had significantly lower values of SDNN compared to controls. PNN50, RMSSD, and HF components mean values were significantly reduced in patients than in controls implying parasympathetic impairment. LF was comparable between the two groups, whereas LF/HF ratio was significantly higher in BD group. The circadian rhythm of HRV was preserved in patient group. There was no significant correlation of CRP or disease duration with HRV indices in Behçet's subjects. BDCAF score was found to be negatively correlated with LF/HF.CONCLUSION:Patients with BD, despite no cardiovascular involvement, have reduced parasympathetic activity compared with controls. However, circadian rhythms of autonomic function were preserved. As known, there is strong evidence for the role of the ANS in the pathogenesis of ventricular arrhythmias. Thus, being a practical tool, HRV can be an interesting approach for the rhythmic follow-up of BD patients.

BACKGROUND:The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL. METHODS:In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Echocardiography was performed and patients with left ventricular ejection fraction of 45% or less were selected. QoL assessment was performed with a disease-specific instrument: the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in a sample of 100 selected patients. Relationships between health-related QoL and the studied variables were examined with bivariate correlations and binary logistic regression analysis. RESULTS:In the total sample (n = 100), mean age was 62.7 years. The majority were male (77%), married (76%), with a mean of 2.5 comorbidities, and in a New York Heart Association (NYHA) functional class III to IV (61%). Mean LVEF was 36%. Half of the patients had poor QoL on the total MLHFQ scale (median = 41.5) as well as on its physical (median = 17.5) and emotional (median = 11.25) domains. In univariate analysis, the following variables were related to poor QoL with p < 0.005: not being employed, suffering from hypertension, renal failure, anemia, being under a low-salt diet, having no regular physical activity, having the physical symptoms of HF, higher NYHA class and longer QRS duration. In multiple regression analysis, the main independent predictors of poor QoL on the total scale were higher NYHA functional class and renal dysfunction,. The data provided no evidence of an association between LVEF and QoL. CONCLUSION:This study has found that higher NHYA functional class and chronic kidney disease are risk factors for impaired QoL, independently of disease severity among patients with heart failure.

Background and study aims: We aimed to assess the relationship of the QT interval and heart rate variability with the severity and aetiology of cirrhosis and determine the effect of propranolol on them. Patients and methods: This prospective study included 44 patients with cirrhosis categorised into three groups based on the Child-Pugh score: groups 1, 2 and 3 (with 12, 15 and 15 patients, respectively). Demographic characteristics, propranolol administration, severity of cirrhosis evaluated by the Child-Pugh score, aetiology of cirrhosis, and serum sodium, potassium and calcium levels were evaluated. All patients underwent 24 h-Holter monitoring. Corrected QT interval (QTc), average heart rate, standard deviation of normal-to-normal intervals (SDNN) and corrected SDNN (cSDNN) were evaluated. Results: The average QTc was significantly longer in group 3 than in groups 1 and 2 (453.4 +/- 17.4 vs 422.8 +/- 18.6 and 428.9 +/- 17.24 ms, p < 0.001). The median SDNN was 70 ms and was significantly lower in group 3 vs groups 1 and 2 (77; interquartile range [IQR], 67-89.5 vs 57; IQR, 38-68 and 75 ms; IQR, 61-81 ms, p = 0.003). cSDNN was significantly lower in group 3 vs groups 1 and 2 (200.0 +/- 42.6 vs 254.5 +/- 75.3 and 277.8 +/- 110.6 ms, p = 0.022). Propranolol administration resulted in a significant increase in the average SDNN value but had no effect on cSDNN or QTc. QTc was associated with the Child-Pugh class (p < 0.001), viral aetiology (p = 0.009) and sex (p = 0.010); SDNN was associated with the mean heart rate (p = 0.015) and Child-Pugh class (p = 0.024). Conclusion: QTc interval prolongation and decreased SDNN are common in cirrhosis. Their prevalence is closely associated with disease severity. Propranolol has no effects on cSDNN or QTc. (C) 2020 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

Background Simulation allows learning in action, reflection and feedback. All these factors suggest the positive contribution of the simulation to the development of clinical reasoning. The main assessment tool for standardized testing of this skill is the script matching test. Aim To assess the impact of teaching through high-fidelity clinical simulation on the clinical reasoning of third-year medical students, while assessing their teaching practices, satisfaction and confidence in the learning they received during this session. Methods We conducted an evaluative bicentric prospective study that included third-year medical students completing their cardiology internship during the first semester of the academic year 2019-2020 in the cardiology departments of Habib Thameur Hospital and Charles Nicolle Hospital, respectively. Results The study included 48 students. The students who participated in this study liked the teaching practices used in the simulation-assisted lessons. Their interest in these practices is validated by the average of 37,2±5,53 obtained for active learning, 8,04±1,85 for collaboration, 8,5±1,51 for diversity of styles and 8,02±1,72 for high expectations. In our study, the results showed that students were satisfied with the learning they had made during the simulation session. The average for the measurement of satisfaction by the 48 externals was 22,37±2,54. The results of our study indicated that students were confident that their learning would allow them to solve problems similar to those presented in the simulation in a real clinical setting. This is supported by the 31,48±4,63 average student confidence in their learning. Our study showed a progression of the students' clinical reasoning with simulation using a Script Concordance Test. The mark obtained by the students after the simulation session is significantly higher than the one obtained by the students before the simulation session with p=0.008. Conclusion Simulation is an innovative pedagogical strategy and a contribution to optimizing the clinical reasoning process and improving the quality of care.

Isorythmic atrioventricular dissociation by interference is a rhythmic entity that is rare in current practice and often unrecognized. Its association with a nodal duality generating a double ventricular response is exceptional.We report the observation of such association in a postoperative context of a surgical correction of interauricular communication following an attempt to close this defect by an amplatzer complicated by a migration of the prosthesis.

Aim: The relationship between type 1 diabetes (T1DM) and cardiac function in children is not well established. The purpose of this study was to investigate whether children and adolescents with T1DM present early asymptomatic abnormalities of left ventricular (LV) and right ventricular (RV) function. In addition, we evaluated the relationship of any such abnormalities with glycemic control and diabetes duration. Methods: This was a prospective study. Standard echocardiography, tissue Doppler imaging, and two-dimensional strain analysis were performed prospectively in 52 children with T1DM. The results were compared with those from 52 healthy children matched for age and sex. Results: There were no significant differences between the two groups in LV ejection fraction or RV systolic function. There was a difference between the two study groups in transtricuspid flow: the E-wave and A-wave velocities were significantly higher in the diabetic group. Left ventricular global longitudinal strain (LV GLS) was significantly lower in children with T1DM (-20.01 +/- 1.86% vs. -22.99 +/- 0.98%, respectively; P < .001), as was RV free-wall longitudinal strain (RV FWLS) (-29.13 +/- 1.85% vs. -30.22 +/- 1.53%, respectively; P = .002). LV GLS was correlated with diabetes duration (r = 0.444, P < .001) and glycated hemoglobin (HbA1c) (r = 0.683, P < .001); however, no correlation was found between RV FWLS and HbA1c or diabetes duration. Conclusions: Our findings suggest that LV GLS and RV FWLS are impaired in children with T1DM and that the decrease in LV GLS is correlated with diabetes duration and HbA1c levels. (C) 2019 Cardiological Society of India. Published by Elsevier B.V.

INTRODUCTION:Vitamin K antagonists (VKA) are currently the most prescribed oral anticoagulant treatment in Tunisia. Despite the standardization of biological monitoring and the better definition of therapeutic objectives, their side effects are a frequent reason for hospitalization.AIM:To evaluate patients' knowledge about their VKA treatment.METHODS:We realized a cross-sectional descriptive study in the Cardiology Department of HabibThameur Hospital from September to October 2016. A questionnaire consisting of 14 items was used in a semi-directed interview in order to assess patients' knowledge on their VKA treatment.RESULTS:Our study included one hundred patients. Mean age was 61 ± 12 years and sex ratio of 1.8. Forty-eight per cent were illiterate. The median duration of AVK intake was 5 years. Atrial fibrillation (AF) was the most frequent indication (57%). Eighty percent of patients had more than five correct answers on the eight items of knowledge: VKA's name (96%), tablet description (93%), dose (99%), time (94%), VKA's effect (70%), INR (56%), treatment's risk (49%) and the target INR (20%). Twenty-two percent had more than four correct answers on the 6 items of know-how: what to do in case of haemorrhage (70%), what to do in case of oblivion (45%), interactions precautions to be observed with food (13%), activities advised against (49%) and medical procedures advised against (27%). In multivariate analysis, only prior VKA information was significantly associated with a better knowledge of VKA (p = 0.027).CONCLUSION:Our patients' knowledge on their VKA treatment was insufficient to ensure the safety and efficacy of treatment. The creation of a therapeutic education program on is therefore necessary to reduce the iatrogenic risk of this treatment.

BACKGROUNDDue to the increase in average life expectancy and the higher incidence of cardiovascular disease, more elderly patients present for cardiac surgery nowadays. At the same time, age has been considered a predictor of morbidity and mortality.AIMTo evaluate the short-term outcomes of cardiac surgery in elderly patients.METHODSWe conducted a descriptive retrospective study including elderly patients who underwent cardiac surgery from January 2012 to 31st of December 2016. All patients were hospitalized before and after cardiac surgery in the cardiology department of Habib Thameur Hospital.RESULTSOur study included 55 patients. Average age was 72±6 years old and sex-ratio was two. Eighty-five percent presented with angina, 18% with dyspnea and one patient with an aortic prosthetic valve endocarditis. Mean left ventricular function was 54 ±9 %. Mean EuroSCORE II was 1.91±1.18. Twenty-six per-cent had an urgent surgery. Mean extracorporeal circulation time was of 77±26 min and mean extubation time was 8±6 h. Eighty-four per cent had a coronary artery bybass grafting and 16% a valve replacement. Four per cent had a redux and 4% a combined surgery. Stay in surgical department varied between 3 and 10 days with average of 4.6±1.2 days. Early mortality rate was of 2% and 98% had complications. Ninety-eight complications occurred after surgery: 35 reintervention for mediastinal bleeding or tamponade, 28 bleedings requiring transfusions, eight heart rhythm disorders, an atrioventricular conduction block requiring ventricular, five atrial fibrillation, two ventricular tachycardias, a ventricular fibrillation, eight low cardiac outpout, seven prolonged mechanical ventilation and eight pneumonias. In univariate analysis, recent myocardial infarction and chronic kidney disease were predictive of early complications.CONCLUSIONOur data shows cardiac surgery is feasible in elderly patients with acceptable risk in terms of mortality and an increased morbidity due to their frailty. Careful patient selection is needed for the success of cardiac surgery in elderly patients.

Introduction. - The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. Aim. - To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. Methods. We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. Results. - There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P < 10(-3)). There was no non-significant decrease of PaCO2 (4.5 mmHg). There was no modification in FEV 1 and in FVC (P > 0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. Conclusions. - Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV. (C) 2018 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Infectious endocarditis (IE) is a rare disease with a high mortality. In 2009, the European society of cardiology restricted antibiotic prophylaxis to a smaller number of cardiac conditions with very high risk for IE. Did these changes in the guidelines have an impact on the epidemiological and bacteriological profile of IE?AIM:The main aim of our work was to study the evolution of the microbiological profile of IE from 1991 to 2016.METHODS:We realized an analytic retrospective study comparing two groups: group 1 included patients admitted for a certain IE before September 2009 and group 2 those admitted after that date.RESULTS:Patients mean age was 46 ± 13 years and sex ratio was of 1.5. Forty percent of the patients were at high risk of IE. Blood cultures were positive in 19 cases. The most frequently isolated germ was Staphylococcus (10 patients). Serology was performed in six patients and was positive for Chlamydia Trachomatis in two cases. Forty-two patients had surgical treatment, 17 had a valve culture that was positive in 3 cases only. Clinical and paraclinic characteristics were comparable among the two groups. Negative blood cultures rates decreased from 72% to 68% between group 1 and 2 (p = 0.789). Staphylococcus positive blood cultures increased from 13% to 21% (p = 0.49). In contrast, Streptococcal positive blood cultures decreased from 11% to 5% in 2009 (p = 0.69).CONCLUSION:Our data suggest that there has been no change in the bacteriological profile of IE after the reduction in antibiotic prophylaxis.

BACKGROUND:Systemic sclerosis is a multisystem disorder characterized by tissue fibrosis and organ damage. Heart involvement is one of the main factors shortening survival, which may be underestimated by conventional echocardiography measurements. Two-dimensional speckle-tracking echocardiography is a powerful novel modality to assess subclinical myocardial dysfunction.AIM:The aim of this study is to investigate heart involvement in systemic sclerosis patients, and to determine the usefulness of ventricular longitudinal deformation using the Two-dimensional speckle tracking technology for an early detection of ventricular dysfunction.PATIENTS AND METHODS:Between May 2016 and September 2016, 25 patients with systemic sclerosis and 25 healthy subjects underwent echocardiography to assess heart abnormalities and the strain of the two ventricles using two dimensions' speckle tracking echography.RESULTS:The two groups were comparable in age and gender. Despite comparable left ventricle systolic function (left ventricular ejection fraction patients 64.58±8.87 vs. in healthy 68.2±7.41, P=0.19), patients presented altered longitudinal peak systolic strain values (global longitudinal strain: patients -17.42±1.62 vs. healthy -19.24±8.85, P<0.0001). Despite comparable pulmonary artery systolic pressure, there was a significant alteration in right ventricular systolic and diastolic function assessed by standard measurement. Longitudinal peak systolic strain of the right ventricle was significantly lower in patients compared with controls (P<0.01).CONCLUSION:Ventricular deformation analysis by two dimensions' speckle tracking echocardiography appears to be a sensitive method to detect early ventricular impairment in patients with systemic sclerosis.