Introduction: Venous thromboembolic diseases (VTED) include deep vein thrombosis of the lower limbs and pulmonary embolism (PE), which is its severe form due to its high mortality. The objective of our study was to determine the epidemio-clinical and paraclinical aspects of patients hospitalized for venous thromboembolic diseases. Patients and method: Cross-sectional study with prospective recruitment from patient records hospitalized for (VTED) from January to December 2023 in the cardiology department of the Mother-Child University Hospital in Bamako, Luxembourg. Results: We collected 55 out of 580 patient records hospitalized for (VTED), a hospital frequency of 9.48%. PE accounted for 58.20% of cases, 10.90% for deep vein thrombosis (DVT), and 30.90% for their association. The mean age of patients was 55.56 years ± 15.52 years. The majority of patients, 90%, were under 66 years of age. The predominance was female, 56%. In lower extremity DVT, calf pain and Homans' sign were present in 56% and 24% of patients. In pulmonary embolism, dyspnea and chest pain were present in 85.50% and 65.50% of patients. Etiological factors were dominated by neoplasia in 10.90%, contraception 5.45% and orthopedic surgery in 5.45% of cases. Cardiovascular risk factors were a sedentary lifestyle (50.90%), obesity (34.45%), high blood pressure (36.36%) and diabetes (21.81%). Laboratory abnormalities were elevation of troponin (46.87%), BNP (40.62%), D-Dimer (62.50%) and anemia (9.09%). Electrocardiographic abnormalities were tachycardia in 65.4% and S1Q3 in 21.81% of patients. Echocardiography showed dilation of the right cavities (47.27%), systolic pulmonary arterial hypertension (38.18%) and thrombus in the right cavitary (5.45%). On thoracic CT angiography, PE was proximal (36.40%), bilateral (61.80%) and massive (29.10%). On venous Doppler ultrasound, TVP was proximal in 65.21%. Conclusion: VETD was more common in women and younger subjects.

Introduction: High blood pressure is a major public health problem worldwide due to its frequency and cardiovascular complications. Adherence to treatment for chronic diseases is a global problem. The aim was to study therapeutic adherence in hypertensive patients followed in ambulatory. Materials and Methods: This was a cross-sectional, descriptive study with prospective recruitment that took place from July 1 to December 31, 2022 (6 months) in the cardiology department of the university hospital of Kati. The variables studied were sociodemographic data, cardiovascular risk factors, comorbidities, the possession of insurance and compliance (the Girerd questionnaire was used to assess adherence). Results: A total of 1182 patients were consulted, including 887 for hypertension, a frequency of 75%. Fifty-six patients were included in the study. The average age was 58.18 ± 13.25 years with extremes of 30 and 80 years. There was a female predominance (75%) with a sex ratio of 0.3. The majority of patients lived in urban areas (89.3%). Out-of-school patients accounted for 44.6%, more than half of patients or 55.4% had no income, patients with medical coverage accounted for 67.9% of cases. The main risk factors were physical inactivity (25%) followed by smoking 14.3%. More than 71% of patients had a compliance problem and the main reasons were forgetting to take the drug with 73.2%, followed by delayed treatment of 50% and drug discontinuation of 28.6%. Conclusion: Compliance is a real challenge and a major public health issue. This study allowed us to find a real problem of compliance in our hypertensive patients. There was a statistically significant relationship between drug adherence and forgetting to take the drug and drug discontinuation.

Introduction: Heart failure is a major public health pandemic, particularly in Africa, where its prevalence continues to increase. In northern Mali, few data exist, hence the interest of this study with the objective of studying the epidemiological, clinical and therapeutic and evolutionary aspects of Heart failure at the regional hospital of Gao. Patients and Methods: This was a cross-sectional, descriptive study that took place from July 2022 to June 2023 in the medical department at Gao Hospital. Results: The hospital prevalence of heart failure was 44.1%. The mean age was 47.30 ± 20 years (range: 16-88). Hypertension was the most common with 46.1%, followed by a sedentary lifestyle, and diabetes with 18.2% and 8.3% respectively; NYHA stage III-IV dyspnea was found in 83.9%. Reduced EF heart failure was present in 110 patients (76.9%), seventeen cases with moderately reduced EF (11.9%) and sixteen patients had preserved EF (11.2%). Global heart failure was the dominant (91.6%). The main etiologies of heart failure were dominated by hypertensive heart disease in 46 patients (32.2%), followed by postpartum cardiomyopathy with 43 cases (30.1%), primary dilated cardiomyopathy in 18 patients (12.6%), ischemic heart disease in 16 patients with 11.2%. Seven cases of valvular heart disease, or 4.9%. The evolution was favorable under treatment in 104 patients or 72.7%. In-hospital mortality was 14.7%. Conclusion: Heart failure is a common condition in sub-Saharan Africa, particularly in our country.

Introduction: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. Objective: to identify the results of coronary angiography in diabetic patients. Patients and method: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. Results: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. Conclusion: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.

Introduction: High blood pressure is defined as blood pressure greater than or equal to 140 mm Hg for systolic and or 90 mm Hg for diastolic. It constitutes a major public health problem, the leading chronic disease in the world. The objective was to determine the prevalence, treatment rate and control of hypertension. Methods: This was a cross-sectional and descriptive study which took place over a period of 6 months in a hospital environment and in the general population. Results: Of the 1000 participants, 637 had hypertension, giving a prevalence of 63.70% with a female predominance. Thirty-three percent (33%) were unaware of their high blood pressure. The age group 60 and more was the most represented (44%). A proportion of 33 and 23.20 were overweight and obese participants, respectively. Male subjects were more overweight than female, unlike obesity which was more common among female subjects. Sixty-two percent (62%) of hypertensives were treated, of whom 44% were non-compliant. The excessively high cost and consumption of medications as needed were the main factors in therapeutic non-compliance. Twenty-two percent (22%) of all hypertensive patients and 35% of treated hypertensive patients were controlled. Women were more treated but less observant and less controlled than men. Therapeutic coverage and combination therapy rates were lower in rural areas. Hypertensives who had a high level of education were better treated and controlled than those who had no level. Conclusion: High blood pressure remains a real public health problem in Mali. It is more common in people aged 60 and over and in females. One in three hypertensives were unaware of their hypertension. The majority received antihypertensive treatments, but only a minority of them had their hypertension controlled.

Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02; p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient's management.

Introduction: Heart failure is a complex syndrome and very frequently observed and secondary to the outcome of many advanced heart diseases. It is made up of a set of symptoms that reflect the tissue and visceral consequences of heart failure. The objective was to determine the hospital prevalence and to describe the management of heart failure in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive cross-sectional study with retrospective data collection, carried out over 24 months and involving the analysis of 266 records of patients hospitalized for heart failure. Results: The frequency of heart failure was 17.6% with a female predominance. The average age was 48 years with extremes of 16 and 90 years. Cardiovascular risk factors were dominated by high blood pressure with 38%. Global heart failure was the mode of discovery in 72.2% of cases. The etiologies were dominated by hypertensive dilated cardiomyopathy in 36.8% and peripartum cardiomyopathy in 32% of cases. The majority of our patients benefited from diuretic treatment, i.e. 95.9% frequency; with a favorable evolution in 96.2% of cases. We recorded 10 deaths, i.e. a lethality of 3.7%. We report some difficulties encountered during our security study because Tombouctou is a war zone and the lack of a technical platform for biology such as (BNP or NT-proBNP). Conclusion: Heart failure is a real public health problem. Its prevalence is increasing due to the aging of the population and especially the poor management of arterial hypertension in our context.

Scleroderma (or systemic sclerosis) is a disease characterized by abnormalities in the functioning of small blood vessels and the immune system, ultimately leading to inflammation and excessive fibrosis of the skin and various organs, including the heart. Management must be multidisciplinary, to avoid complications that are often serious. We report the case of a 20-year-old patient with no known cardiovascular history who consults for dyspnea, and retrosternal pain associated with a dry cough. On physical examination, she had tachycardia, swelling of the lower limbs, jugular turgidity, and deafening heart sounds. Cardiac Doppler ultrasound shows dilation of the right cavities, paradoxical septum and significant pulmonary arterial hypertension, pericardial effusion of medium abundance. On oral examination, it presents an ulceration of the lips, dermatological examination finds scattered hypo chromic spots in the body, more accentuated in the face. Before the hypo chromic dermatosis, a dermatological consultation was carried out with an autoimmune assessment that came back positive for systemic scleroderma.

Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the Ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifestations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores; 51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis and early recovery in a hospital environment, remains the effective means of combating this condition.

Venous thromboembolic disease (VTE) is a nosological group that consists mainly of deep vein thrombosis (DVT) and pulmonary embolism (PE). The objective of our study was to determine the hospital prevalence of VTE in this Nianakoro Fomba Regional Hospital (HNF) in Ségou, Mali, to describe the sociodemographic aspects of these patients and the therapeutic possibilities in this locality. Materials and Methods: We conducted a prospective descriptive study from June 2019 to June 2020 in the cardiology department of the HNF of Ségou. All patients of all ages and both sexes who had VTE on clinical and paraclinical criteria (pulmonary Angio scan and/or venous Doppler echo) during the study period were included. Result: 31 patients were included out of 366 hospitalized patients, with a hospital prevalence of 8.47%. The 41-60 and 61 - 80 age groups were both dominant with 35.48% of cases each. The female sex was the most represented with 58.06% of cases and a sex ratio of 0.97. High blood pressure (hypertension) was the preeminent cardiovascular risk factor in 32.2% of cases and predisposing factors for VTE were dominated by immobilization (41.94%), peripartum (16.13%) and heart failure (16.13%). Dyspnea and chest pain were the frequent reasons for consultation with 93.54% and 83.87% of cases respectively and 6 patients (19.35%) had calf pain. More than 3/4 of the patients had tachypnea or 90.32% and tachycardia in nearly 74.19%. The clinical probability of VTE was intermediate at 51.61% according to the Wells score. D-Dimers were elevated in 38.70%, or all 12 patients who performed it. The electrocardiogram (ECG) recorded a sinus rhythm in 93.54% of cases, a right branch block and atrial fibrillation (AF) in 35.48% and 6.45% of cases, respectively. Dilation of the right ventricle was present in 64.51% of cases with PAH in 61.29% on cardiac Doppler ultrasound. In the majority of cases (82.15%) it was a massive bilateral proximal and distal pulmonary embolism. Treatment was based on low molecular weight heparin (HPBM) and antivitamin K (AVK) in all patients (100%). No bleeding incidents; the average hospital stay was 10 days and an intra-hospital mortality rate of 29%.

Introduction: Cardio-renal syndrome is a pathophysiological disorder of the heart and kidneys in which chronic or acute dysfunction of one can lead to chronic or acute dysfunction of the other.The objective of this study was to determine the prevalence of cardio-renal syndrome in the Medical Department of the Tombouctou Hospital in Mali.Methods: It is about a descriptive transversal study carried out over 18 months, from January 01 st , 2020 to June 30 th , 2021 and relating to the analysis of 75 files of patients hospitalized for heart failure and with impaired renal function.Results: The frequency of cardio-renal syndrome was 6.4% with a predominance of men (sex ratio: 2).Hypertension was the most widely described risk factor (50.6%).The history was dominated by chronic heart failure (14.6%) and diabetes (6.6%).The average age was 58 with extremes of 18 and 90.The main aetiologies were dilated cardiomyopathy (46.6%) and ischemic heart disease (20%).Symptoms were dominated by dyspnea (90.6%) and edema of the lower limbs and face (74.6%) accompanied by cough (74.6%).Anemia was noted in 15 patients (20%).The mean clearance (MDRD) was at 32 ml/min.Doppler echocardiography found left ventricular dilation (66.6%), lower left ventricular systolic fraction (64%) and kinetic abnormalities (20%).The kidney ultrasound performed in 9 patients returned to normal in 8 cases and in 1 patient the kidneys were small.Eight deaths (10.6%) were noted.Conclusion: Cardio-renal syndrome is a common feature in which mixed failure is observed in the unfavorable course of heart disease and nephropathy.Its prevalence is unfortunately under evaluated in cardiological settings in Africa and particularly in Mali, hence the interest of a more advanced study.

Introduction: Neurological complications are possible during infective endocarditis. They are often life-threatening and can be a source of sequelae. Case Presentation: We report the case of an 11-year-old patient admitted to the cardiology department of the CHU-ME “LUXEMBOURG” in Bamako for functional impotence of the left hemibody, accompanied by fever and NYHA stage II dyspnea. The clinical examination on admission shows the poor general condition, normal consciousness, and sensory-motor deficit of the pyramidal type of the left hemibody. The cardiovascular examination notes a systolic murmur at the mitral focus, hepato-jugular reflux, hepatomegaly, and slight edema in the lower limbs. Brain CT showed localized hypodensity in favor of an ischemic stroke. The electrocardiogram shows a sinus rhythm. Transthoracic Doppler echocardiography revealed mitral insufficiency with vegetation of 17 × 14 mm on the anterior mitral valve, with left ventricular ejection fraction estimated at 75%. Dual antibiotic therapy associated with conventional treatment for heart failure was initiated. The clinical evolution was marked by the persistence of the deficit of the left upper limb, the cardiac Doppler echography of control after 6 weeks of treatment found the same vegetation. A discussion with the heart team with a view to a surgical cure has been initiated for the rest of the treatment. Conclusion: A motor deficit associated with fever related to an ischemic vascular accident should lead to a search for infective endocarditis on cardiac Doppler ultrasound.

The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron® tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

Objective . This study aimed to compare 2 laborless tools, namely, the body mass index-based Framingham (bmi-Frm) and low-information WHO- (li-WHO-) based risk scores, and assess their agreement in outpatients in a cardiology department. Methodology . Data stem from a cross-sectional previous study performed from May to September 2016 in the Cardiology Department of University Hospital Gabriel Touré (UH-GT) in Bamako. All patients aged 40 and more were included in the study allowing the assessment of bmi-Frm and li-WHO prediction charts. The cardiovascular risk (CVR) was evaluated using a calculator prepared by D‘Agostino et al. for the bmi-Frm and the li-WHO chart for the Afro-D region of the WHO. The risk score for both ranged from <10 to ≥40. The data were entered in an ACCESS 2010 database, then processed by MS Excel 2010, and finally analysed using IBM SPSS Statistics 20. Continuous variables were presented as means and standard deviations, and categorical variables were presented as frequencies with percentages. P < 0.05 was considered the statistical significance level. After sample description, the risk score was assessed using bmi-Frm and li-WHO prediction tools. Finally, a kappa test was performed to check for the interreliability of both methods. For weighted kappa, coefficients were given all five classes of risk groups in 0, 25 steps from 1 for total concordance to 0 for total discordance. Results . This study involved 793 outpatients, 63.7% being female, 35.1% of them younger than 50 years, 57.9% with no formal education, and 67.7% with no medical insurance. Means for age, body mass index (BMI), and systolic blood pressure (SBP) were, respectively, 53.81 ± 16.729 years, 25.29 ± 06.151 kg/m2, and 139.49 ± 27.110 mm Hg. Using the li-WHO prediction chart gives a much higher proportion of low-risk patients compared to bmi-Frm (83.6 vs. 37.7). Sociodemographic characteristics such as education or income level were not different in risk score neither for the bmi-Frm nor for the li-WHO risk score. The percentage of agreement between both tools was 40.4%, and agreement (kappa of 0.1 and weighted kappa of 0.2) was found to be slight. Conclusion . Using the bmi-Frm and li-WHO tool gives a similar risk estimation in younger female patients. Older patients must be evaluated using high-information tools with cholesterol, e.g., versions of the Framingham risk equation or WHO using cholesterol. These must be confirmed in further studies and compared to data from prospective studies

Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.

ABSTRACTObjective. To estimate the concordance rate and find the characteristics of discordant patients using the two versions of the WHO/ISH prediction charts in a population of outpatients in the University Hospital Gabriel Toure (UH-GT). Methodology. This study involved outpatients for whom cholesterol data was available. We use WHO/ISH Afro-D prediction charts with and without cholesterol to assess the 10-years cardiovascular risk score. IBM SPSS software was used for uni- and bivaluate analyses and Cohen’s test for the reliability of both charts. Results. The concordance rate for both cholesterol free and available WHO/ISH risk scores was 74.1%. Patients showing discordant risk scores were older (p=0.012) and had higher systolic, diastolic pressures, respectively of 163.26 vs 137.54 mmHg with p<0.0001, 92.50 versus 85.67 mmHg with p=0.001. The agreement between the two WHO/ISH prediction tools was fair with a κ of 0.334 (95% CI, 0.316 to 0.351), p < 0.001.. Conclusion. The discordance rate was about one-fourth and only age and pressure values were higher in patients with discordant scores. Further large sample data are needed to confirm these findings, particularly in the setting of low resources. Identifying patients who will benefit from lipid checking is essential and could aid to save resources and their allocation. RESUMEObjectif. Estimer le taux de concordance et retrouver les caracteristiques des patients discordants a l'aide des deux versions des outils de prediction OMS/ISH du risque cardiovasculaire (RCV) dans une population de patients ambulatoires du CHU Gabriel Toure (UH-GT). Methodes. Cette etude portait sur des patients ambulatoires pour lesquels des donnees sur le cholesterol etaient disponibles. Nous avons utilise les tableaux de prediction OMS/ISH du RCV pour la zone Afro-D avec et sans cholesterol afin d’evaluer le score de risque cardiovasculaire a 10 ans. Le logiciel IBM SPSS a ete utilise pour les analyses uni- et bivariees ainsi qu'un test de Cohen pour l’accord entre les deux outils. Resultats. Le taux de concordance entre les scores de risque OMS/ISH avec ou sans cholesterol etait de 74,1 %. Les patients presentant des scores de risque discordants etaient plus âges (p=0,012) et avaient des pressions systolique et diastolique plus elevees, respectivement de 163,26 contre 137,54 mm Hg avec p<0,0001, 92,50 contre 85,67 mm Hg avec p=0,001. L’accord entre les deux outils de prediction de l'OMS/ISH etait passable avec un de 0,334 (IC a 95 %, 0,316 a 0,351), p < 0,001. Conclusion. Le taux de discordance etait d'environ un quart et seules les valeurs d'âge et de pression etaient plus elevees chez les patients avec des scores discordants. Des donnees issues d'echantillons plus larges sont necessaires pour confirmer ces resultats, en particulier dans le contexte de faibles ressources. L'identification des patients qui beneficieront d'un bilan lipidique est essentielle et pourrait contribuer a economiser les ressources et leur affectation.