- Email: [email protected]
Can significant mitral stenosis be a cause of paradoxical low gradient, low flow in patients with severe aortic stenosis? An echocardiographic and outcome study
69
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
5.4±3.4 mmHg (p<0.001). PMBC was safe in the two groups but a lower mitral surface gain in the group of patients with WS between 9 and 11 (0,9cm2 versus 1,07cm2, p<0.001). During the follow-up, patients in the gray zone presented higher rate of restenosis (p<0.001) and required more frequently a mitral valve replacement (p=0.006). Conclusion PMBC was a safe procedure in both WS groups. Patients with a Wilkins score 9 – 11 had worse outcomes during follow-up. The authors hereby declare no conflict of interest
453 Impact of commissural calcification on the immediate result of percutaneous mitral commissurotomy L. Bezdah*, E. Allouche, S. Sidhom, H. Boussaid, N. Hammami, H. Ben Ahmed, W. Ouchtati, H. Baccar Hôpital Charles Nicolle, Cardiologie, Tunis, Tunisie *Corresponding author: [email protected] Background Percutaneous mitral balloon commissurotomy (PMC) is an effective treatment for symptomatic mitral valve stenosis and favourable anatomy. However, whether PMC should be attempted in patients with commissural calcifications remained debated, since commissural splitting is the mechanism by which mitral valve stenosis is relieved.
namic and echocardiographic characteristics can predict the immediate and long-term outcome. Patients and Methods The study involved 350 procedures of PBMV for severe mitral stenosis at the department of cardiology of the Mongi SLIM hospital, Marsa between January 1994 and May 2009. Results Procedural success, defined as mitral valve area ³1,5cm² and a mitral regurgitation ≤2/4, was achieved in 315 patients (90%). PBMV resulted in significant increase of MVA from to 1,89±0,24cm². A severe mitral Valve Regurgitation (MVR) was observed in 24 patients. NYHA class III or IV, an atrial fibrillation, an associated tricuspide and/or mitral regurgitation; a unilateral commissural fusion, the splitting of one commissure and a score of Wilkins >8 and Padial ³ 10 are identified as predictive factors of procedural failure and/or severe MVR. A left atrial pressure ³ 25mmHg, a systolic pulmonary artery pressure (PAPS) ³ 50mmHg and a pre-PMV MVA <0,9 cm² are identified as predictive of procedural failure. Among the parameters of Wilkins score, only thickening under valvular and calcifications valvular are also predictive factors. Follow-Up Events such as a valvular replacement, a restenosis or a death, were observed in 48 patients. The restenosis was observed in 63 patients. The presence of severe mitral valvular regurgitation in post procedure, post-procedure mitral valvular area <1.8cm², a high echographic score, were predictive factors of clinical events and restenosis. Conclusion Clinical baseline, hemodynamic and echocardiographic characteristics can predict the immediate and long-term outcome which will allow a better selection of the patients for PBMV. The authors hereby declare no conflict of interest
Purpose To determine whether the presence of calcium in the mitral valve commissures influence the immediate result of PMC. Methods PMC by the Inoue balloon was attempted in 247 patients (mean age: 35 years) with severe mitral valve stenosis. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification (CC) and to determine the Wilkins score. According to the absence or presence of CC, patients were divided into 2 groups: 216 patients in group CC- (no commissural calcification) and 31 patients in group CC+ (presence of calcification in 1 or 2 commissures). Baseline mitral valve area (MVA) was 1±0,19cm², the mean value of Wilkins score was 7,98±1,61 and 29 patients had unilateral commissural calcification. Post-PMC success was defined as final MVA ≥1,5cm² and no mitral regurgitation ≥ grade3. Results After PMC, the mean MVA increased to 1,79±0,34cm² resulting in a success rate of 83%. Severe mitral regurgitation (MR) occured in 5 patients (2%). Final MVA (1,83±0,32cm² versus 1,50±0,36cm²), success rate (87% versus 55%) and the rate of opening of at least one commissure (97% versus 77%) were significantly different between groups CC- and CC+(p<0,001). The rate of post-PMC MR of grade ≥3 was not different between the two groups (2% in group CC- and 0% in group CC+; p=0,6). Conclusion Our results showed that the presence of commissural calcification was associated with a lower procedural success rate but a good immediate result could be achieved in half of cases. Then, unilateral commissural calcification should not be considered as a contra-indication to PMC. The authors hereby declare no conflict of interest
759 Functional results after percutaneous mitral valvuloplasty in a series of 350 procedures and analysis of predictive factors S. Milouchi* (1), O. Abid (2) –, H. Ajmi (3), S. Ferjani (3) (1) Service universitaire de Cardiologie, Faculté de Médecine de Tunis, Tunis, Tunisie – (2) Service universitaire de Cardiologie, Faculté de Médecine de Sfax, Sfax, Tunisie – (3) Faculté de Médecine de Monastir, Monastir, Tunisie *Corresponding author: [email protected]
380 Can significant mitral stenosis be a cause of paradoxical low gradient, low flow in patients with severe aortic stenosis? An echocardiographic and outcome study A. Soufiani (1), H. Ougnou (2), FZ. Elhattab (1), N. Bendagha (1), L. Mahfoudi (1), F. Lachhab (1), M. Tribak (1), S. Moughil (1), D. Mohty* (2) (1) CHU Avicenne, Chirurgie cardiaque B, Rabat, Maroc – (2) CHU Limoges, Cardiologie, Limoges, France *Corresponding author: [email protected] Background Rheumatic disease remains the main cause of polyvalvular disease in developing countries. The most frequent combinaison is the mitral stenosis (MS) and aortic regurgitation. The association of concomitant pure mitral and aortic stenosis (AS-MS) is less common; however, its prevalence, hemodynamic consequence and prognosis are poorly investigated. Methods and Results From 2000 to 2010, 1631 patients were referred for valve surgery in one single center. After excluding all patients who had aortic and/or mitral surgery for other than pure severe isolated AS or for associated severe pure AS and MS, we had 85 patients with pure AS only, and 30 patients with both: pure AS and pure MS (2%). Thus, we studied 115 patients and all had preserved LVEF > 50% (mean age 53+/-13 yrs, 43% female). Compared to patients with isolated AS, those with AS-MS were significantly younger (41±8 vs. 58±12 years, p<0.0001) with significantly higher rate of AF (40% vs. 0%, p<0.0001) and systolic pulmonary hypertension (PH ≥40mmHg) (7% vs. 47%; p<0001). 21% of AS-MS patients had a low gradient ≤40mmHg despite small aortic valve area. Echocardiographic parameters are compared in Table. After adjusting for age and PH, patients with MS-AS had lower survival at 10 yrs (84±8% vs. 90±4% p=0.0002). Conclusion Among patients with AS referred for surgery, concomitant mitral stenosis is rare. However, it leads to a lower mean aortic gradient and LV stroke volume, higher rate of pulmonary hypertension and lower 10-year survival. The authors hereby declare no conflict of interest
Aim We sought to evaluate the immediate and long-term results of PBMV, to study the morphologic features of the mitral valve, using transthoracic and transesophageal echocardiography, according to the mitral echocardiographic score of Wilkins and Padial, and to determinate baseline clinical, hemody-
© Elsevier Masson SAS. All rights reserved.
70
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
Abstract 380 – Table: comparison of hemodynamic variables Comparison of hemodynamic variables Echo variables
Isolated AS (85 pts)
AS-MS (30 pts)
P value –
Mean mitral Gradient (mmHg)
–
11±5
Mitral valve area (cm2)
–
1.29±0.5
–
Aortic valve area (cm2)
0.68±0.15
0.73±0.17
0.18
Mean aortic Gradient (mmHg)
81±15
55±12
0.02
Low gradient <40mmHg (%)
4
21
0.006
71+15
61±31
0.05
Stroke volume (ml) Stroke volume <50ml (%) () Systolic PH (mmHg)
6
23
0.01
25±7
36±12
<0.0001
secondary chemoprophylaxis for RF was only 28.7%. Common complications were pulmonary hypertension (95.4%) pulmonary congestion (51.7%) and atrial fibrillation (AF) (40.2%). Only AF was affected by advancing age (p 0.034). AF, stroke and infective endocarditis were associated with prolonged hospitalization (p 0.000). More than half of patients were severely stenosed. Severity of stenosis increased left atrial dilatation (LAD) (p 0.033), Transmitral Gradient (TMG) (p 0.000) and Pulmonary Artery. Systolic Pressure (PASP) (p 0.0001). The tendency of AF was not influenced by LAD (p 0.309). Left ventricular systolic function (EF%) was normal in 89.7%. Case fatality was 9.2%; 75% were atrial fibrillation, 37.5% stroke and 37.5% frank pulmonary edema. Of all, 52.9% were recommended for BMVP, 28.7% surgical and 18.4% follow up, only 23.9% underwent interventional therapy; 34.8% of planned for BMVP and 4% of surgical intervention. Conclusion Pure RMS is still the commonest acquired rheumatic heart diseases with female predilection, rapid progressive course and poor prophylactic coverage. Most patients present at a late stage with complications necessitating interventional therapy. Importance of screening patients at an earlier stage and encouragement of adherence to prophylaxis program are emphasized hand in hand to provide means for regular follow up and interventional therapy. The authors hereby declare no conflict of interest
363 Percutaneous mitral commissurotomy in the pregnant woman
359
K. Kharbouche*, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
Predictors of thromboembolic complication of mitral stenosis occurred in sinus rhythm
Introduction The mitral stenosis (MS) is the most common valvular disease in the Maghreb; young women of procreation age are most concerned. Percutaneous mitral commissurotomy (PMC) has changed the prognosis of symptomatic MS of pregnant woman. Methods We report our experience on eighty-three patients requiring PMC during the third trimester of pregnancy, between June 2014 and April 2016. Results Their mean age was 29±4, 9 years; the presumed age of pregnancy was 27.5±2.9 weeks of gestation. Fifteen were in New York Heart Association class II; fifty in class III and eighteen in class IV. Twelve patients with atrial fibrillation. Wilkins score calculated in all patients with an average 7±2. No fetal deaths were noted after the procedure. 1 case of stroke, transient. No abortions occurred following the procedure. We report a maternal death fifteen days after delivery. All patients have improved after the surgery at least one class of NYHA. Mitral surface area and hemodynamic parameters improved significantly after PMC; mean left atrial pressure fell from 30±6.3 to 12.2±7 mmHg, mean transmitral gradient from 21±7.2 to 6.1±3.2mmHg and mitral valve area from 0.8±0.15 to 2.15±0.2cm2. Conclusion During pregnancy the PMC is the treatment of choice of MS must be performed by an experienced team because the angle of the trans septal puncture is subject to changes in pregnant women. The authors hereby declare no conflict of interest
Purpose to analyze the factors favoring the occurrence of thromboembolic complications in mitral stenosis in sinus rhythm and propose preventive therapeutic measures Materials and Methods This is a descriptive and analytical retrospective study, conducted in Ibn Rochd Center of Cardiology from January to June 2014, which included 45 patients with a sever RM, divided into two groups according to the occurrence (Group I: n=17, age: 34.2±8 31 years) or not (Group II: n=28, age: 32.6±9.7 years) of thromboembolic complications. Statistical analysis was performed on IBM SPSS Statistics 20. Results fIn our series, there was a female predominance in the 2 groups (79% vs 62%, group I, group II). There was no significant difference between the two groups for age, sex and functional class. Patients in group I had a dilated left atrium (57.3±4.5 vs 48.4±4.7mm, p<0.001) and a smaller mitral valve area (0.8±0.15 vs 1 1±0.21cm2, p<0.05). The phenomenon of spontaneous left – ear contrast was more frequently observed in patients with thromboembolic complications (23 of 27) than in those free of this complication (17 of 58) (p<0.001). This phenomenon was the only independent predictor in multivariate analysis. Conclusion dilation of the left atrium, the severity of mitral stenosis and especially the presence of spontaneous contrast are the main predictors of the occurrence of thromboembolic complications in mitral stenosis in sinus rhythm. Patients with one or more of these factors can benefit from anticoagulant therapy for preventive.
357 Rheumatic mitral valve stenosis: frequency, clinical characteristics and management: Moroccan experience K. Kharbouche*, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
The authors hereby declare no conflict of interest
172
Objectives To describe clinical characteristics, hemodynamics, complications, outcomes and management of patients with pure rheumatic mitral valve stenosis. Methods This study is a descriptive analytic prospective for a period of 9 months, from 1st June, 2014 to February, 2015. 45 Patients were assessed by symptoms, physical signs, blood tests, chest X-rays, ECG and echocardiography. Results Pure RMS constitutes 43.2% of RHD admitted, females were more prone (male: female 1:2.4). the mean age was 36.02±8.13yrs. Adherence to
© Elsevier Masson SAS. All rights reserved.
K. Kharbouche*, J. Hassari, I. Elhaddad, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
Maternal and fetal complications in pregnant women with mitral valve stenosis N. Benatta*, DD. Batouche CHU Oran, Faculté de Médecine, Cardiologie, Oran, Algérie *Corresponding author: [email protected] Purpose The management of pregnancy in patients with mitral valve stenosis continues to pose a challenge to the clinician. Pregnancy associated cardiovascular changes may result in a significate burden and can lead to morbidity in women with mitral stenosis. We evaluate the association between mitral valve stenosis and maternal and fetal outcome
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
5.4±3.4 mmHg (p<0.001). PMBC was safe in the two groups but a lower mitral surface gain in the group of patients with WS between 9 and 11 (0,9cm2 versus 1,07cm2, p<0.001). During the follow-up, patients in the gray zone presented higher rate of restenosis (p<0.001) and required more frequently a mitral valve replacement (p=0.006). Conclusion PMBC was a safe procedure in both WS groups. Patients with a Wilkins score 9 – 11 had worse outcomes during follow-up. The authors hereby declare no conflict of interest
453 Impact of commissural calcification on the immediate result of percutaneous mitral commissurotomy L. Bezdah*, E. Allouche, S. Sidhom, H. Boussaid, N. Hammami, H. Ben Ahmed, W. Ouchtati, H. Baccar Hôpital Charles Nicolle, Cardiologie, Tunis, Tunisie *Corresponding author: [email protected] Background Percutaneous mitral balloon commissurotomy (PMC) is an effective treatment for symptomatic mitral valve stenosis and favourable anatomy. However, whether PMC should be attempted in patients with commissural calcifications remained debated, since commissural splitting is the mechanism by which mitral valve stenosis is relieved.
namic and echocardiographic characteristics can predict the immediate and long-term outcome. Patients and Methods The study involved 350 procedures of PBMV for severe mitral stenosis at the department of cardiology of the Mongi SLIM hospital, Marsa between January 1994 and May 2009. Results Procedural success, defined as mitral valve area ³1,5cm² and a mitral regurgitation ≤2/4, was achieved in 315 patients (90%). PBMV resulted in significant increase of MVA from to 1,89±0,24cm². A severe mitral Valve Regurgitation (MVR) was observed in 24 patients. NYHA class III or IV, an atrial fibrillation, an associated tricuspide and/or mitral regurgitation; a unilateral commissural fusion, the splitting of one commissure and a score of Wilkins >8 and Padial ³ 10 are identified as predictive factors of procedural failure and/or severe MVR. A left atrial pressure ³ 25mmHg, a systolic pulmonary artery pressure (PAPS) ³ 50mmHg and a pre-PMV MVA <0,9 cm² are identified as predictive of procedural failure. Among the parameters of Wilkins score, only thickening under valvular and calcifications valvular are also predictive factors. Follow-Up Events such as a valvular replacement, a restenosis or a death, were observed in 48 patients. The restenosis was observed in 63 patients. The presence of severe mitral valvular regurgitation in post procedure, post-procedure mitral valvular area <1.8cm², a high echographic score, were predictive factors of clinical events and restenosis. Conclusion Clinical baseline, hemodynamic and echocardiographic characteristics can predict the immediate and long-term outcome which will allow a better selection of the patients for PBMV. The authors hereby declare no conflict of interest
Purpose To determine whether the presence of calcium in the mitral valve commissures influence the immediate result of PMC. Methods PMC by the Inoue balloon was attempted in 247 patients (mean age: 35 years) with severe mitral valve stenosis. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification (CC) and to determine the Wilkins score. According to the absence or presence of CC, patients were divided into 2 groups: 216 patients in group CC- (no commissural calcification) and 31 patients in group CC+ (presence of calcification in 1 or 2 commissures). Baseline mitral valve area (MVA) was 1±0,19cm², the mean value of Wilkins score was 7,98±1,61 and 29 patients had unilateral commissural calcification. Post-PMC success was defined as final MVA ≥1,5cm² and no mitral regurgitation ≥ grade3. Results After PMC, the mean MVA increased to 1,79±0,34cm² resulting in a success rate of 83%. Severe mitral regurgitation (MR) occured in 5 patients (2%). Final MVA (1,83±0,32cm² versus 1,50±0,36cm²), success rate (87% versus 55%) and the rate of opening of at least one commissure (97% versus 77%) were significantly different between groups CC- and CC+(p<0,001). The rate of post-PMC MR of grade ≥3 was not different between the two groups (2% in group CC- and 0% in group CC+; p=0,6). Conclusion Our results showed that the presence of commissural calcification was associated with a lower procedural success rate but a good immediate result could be achieved in half of cases. Then, unilateral commissural calcification should not be considered as a contra-indication to PMC. The authors hereby declare no conflict of interest
759 Functional results after percutaneous mitral valvuloplasty in a series of 350 procedures and analysis of predictive factors S. Milouchi* (1), O. Abid (2) –, H. Ajmi (3), S. Ferjani (3) (1) Service universitaire de Cardiologie, Faculté de Médecine de Tunis, Tunis, Tunisie – (2) Service universitaire de Cardiologie, Faculté de Médecine de Sfax, Sfax, Tunisie – (3) Faculté de Médecine de Monastir, Monastir, Tunisie *Corresponding author: [email protected]
380 Can significant mitral stenosis be a cause of paradoxical low gradient, low flow in patients with severe aortic stenosis? An echocardiographic and outcome study A. Soufiani (1), H. Ougnou (2), FZ. Elhattab (1), N. Bendagha (1), L. Mahfoudi (1), F. Lachhab (1), M. Tribak (1), S. Moughil (1), D. Mohty* (2) (1) CHU Avicenne, Chirurgie cardiaque B, Rabat, Maroc – (2) CHU Limoges, Cardiologie, Limoges, France *Corresponding author: [email protected] Background Rheumatic disease remains the main cause of polyvalvular disease in developing countries. The most frequent combinaison is the mitral stenosis (MS) and aortic regurgitation. The association of concomitant pure mitral and aortic stenosis (AS-MS) is less common; however, its prevalence, hemodynamic consequence and prognosis are poorly investigated. Methods and Results From 2000 to 2010, 1631 patients were referred for valve surgery in one single center. After excluding all patients who had aortic and/or mitral surgery for other than pure severe isolated AS or for associated severe pure AS and MS, we had 85 patients with pure AS only, and 30 patients with both: pure AS and pure MS (2%). Thus, we studied 115 patients and all had preserved LVEF > 50% (mean age 53+/-13 yrs, 43% female). Compared to patients with isolated AS, those with AS-MS were significantly younger (41±8 vs. 58±12 years, p<0.0001) with significantly higher rate of AF (40% vs. 0%, p<0.0001) and systolic pulmonary hypertension (PH ≥40mmHg) (7% vs. 47%; p<0001). 21% of AS-MS patients had a low gradient ≤40mmHg despite small aortic valve area. Echocardiographic parameters are compared in Table. After adjusting for age and PH, patients with MS-AS had lower survival at 10 yrs (84±8% vs. 90±4% p=0.0002). Conclusion Among patients with AS referred for surgery, concomitant mitral stenosis is rare. However, it leads to a lower mean aortic gradient and LV stroke volume, higher rate of pulmonary hypertension and lower 10-year survival. The authors hereby declare no conflict of interest
Aim We sought to evaluate the immediate and long-term results of PBMV, to study the morphologic features of the mitral valve, using transthoracic and transesophageal echocardiography, according to the mitral echocardiographic score of Wilkins and Padial, and to determinate baseline clinical, hemody-
© Elsevier Masson SAS. All rights reserved.
70
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
Abstract 380 – Table: comparison of hemodynamic variables Comparison of hemodynamic variables Echo variables
Isolated AS (85 pts)
AS-MS (30 pts)
P value –
Mean mitral Gradient (mmHg)
–
11±5
Mitral valve area (cm2)
–
1.29±0.5
–
Aortic valve area (cm2)
0.68±0.15
0.73±0.17
0.18
Mean aortic Gradient (mmHg)
81±15
55±12
0.02
Low gradient <40mmHg (%)
4
21
0.006
71+15
61±31
0.05
Stroke volume (ml) Stroke volume <50ml (%) () Systolic PH (mmHg)
6
23
0.01
25±7
36±12
<0.0001
secondary chemoprophylaxis for RF was only 28.7%. Common complications were pulmonary hypertension (95.4%) pulmonary congestion (51.7%) and atrial fibrillation (AF) (40.2%). Only AF was affected by advancing age (p 0.034). AF, stroke and infective endocarditis were associated with prolonged hospitalization (p 0.000). More than half of patients were severely stenosed. Severity of stenosis increased left atrial dilatation (LAD) (p 0.033), Transmitral Gradient (TMG) (p 0.000) and Pulmonary Artery. Systolic Pressure (PASP) (p 0.0001). The tendency of AF was not influenced by LAD (p 0.309). Left ventricular systolic function (EF%) was normal in 89.7%. Case fatality was 9.2%; 75% were atrial fibrillation, 37.5% stroke and 37.5% frank pulmonary edema. Of all, 52.9% were recommended for BMVP, 28.7% surgical and 18.4% follow up, only 23.9% underwent interventional therapy; 34.8% of planned for BMVP and 4% of surgical intervention. Conclusion Pure RMS is still the commonest acquired rheumatic heart diseases with female predilection, rapid progressive course and poor prophylactic coverage. Most patients present at a late stage with complications necessitating interventional therapy. Importance of screening patients at an earlier stage and encouragement of adherence to prophylaxis program are emphasized hand in hand to provide means for regular follow up and interventional therapy. The authors hereby declare no conflict of interest
363 Percutaneous mitral commissurotomy in the pregnant woman
359
K. Kharbouche*, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
Predictors of thromboembolic complication of mitral stenosis occurred in sinus rhythm
Introduction The mitral stenosis (MS) is the most common valvular disease in the Maghreb; young women of procreation age are most concerned. Percutaneous mitral commissurotomy (PMC) has changed the prognosis of symptomatic MS of pregnant woman. Methods We report our experience on eighty-three patients requiring PMC during the third trimester of pregnancy, between June 2014 and April 2016. Results Their mean age was 29±4, 9 years; the presumed age of pregnancy was 27.5±2.9 weeks of gestation. Fifteen were in New York Heart Association class II; fifty in class III and eighteen in class IV. Twelve patients with atrial fibrillation. Wilkins score calculated in all patients with an average 7±2. No fetal deaths were noted after the procedure. 1 case of stroke, transient. No abortions occurred following the procedure. We report a maternal death fifteen days after delivery. All patients have improved after the surgery at least one class of NYHA. Mitral surface area and hemodynamic parameters improved significantly after PMC; mean left atrial pressure fell from 30±6.3 to 12.2±7 mmHg, mean transmitral gradient from 21±7.2 to 6.1±3.2mmHg and mitral valve area from 0.8±0.15 to 2.15±0.2cm2. Conclusion During pregnancy the PMC is the treatment of choice of MS must be performed by an experienced team because the angle of the trans septal puncture is subject to changes in pregnant women. The authors hereby declare no conflict of interest
Purpose to analyze the factors favoring the occurrence of thromboembolic complications in mitral stenosis in sinus rhythm and propose preventive therapeutic measures Materials and Methods This is a descriptive and analytical retrospective study, conducted in Ibn Rochd Center of Cardiology from January to June 2014, which included 45 patients with a sever RM, divided into two groups according to the occurrence (Group I: n=17, age: 34.2±8 31 years) or not (Group II: n=28, age: 32.6±9.7 years) of thromboembolic complications. Statistical analysis was performed on IBM SPSS Statistics 20. Results fIn our series, there was a female predominance in the 2 groups (79% vs 62%, group I, group II). There was no significant difference between the two groups for age, sex and functional class. Patients in group I had a dilated left atrium (57.3±4.5 vs 48.4±4.7mm, p<0.001) and a smaller mitral valve area (0.8±0.15 vs 1 1±0.21cm2, p<0.05). The phenomenon of spontaneous left – ear contrast was more frequently observed in patients with thromboembolic complications (23 of 27) than in those free of this complication (17 of 58) (p<0.001). This phenomenon was the only independent predictor in multivariate analysis. Conclusion dilation of the left atrium, the severity of mitral stenosis and especially the presence of spontaneous contrast are the main predictors of the occurrence of thromboembolic complications in mitral stenosis in sinus rhythm. Patients with one or more of these factors can benefit from anticoagulant therapy for preventive.
357 Rheumatic mitral valve stenosis: frequency, clinical characteristics and management: Moroccan experience K. Kharbouche*, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
The authors hereby declare no conflict of interest
172
Objectives To describe clinical characteristics, hemodynamics, complications, outcomes and management of patients with pure rheumatic mitral valve stenosis. Methods This study is a descriptive analytic prospective for a period of 9 months, from 1st June, 2014 to February, 2015. 45 Patients were assessed by symptoms, physical signs, blood tests, chest X-rays, ECG and echocardiography. Results Pure RMS constitutes 43.2% of RHD admitted, females were more prone (male: female 1:2.4). the mean age was 36.02±8.13yrs. Adherence to
© Elsevier Masson SAS. All rights reserved.
K. Kharbouche*, J. Hassari, I. Elhaddad, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected]
Maternal and fetal complications in pregnant women with mitral valve stenosis N. Benatta*, DD. Batouche CHU Oran, Faculté de Médecine, Cardiologie, Oran, Algérie *Corresponding author: [email protected] Purpose The management of pregnancy in patients with mitral valve stenosis continues to pose a challenge to the clinician. Pregnancy associated cardiovascular changes may result in a significate burden and can lead to morbidity in women with mitral stenosis. We evaluate the association between mitral valve stenosis and maternal and fetal outcome