Feb 2024 DOI 10.14302/issn.2329-9487.jhc-24-4910
Ebstein’s anomaly is a rare congenital heart disease. It is usually associated with other congenital defects, particularly atrial septal defect/patent foramen ovale (PFO). We report here the case of Ebstein's disease revealed in a 23-year-old adult admitted for palpitations and exertional dyspnoea. He was in heart failure. The EKG showed atrial flutter . Cardiomegaly was present with a cardiothoracic index of 0.7. On echocardiography, the apical displacement of the tricuspid septal leaflet was 15 mm/m2 , the Celermajer index was Grade 3. There was a large thrombus floating in the right atrium. While awaiting surgical management, the patient was being treated with diuretics, digitalis and anticoagulants.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Aug 2014 DOI 10.14302/issn.2329-9487.jhc-13-313
Objective: Ablation of foci within the atria has been shown to resolve symptoms of atrial fibrillation and atrial flutter. However, no standard has been established for anticoagulation after the procedure. Enoxaparin has been well described in the literature as a means to provide anticoagulation after ablation procedures. The only enoxaparin doses previously studied were 0.5 mg/kg and 1 mg/kg, both given every 12 hours. The purpose of the study was to compare the incidence of a major bleed or vascular complication in patients who received enoxaparin doses between 0.5 mg/kg and 1 mg/kg every 12 hours with patients who received either 0.5 mg/kg or 1 mg/kg every 12 hours. Methods: This IRB-approved, single-center, retrospective, cohort study included subjects greater than 18 years of age who received an atrial fibrillation or atrial flutter ablation procedure and at least one dose of enoxaparin post-ablation. Results: There were 119 subjects who satisfied the inclusion criteria. The primary outcome, incidence of major bleeding or vascular complication, did not demonstrate a statistically significant difference between groups (p = 0.92). The incidences were 4.8% with enoxaparin ≥ 1 mg/kg, 3% with enoxaparin between 0.5 mg/kg and 1 mg/kg, and 3.2% with enoxaparin ≤ 0.5 mg/kg. No subject experienced an ischemic stroke or transient ischemic attack within 28 days of a cardiac ablation procedure. Conclusion: Significant increases in major bleeding or vascular complications may not exist with an intermediate dose of enoxaparin provided after a cardiac ablation procedure.