Dilatation Of Right Cavities Research Articles

Pulmonary Embolism in Critically Ill COVID-19 And Non-COVID-19 Patients: Systematic Analysis of Risk Factors, Diagnostic and Management Strategies, and Prognosis.

Background: Coronavirus disease of 2019 or COVID-19 is characterised by two main features: the first is the respiratory compromise which corresponds to acute respiratory distress syndrome while the second corresponds to the state of hypercoagulability responsible for thromboembolic complications particularly pulmonary embolism which is the subject of this work. Indeed, a high prevalence of pulmonary embolism has been reported throughout the pandemic period with a significant morbidity and mortality. This reflects the severity of this life-threatening emergency chiefly in the elderly, hemodynamically unstable patients, and patients with severe underlying conditions, mainly cardio-pulmonary comorbidities. The aim of our study is to point out the incidence, the risk factors, the clinical and paraclinical features, the management strategies, and the overall prognosis of pulmonary embolism in critically ill COVID-19 and non-COVID-19 patients. Patients and methods: It is a retrospective observational study carried out over a two-year-period from January 2019 (non-COVID-19) to December 2020 (COVID-19). Over the study period, 42 cases of COVID-19 and non-COVID-19 pulmonary embolism were collected from an overall set of 611 patients admitted to the medical intensive care unit of the IBN ROCHD university hospital of Casablanca. Results: The mean age in the COVID-19 group was 64-year-old versus 46-year-old in the non-COVID-19 group. The sex ratio was 1.2 and 0.94 in the non-COVID-19 and COVID-19 group, respectively. Clinical symptomatology was dominated by respiratory failure and chest pain in non-COVID-19 patients while in the COVID-19 group, semiology was dominated by dyspnea, cough, and chest pain. The major sign of severity in both groups was tachypnea. The chest X-ray was performed in all our patients, it displayed radiological abnormalities in all patients mainly hyper clarity in pulmonary fields. D-dimers were performed in all patients within the two study groups. A chest computed tomography angiogram was performed for all patients and showed unilateral pulmonary embolism in 61% of cases in the non-COVID-19 group versus 61.3% in the COVID-19 group. Cardiac ultrasound was performed for all patients. It showed dilatation of right cavities in both groups (81.8% in non-COVID-19 versus 93.5% in COVID-19 patients). Venous ultrasound of the lower limbs was performed in 96.8% of COVID-19 patients and in 72.7% of non-COVID-19 patients. With regards to management, all COVID-19 and non-COVID-19 patients received anticoagulation therapy based on standard heparin and anti-vitamin K. Mortality accounted for 54.5% in non-COVID-19 patients versus 74.2% in COVID-19 patients. Conclusion: COVID-19 pulmonary embolism is often associated with significantly higher morbidity and mortality as compared with non-COVID-19 pulmonary embolism.

Management and prognostic of right ventricular extended myocardial infarction: About a Moroccan experience

Myocardial infarction can affect any myocardial territory, however, the isolated right ventricle infarction is exceptional. It is often biventricular with a high mortality of about 30% compared to that of isolated LV (6%). Assess the prevalence of acute myocardial infarction extended to RV, and study the epidemiological, clinical, diagnostic, therapeutic and prognostic. Retrospective and descriptive study conducted in the Cardiology department in CHU Ibn-Rochd in Casablanca. It was conducted on patients admitted in ICU for acute MI extended to the RV, in the period January 2016 to June 2018. Of the 360 patients, who suffered a myocardial infarction in acute phase, 22 patients (6% of all AMI, 23% inferior MI) had an acute MI extended to RV. The average age of our patients was 61 years ranging from 53 to 70 years, with a male predominance. The majority of our patients (81%) have more than 03 cardiovascular risk factors. Chest pain with in physical examination: the jugular turgor, hypotension and bradycardia were the most common clinical signs in our patients. The ECG showed an ST-elevation in right leads (V3R, V4R) and in the inferior territory (DII, DIII and AvF) in all our patients. Dilatation of right cavities and wall motion disorders were the most frequent echocardiographic abnormalities (63% of patients). The most frequent complications were hemodynamic instability (46%) and rhythmic complications (36%). From the therapeutic point, thrombolysis was performed in 18 patients, which 6 patients received an additional angioplasty after failed thrombolysis. Ten patients required vascular filling, and inotropic drugs were used in 4 of our patients. Mortality in our series was 10%. Our series underscores the value of nearly management of patients admitted to the acute phase of MI extended to RV, and the considerable contribution of thrombolysis as a means of revascularization and its positive impact on prognosis.

0236 : Epidemiological profile and prognostic factors of right myocardial infarction

Myocardial infarction can affect any myocardial territory, however, the isolated right ventricle infarction is exceptional. It is often biventricular with a high mortality of about 30% compared to that of isolated LV (6%). To study the features epidemiological, clinical, diagnostic, therapeutic and prognostic of it. Retrospective and descriptive study conducted in the Cardiology department of UH Ibn Rochd of Casablanca. It was conducted on 13 patients admitted for acute MI extended to the RV, in the period April 2013 to March 2014. The average age of our patients was 58 years ranging from 39 to 71 years, with a male predominance (77% VS 13%). The majority of our patients (85%) have more than 03 cardiovascular risk factors. Chest pain with in physical examination: the jugular turgor, hypotension and bradycardia were the most common clinical signs in our patients. The ECG showed an ST-elevation in right leads (V3R, V4R) and in the lower area (DII, DIII and AvF) in all our patients. Dilatation of right cavities and wall motion disorders were the most frequent echocardiographic abnormalities (69% of patients). The most frequent complications were hemodynamic instability (54%) and rhythmic complications (38%). From the therapeutic point, thrombolysis was performed in 10 patients, which 06 received an additional angioplasty after failed thrombolysis. 07 patients required vascular filling, and inotropic drugs were used in 05 of our patients. Mortality in our series was 23%. Our series underscores the value of an early management of patients admitted to the acute phase of MI extended to RV, and the considerable contribution of thrombolysis as a means of revascularization and its positive impact on prognosis.

Diagnostic accuracy of multidetector spiral computed tomography for preoperative assessment of sinus venosus atrial septal defects in children

To prospectively assess the value of multidetector computed tomography (MDCT) for detecting partial anomalous pulmonary venous return (PAPVR) in children with suspected sinus venosus-atrial septal defect (SV-ASD). Forty-four children (mean age, 7.3years; range, nine months-16years) from whom transthoracic echocardiography (TTE) was inconclusive for the diagnosis underwent MDCT after contrast medium injection. Diagnosis was suspected on TTE by abnormal pulmonary venous return, no visualization of pulmonary venous ostia, or unexpected dilatation of right cavities. The first 11 children also underwent cardiac catheterization. Surgical findings constituted the diagnostic reference standard. Thirty-two (73%) children had SV-ASD with PAPVR. Of the first 11 patients, one had PAPVR by MDCT and 10 by conventional angiography; these 11 patients had PAPVR by surgery. Of the remaining 33 patients, 21 had SV-ASD and 12 had ostium secundum ASD, by both MDCT and surgery. MDCT had 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value for diagnosing PAPVR in patients with suspected SV-ASD. Contrast-enhanced MDCT is a highly accurate, minimally-invasive technique for detecting PAPVR associated with SV-ASD. Contrast-enhanced MDCT may be used safely to replace conventional angiography for the definitive diagnosis and preoperative evaluation of children with suspected SV-ASD.