RESUMEN
The authors have conducted research on conduction disturbances in the endomyocardial fibrosis, synonymous with chronic parietal endocarditis, about 170 cases at the Institute of Cardiology in Abidjan, from January 1977 to June 1991. The anatomical and/or angiographic examination have permitted to describe 64 cases of right fibrosis, 24 cases of left fibrosis and 82 cases of bilateral fibrosis. Conduction anomalies have been observed among 42.9% of the patients. Among 92 anomalies recorded, the most frequent has been the first degree heart block (43.5%) and the incomplete right bundle branch block (30.4%). The old age of the patients and the right localization were the factors associated with conduction disturbances in endomyocardial fibrosis (difference not significant). Yet, fibrosis surgery, especially the decortication of the fibrous endocardium of the right ventricle, have generated one or many conduction anomalies among most of our operated patients. The right branch of the fasciculus of the His has been the most injured by the fragmented techniques of METRAS who had, therefore, the merit to have minimized the incidence of the complete post-operative heart blocks still high in European and Brazilian series. In term of prognosis, no conduction disturbance has directly caused a patient's death, even if those anomalies cannot be totally ruled out in the 16 cases of sudden death.
Asunto(s)
Endocarditis/complicaciones , Fibrosis Endomiocárdica/complicaciones , Bloqueo Cardíaco/etiología , Sistema de Conducción Cardíaco , Adolescente , Adulto , Distribución por Edad , Causas de Muerte , Niño , Preescolar , Enfermedad Crónica , Angiografía Coronaria , Côte d'Ivoire/epidemiología , Electrocardiografía , Endocarditis/diagnóstico , Endocarditis/cirugía , Fibrosis Endomiocárdica/diagnóstico , Fibrosis Endomiocárdica/cirugía , Femenino , Bloqueo Cardíaco/diagnóstico , Bloqueo Cardíaco/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8% of 104 coronary patients undergoing coronary angiography in this series. These 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ventricular aneurysms and 2 cases of silent ischemia in diabetic patients. Twenty-five patients were men (80.6%). There were 6 women (19.3%) two of whom presented in the post-partum period. The average age of these patients was 45 years (males: 47.7 years; females: 41.8 years). The following risk factors were noted: smoking (60%), hypertension (25.8%), obesity (29%), diabetes (12.9%), serum cholesterol (average 2.15 g/l), serum triglycerides (average 1.25 g/l). The risk index per patient was 1.29. In comparison with coronary patients with angiographic coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk factors (especially hypertension and diabetes), though this was not statistically significant. The prevalence of inaugural infarction was 81.2% in the cases of infarction with normal coronary arteries. These infarcts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6%) at coronary angiography. A provocative test was performed in only 2 cases and 1 was positive. This deserves further study and may have therapeutic implications. The authors emphasise the high incidence of hemoglobin S or C traits (57.1%). These heterozygotic hemoglobinopathies could be a risk factor in these coronary patients with normal coronary angiography.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Angiografía Coronaria , Enfermedad Coronaria/epidemiología , Adulto , Población Negra , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/etiología , Vasoespasmo Coronario/diagnóstico por imagen , Vasoespasmo Coronario/epidemiología , Vasoespasmo Coronario/etiología , Côte d'Ivoire/epidemiología , Femenino , Enfermedad de la Hemoglobina C/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Rasgo DrepanocíticoRESUMEN
Dans cet article; il s'agit d'une etude dont le travail avait pour but d'evaluer la nature et la prevalence des arythmies au cours de l'endocardite parietale chronique (EPC) ou fibrose endomyocardique (FEM) et de determiner le role de certains facteurs tels que l'age; la taille des cavites; le niveau des pressions telediastoliques dans la survenue de ces arythmies. Cette etude retrospective portait sur 160 patients hospitalises a l'Institut de Cardiologie d'Abidjan du 1er janvier 1977 au 31 decembre 1989. Le diagnostic de EPC a ete porte soit par l'angiocardiographie soit par l'autopsie. Les explorations cardiologiques habituelles ont ete realisees et l'electrocardiogramme a ete systematiquement analyse pendant l'hospitalisation et a chaque consulltation.On y trouve des troubles du rythme les plus frequemment rencontrees. D'autres arythmies sont plus frequentes chez les enfants que chez les adultes. Les donnees quelque peu contradictoires conduisent a evoquer l'intervention d'autres facteurs dans le determinisme des arythmies; notamment supraventriculaires; rencontrees au cours de l'EPC
RESUMEN
Les auteurs ont rapporte 81 patients operes d'endocardite parietale chronique (EPC) ou fibrose endomyocardique (PEM) par la technique fragmentee de Metras a l'Institut de Cardiologie d'Abidjan de janvier 1978 a juillet 1991. Cette etude; apres un recul d'une dizaine d'annees; confirme l'objectif de cette methode qui etait de diminuer l'incidence des blocs auriculoventriculaires complets (2;5 pour cent des patients) encore elevee dans les series europeennes et bresiliennes. En revanche; comme dans toute chirurgie endoventriculaire; les branches de division du faisceau de His ont ete lesees. Parmi celles-ci; la branche droite a paru avoir paye le plus lourd tribut a cette chirurgie mutilante. Le risque operatoire d'apparition du bloc de branche droit a ete de 81;6 pour cent contre 22;2 pour cent pour le bloc de branche gauche et 7;4 pour l'hemibloc anterieur gauche. Cette plus grande vulnerabilite de la branche droite tient au caractere superficiel et compact de ses fibres