CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 15 AFRICA MODERATED POSTER SESSION 1 Submission ID: 1128 3D TRANSOESOPHAGEAL ECHOCARDIOGRAPHY ASSESSMENT OF MITRAL STENOSIS AMROUCHE AMEL, SALEM MOHAMED AMINE, DJEMMAL BILAL, DAHIMENE NAWEL, DJERMANE DALILA, OUABDESSLEM SOUHILA, BOURAHLA LAMIA, SMAILI RYM, AZAZA ADEL, SAIDANE MOURAD, AITMOKHTAR OMAR, BENKHEDDA SALIM A2 cardiology department Mustapha hospital mohamed lamine debaghine hospital, Algeria Introduction: Mitral stenosis is defined by a mitral valve area less than 1.5cm2. The planimetry of the mitral valve is the reference method to assess mitral valve stenosis, but it is not always easy to perform with 2D transthoracic echocardiography in some patients, we then use the trans esophageal echocardiography to complete our study, since the introduction of 3D modes we improved our comprehension of the mitral anatomy, 3DE improves MVA measurement since it allows to acquire front view of the mitral valve (surgical view) witch is impossible with 2D, in this acquisition we can perform the mitral planimetry very reliably with an alignment of the orthogonal planes. In addition to the benefits it offers for planimetry, it is also mandatory to evaluate the anatomy of the valve to ensure the feasibility of percutaneous mitral commissurotomy (PMC); indeed in our country the cause of mitral stenosis is mostly rheumatic and therefore better suited for PMC. Classically the Wilkins score is used, this score is based on the assessment of four parameters (in 2D echocardiography), which include: leaflets mobility, thickness, calcification, and subvalvular apparatus. currently 3D has a supplementary value in this purpose and there is some new scores developed for this purpose for exemple 3DRTE score: each leaflet is divided into three scallops (anterolateral A1-P1, middle A2-P2, and posteromedial A3-P3) and each part is scored separately for thickness, calcification, and mobility. There is sufficient evidence that 3D is superior to 2D echocardiography and may be routinely used in the quantification of the MVA and the mitral anatomy in mitral stenosis. Submission ID: 1161 ATRIAL SEPTAL DEFECT AND THREE DIMENSIONAL TRANS ESOPHAGEAL ECHOCARDIOGRAPHY : WHEN THE 3D SAVES THE DAY? DAHIMENE NAWEL, AMROUCHE AMEL, DJERMANE DAHLIA, KARA MAAMER, AIT MOKHTAR OMAR, SALEM AMINE, OUABDESSELAM S, SAID OUAMER DALILA, LOUALI INSSAF, SMAILI RYM, BOURAHLA LAMIA, BENKHEDDA SALIM A2 cardiology department, Mustapha Bacha hospital, Algeria Introduction Atrial septal defect (ASD) is one of the most common acyanotic congenital cardiac diseases. The clinical presentation is variable and the closure indication are clear in most cases. The challenge is to select the right candidate for the right modality. Transcatheter procedures are less invasive and provide rapid recovery and early discharge of the patient; it is now widely accepted as the first therapeutic approach. The 3 D Transesophageal echocardiography ( 3D TEE) seems to be the appropriate tool to get a detail morphological evaluation of the defect which is the key to achieve a successful closure In these two cases we are going to discuss how the 3D TEE helps us decide which of these two patients is eligible to a transcatheter closure and what is the added-value of the 3D in this situation. Two patients were addressed to our echolaboratory , the first has excercise dyspnea, the second was paucisymptomatic, both have major right ventricular dilatation and volumetric overload due to an ostium secondum atrial septal defect but only one was selected to a transcatheter closure despite similar TTE finding. The 3D TEE has shown better description of the rims bordering the defect so the selection was easier and more accurate. Key words: Atrial septal defect - Three dimensional transosophageal echocardiography- transcatheter closure Submission ID: 989 A JELLYFISH SHAPED PROXIMAL LEFT ANTERIOR DESCENDING CORONARY ARTERY: ABOUT AN INTRIGUING CASE WAEL YAAKOUBI, BASSEM REKIK, SLIM BOUDICHE, FOURAT ZOUERI, FATHIA MGHAITH, SANA OUALI, MANEL BEN HLIMA, SAMI MOURALI MED RABTA Hospital, Tunisia Background: Coronary artery fistula (CAF) is an abnormal communication between a coronary artery and one of the cardiac chambers or a great vessel, so bypassing the myocardial capillaries. They are usually discovered incidentally upon coronary angiography. Clinical manifestations are variable depending on the type of fistula, the severity of shunt, site of shunt, and presence of other cardiac conditions. Case presentation: A 63 years old tabetic and hypertensive man was referred to cardiology clinic of LA RABTA with chest pain. His chest pain was retrosternal and effort-related, was relieved by rest, radiated to left arm. He had no history of diabetic mellitus, hyperlipidaemia, and family history of coronary artery disease. There were no signs of cardiopulmonary insufficiency. Physical examination and heart auscultation revealed nothing unusual. ECG showed a sinus rhythm of 76 beats/min, without repolarisation anomalies. The transthoracic echocardiogram demonstrated normal wall motion with an ejection fraction of 55% and heart function valve was unremarkable. Seen a high probability of coronary artery disease, the patient underwent a coronary arteriogram, which revealed a big and complex fistula connection arising from the left anterior descending artery (LAD) which was mildly calcified and draining into left pulmonary artery. The fistula was serpiginous and jellyfish-like from proximal left anterior descending artery (LAD) and it ends in two ways on the left pulmonary artery. There was a significant stenosis at the mid of LAD. The CT-Scan of coronary arteries confirmed the presence of an aneurysmal and tortuous coronary artery fistulae between proximal segment of LAD and left pulmonary artery. Considering the complexity of this fistulae, we thought that transcatheter repair would not occlude it totally and therefore, surgery would be a more feasible and effective approach. After discussing the risks and benefits of the surgical and transcatheter approaches with the patient, the decision was made to pursue surgical repair. Conclusion: Our case is a good example of a rare congenital anomaly in which coronary artery pathology can remain entirely asymptomatic over many years. Despite the fact that CAF is rare, this diagnosis should be considered in all patients who present with angina, as was evident in this case.
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