CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 17 AFRICA Submission ID: 1006 BALLOON MITRAL VALVOTOMY FOR PATIENTS WITH MITRAL STENOSIS IN ATRIAL FIBRILLATION: IMMEDIATE AND LONG TERM Fadwa Omri, Mejdi Ben Messaoud, Skander Bouchnag, Ammar Dhouibi, Mahdi Boussaada, Nidhal Bouchahda, Marouen Mahjoub, Majed Hassine, Fethi Betbout, Habib Gamra Introduction: Atrial fibrillation (AF) is a common finding in patients with severe mitral stenosis requiring Balloon Mitral Valvotomy (BMV). Its immediate and long term prognosis remains controversial Materials and methods: The immediate procedural and the long-term clinical outcome after BMV of 139 patients with AF were collected and compared with those of 381 patients in normal sinus rhythm (NSR). Objectives: We sought to evaluate the effect of AF on the immediate and longterm (23 years) outcome of patients undergoing BMV. Results: Patients with AF were older (43.3 vs. 29.7 years; p < 0.001), had frequently a history of systemic embolism (9.4% vs. 1.6%, p< 0.001) and of mitral commissurotomy (28.1% vs. 19.4%, p=0.035). Symptoms were similar between the two groups (NYHA > II: 48.9% vs. 49.9 %, p= 0.648). Patients with AF had more frequently a Wilkins score > 8 (51.4% vs. 30.9%, p <0.001), a larger left atrium (41 cm2 vs. 32 cm2, p= 0.001) and a lower transmitral gradient (11.1 mmhg vs. 16.6 mmhg, p < 0.001). BMV was equally successful in the two groups (90.6% vs. 94%, p= 0.187) but resulted in a smaller post BMV area (2 cm2 vs. 2.15 cm2 , p= 0.012) with a lower mitral valve area gain (0.9 cm2 vs. 1 C, p=0.015). BMV was not associated with a higher risk of complications (4.3% vs. 4.7%, p= 0.844). After a mean follow-up of 74 months, patients with AF had the same rate of restenosis (28.3% vs. 25.6%, p=0.96) but required more frequently a mitral valve replacement (16.3% vs. 7.7%, p= 0.012). They also experienced higher rates of systemic embolism (3.8% vs. 0.6%, p=0.018) and had a lower rate of event free survival (freedom from death, restenosis and systemic embolism) (52.2% vs 68.8%, p= 0.047). In the group of patients in AF, predictive factors for combined adverse events including death, restenosis, and systemic embolism and mitral valve replacement are: post BMV area < 2cm2 (OR: 2.5, 95% CI [1.2; 5.18], p= 0.014), procedural complications including severe mitral regurgitation and tamponnade (OR: 3.95, 95% CI [1.4; 11.13], p= 0.009) and NYHA ≥ II during follow up (OR: 3.46, , 95% CI [2.09; 5.73], p <0.001). Conclusion: Our data support the fact that patients with AF have worse immediate and long term outcomes after BMV. Post BMV area < 2cm2, procedural complications and dyspnea predict adverse events during follow up. Submission ID: 1015 ANOMALOUS ORIGIN OF LEFT CORONARY ARTERY FROM THE RIGHT PULMONARY ARTERY: AUTOPSY CASE AND LITERATURE REVIEW Sarra BEN ABDERRAHIM, Meriem Gharbaoui, Olfa Békir, Moncef Hamdoun, Mohamed Allouche Department of Forensic Medicine – Charles Nicolle University Hospital, Tunis, Tunisia Introduction: Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) MODERATED POSTER SESSION 1 is a rare congenital heart disease (0.46% of all congenital anomalies) responsible for the development of heart failure, most often at an early age. Few cases of survival to adulthood with no surgical correction have been published in the literature, with a diagnosis made at autopsy in 41% of cases. We report a case of incidental discovery of ALCAPA during a sudden death autopsy in a young adult, with the aim to discuss novel insights into the pathophysiology of this heart defect. Case report: The case involves a 23-year-old male subject, with a family history of sudden death, who quickly died after the onset of acute chest pain. The autopsy revealed a heart weighing 345gr, with an anomalous origin of the left coronary trunk arising from the pulmonary trunk, which then divides into two branches, the left anterior descending coronary artery, and the circumflex artery. The right coronary artery arises from the left Valsalva sinus and runs along the anterior part of the atrioventricular sulcus. The coronary network was free from any atherosclerotic plaque. The heart walls were thickened, and white myocardial areas were found at the anterior and lateral wall of the left ventricle, corresponding to old myocardial fibrosis (supported by the histological study). The cause of death was concluded as an ischemic heart failure related to an anomalous coronary artery origin. The manner of death was retained as natural (after a negative toxicological study). Conclusion: The diagnosis of ALCAPA was made postmortem in our case. This form is known in the literature as a moderate form of ALCAPA, where the collateral network between the coronaries is sufficient, at least until the anomaly is revealed in the event of sudden death. Submission ID: 1021 CLINICAL CHARACTERISTICS OF HIGH BLEEDING RISK PATIENTS ADMITTED FOR NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION Fares Ammar, Aymen ben Abdesslem, Anis Ghariani, Semah Afli, Abdallah Mahdhaui, Gouider Jeridi UHC Farhat Hached, Tunisia Background: Patients presenting with Non-ST segment elevation myocardial infarction (NSTEMI) represent an heterogeneous population, with often significant overlap of both ischemic and major bleeding risk factors. Aim: We sought to evaluate the prevalence of HBR patients among those admitted for NSTEMI and their prognosis Methods: From January 2017 to December 2020, patients, admitted for NSTEMI and treated with PCI, were enrolled, Bleeding risk factors were evaluated by calculating the ARC HBR score with the online application. Results: Two hundred and fifty patient were enrolled. Sixty nine patients (27.5 %) were at high bleeding risk, among them, 33 had only one major criteria (47.8%), 29 patients had two minor criteria (42 % ) and 7 patients (10%) had more than one major criteria. High bleeding risk patients were older (79.4 % vs. 19 %, p<0,001), more commonly female (50 % vs 21.4 %, p<0,001), had more cardiovascular risk factors such as diabetes mellitus (54.4 % vs 35.7%, p=0,007) arterial hypertension (63.2 % vs 40.7%, p=0,002) and dyslipidemia (33.8 % vs 17 %, p =0.004). Furthermore, these patients had more comorbidities such as oral anticoagulation (19.1 % vs 0% , p<0,001), previous ischemic stroke (16.2 % vs 1.1%, p <0,001), chronic kidney disease (42.6 % vs 6.6 %, p<0.001), mild and severe
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