CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 21 AFRICA Submission ID: 1113 ACCESSORY AND SOLITARY MAIN PAPILLARY MUSCLE HYPERTROPHY RESULTING IN DYNAMIC MID - LEFT VENTRICULAR OBSTRUCTION: CONTRIBUTION OF MULTIMODALITY IMAGING IN HIGHLIGHTING OF DYNAMIC AND STRUCTURAL ABNORMALITIES Emna Rekik, Saoussen Antit, Oussema Wachem, Marwa Abdelhedi, Dorra Aouadi, Elhem Boussabah, Lilia Zakhama Interior Security Forces Hospital, Tunisia Introduction: Solitary main and/or accessory papillary muscle hypertrophy may be an uncommon type of hypertrophic cardiomyopathy that does not meet all the usual criteria. The dynamic intraventricular obstruction it may cause is deleterious with an important clinical impact on patients. The mechanisms of such obstruction attracted a lot of attention in order to propose an appropriate treatment. Case presentation: We report a case of a 36-years-old man presented with a chief complaint of progressively worsening exertional dyspnea. He had demonstrated labile systolic murmur for more than 3 years. Rest echocardiography revealed coexistence of a solitary main papillary muscle (PM) hypertrophy and additional accessory PM with no left ventricular outflow tract or mid ventricle obstructions. Patient underwent exercise stress echocardiography unmasking severe mid-ventricle obstruction (Peak systolic gradient at exercise of 100 mmHg). There was no obvious parietal hypertrophy elsewhere. Cardiac Magnetic Resonance Imaging was conclusive for the incrimination of main and accessory PM in the dynamic process of obstruction. Conclusion: Multimodality imaging has a determinant role in the screening of spatial configuration and structural abnormalities of papillary muscles in order to avoid the misinterpreting of some atypical presentations of Hypertrophic cardiomyopathy. Submission ID: 1119 ACCURACY OF 64-SLICE COMPUTED TOMOGRAPHY IN THE PREOPERATIVE ASSESSMENT OF CORONARY DISEASE AS COMPARED WITH CONVENTIONAL INVASIVE CORONARY ANGIOGRAPHY Drissa Mariem, Aouji Cyrine, Mousli Essia Chahnez, Drissa Habiba Tunisia Introduction: Conventional coronary angiography (CA) is currently the reference test for coronary artery disease assessment. Recent advances in multislice computed tomography (MSCT) are offering a noninvasive alternative to conventional angiography in the assessment of coronary artery diseases. This study was designed to define the current role of 64-slice computed tomography (MSCT) for the diagnosis of coronary artery MODERATED POSTER SESSION 1 Predominance of arterial hypertension in the control group (54% vs. 50%) without the presence of a statistically significant difference (p=0,69). The proportion of chronic kidney disease was the same in both populations (8%). Conclusion: Cardiovascular risk factors were more present in the case group without reaching statistically significant thresholds. disease (CAD) before surgery, compared with conventional coronary angiography. Methods: Our study is a prospective transversal study that enrolled 20 patients who were scheduled for surgery between June 2019 and December 2019. All patients underwent a 64 slice CT before conventional coronary angiography. We analyzed the results of CAD assessment by means of both MSCT and conventional CA. Results: The mean age was 65±10 years. The majority of patients had less than two risk factors. All patients had atypical angina symptoms. 8 patients were scheduled for non-cardiac surgery and 12 patients for cardiac surgery ( valve replacement). Exercise tests were not possible most of the time because of a physical handicap. All patients underwent a CT scan followed by coronary angiography. The results of the coronary angiography were compared with those of the CT scan. The sensitivity, specificity, predictive positive value and predictive negative value for the detection of stenosis by means of the CT scan were respectively 94%, 96%, 90%, 99%. Conclusion: The 64 slice- CT has excellent diagnostic performance in the analysis of coronary artery disease before surgery. This technology can be used as a good alternative to coronary angiography. Submission ID: 1134 A SEVERE PULMONARY ARTERIAL HYPERTENSION COMPLICATED A SYSTEMIC-ONSET JUVENILE ARTHRITIS IN A CHILD Houda Ajmi, Rihab Sghir, Sameh Mabrouk, Fadoua Majdoub, Salsabil Nouir, Noura Zouari, Elyes Nafetti, Jalel Chemli, Saoussen Abroug Pediatric department of Sahloul teaching hospital of Sousse, Tunisia Introduction: Systemic-onset juvenile arthritis is an autoinflammatory pathology with rare pulmonary and cardiac involvement. We report a case of a patient who developed severe precapillary pulmonary arterial hypertension (PAH) during a systemic-onset juvenile arthritis with fatal outcome. Case report: A six-year-old girl was initially hospitalized in the Pediatric department of Sahloul teaching hospital for polyarthralgia, prolonged fever, hepatosplenomegaly, swelling of lymphnode and cutaneous rash. Laboratory tests revealed marked leucocytosis (WBC=25000), elevated ESR (116mm), high levels of CRP (179mg/L) and ferritin (10500ng/L). All infectious disease testing were negative as well as antinuclear antibodies. Anatomic pathologic examination of axillary lymph nodes showed no evidence of lymphatic infiltration and bone marrow aspirate had isolated no anomalies. She was diagnosed as systemic-onset juvenile arthritis by characteristic clinical course and laboratory data. The patient has been treated by corticosteroid. However, Rapidly, she began to complain of dry cough and dyspnea. A cardiac ultrasound performed during hospitalization showed severe PAH at 45 and PAPS at 90 mmHg with dilation of right cavities. Angio CT scan reveal no pulmonary embolism and right heart catheterization confirmed the pulmonary precapillary hypertension. The patient has been treated by Sildenafil. However, the outcome was rapidly fatal. Conclusion: PAH is an underrecognized complications of Systemic-onset juvenile arthritis. It may be the result of severe uncontrolled disease and the prognosis of children having this association remain poor and frequently fatal.
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