AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 36 Submission ID: 1248 CORONARY PERFORATION: ALWAYS UNEXPECTED Sami Ben Ouanes, Hella Kaddour, Saeb Ben Saad, Nouha Mekki, Ayoub Meddeb, Marwen Kacem, Sameh Ben Farhat, Rym Gribaa, Mehdi Slim, Aymen Hraiech, Faten Yahya, Elyes Naffeti Tunisia Introduction Coronary artery perforation (CAP) is a rare but potentially lifethreatening complication of percutaneous coronary intervention (PCI). The occurrence of perforation increased with the evolving of interventional devices and techniques. Cardiac tamponade constitutes the most severe clinical consequence. Case Report Our patient was 78 years old, with a history of hypertension, diabetes and chronic obstructive pulmonary disease. He was admitted in our hospital for acute chest pain. He Had been having angina for 2 months, untreated. His physical examination showed uncontrolled hypertension at 16/8 and pulse at 70/min. His electrocardiogram showed diffuse ST segment depression and ST segment elevation in lead avR. His laboratory tests were normal, with a normal level of troponin. Cardiac echography showed a fraction of ejection at 60% with no wall motion abnormalities, Submission ID: 1257 EVALUATION OF THE MANAGEMENT OF PEDIATRIC CARDIAC ARREST BY IN SITU SIMULATION Hela Amara, Amal Mansour, Farrouk Douma, Dorra Loghmari, Nabil Chebbi, Sarra Soua, Roua Chouihi, Naoufel Chebili SAMU03 Sahloul, Tunisia Introduction: Pediatric cardiopulmonary arrest (CA) is a rare event with a poor prognosis. As part of a process of evaluation and improvement of our practices, we have chosen to evaluate the impact of an international certified training course: European Pediatric Life Support (EPALS) on the management of pediatric CA. Materials and methods: This is a prospective observational study on a population of 72 health professionals (38 emergency physicians, 30 pediatricians, 2 pediatric technicians, and 2 emergency technicians). Subjects were distributed over 3 EPALS sessions, each session was attended by 24 participants. We evaluated the performance of pediatric CA resuscitation at the beginning and at the end of the training. Results: The quality of resuscitation was significantly improved between the two evaluations (pre-and post-training), especially for specialized resuscitation. Airway clearance improved (98% post-course versus 43% initially). The quality of ventilation also improved (75% postcourse vs. 57% initially). Immediate initiation of external cardiac massage after the 5 insufflations also improved (92% vs. 43%). There was a significant improvement in checking cardiac rythm every 2 minutes (92% vs. 43%). The search for reversible causes (4 H, 4 T), initially insufficient, was significantly high at the end ( 14% vs 96%). Conclusion: This work highlights the interest of simulation training on the management of pediatric resuscitation. It allows a precise evaluation of teams’ strengths and weaknesses when confronted to emergencies and allows setting up improvements. MODERATED POSTER SESSION 2 were enrolled. B- Lines were evaluated at admission and the pulmonary congestion score was calculated using two methods: one score out of 30 analyzing B-lines in 8 fields and the second score out of 15 assessing them in 4 fields. The gold standard for the diagnosis of acute heart failure was based mainly on pro –BNP level. Results: 560 chest sonographies were performed on patients who initially presented to the emergency department with dyspnea. The mean age was 68 ±13 years. Sex ratio was 1.23. The diagnosis of acute heart failure was retained in 56 % of the population study. In 247 patients,an Pulmonary Congestion score (SCP-1) was obtained by summing the number of B-lines of 4 zones of chest scans. In 313 patients a (SCP-2) was obtained by summing the number of B-lines of 8 zones. The area under the curve of SCP-1 is 0.820 and the area under the curve of SCP-2 is 0.838 Conclusion: This novel simplified lung ultrasonography scoring method counting only B-lines in 4 fields provides not only easy–to-acquire data in an emergency setting but also as refined as counting them in 8 fields in order to assess pulmonary congestion in patients with heart failure. diastolic dysfunction and mild mitral regurgitation. Given the symptoms, we proceeded with coronarography that revealed significant, long and calcified stenosis in the middle and distal left anterior descending artery (LAD), significant stenosis in the distal circumflex artery and significant stenosis in the middle right coronary artery. After cannulating the right coronary ostium, guide catheter and crossing the lesion, the lesion was pre-dilated using 2mm × 15 mm balloon at 12 atms pressure. The control angiography (CAG) showed a type III coronary perforation of the Ellis classification. Prolonged balloon inflation with the same balloon 2,5mm*15mm was applied to the ruptured area and the CAG showed no extravasation. We proceeded with the direct stenting of the lesion with 2,5*30mm DES with a good angiographic result. The patient remained hemodynamically stable during the procedure and showed no ECG changes. There was no pericardial effusion on transthoracic echocardiography after the procedure. Our patient was discharged 2 days after. He was readmitted 3 months later. A middle LAD angioplasty with Rotablator was performed with the stenting of the left marginal artery by 2,75*18mm DES. He was discharged the day after with optimal medical treatment. Conclusion: CAP is a rare but feared complication in the catheterization laboratory that can be fatal. It requires rapid diagnosis and management. Choosing appropriate therapy may be lifesaving.
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