CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 39 AFRICA MODERATED POSTER SESSION 3 Submission ID: 983 NEONATAL REVELATION OF EBSTEIN ANOMALY: WHEN THE TRICUSPID VALVE IS LETHAL GHARDALLOU Houda, HAKIM Kaouthar, KARMOUS Rahma, BEN OTHMENE Rihab, OUAGHLANI Khalil, EL BARDI Mouadh La Rabta Hospital, Tunisia Background: Ebstein anomaly is a congenital malformation of the tricuspid valve and the right ventricle (RV), combining an abnormality of the insertion of the tricuspid valve and an atrialization of a more or less extensive part of the RV. This disease is often discovered during childhood or adolescence for heart murmur. Diagnosis during adulthood is not an exception, especially in minor or moderate forms of the disease. Conversely, neonatal revelation is very rare and is observed in severe forms of the disease with a particular pathophysiology relating to what is called “the circular shunt”. Case presentation: We report the case of a newborn male referred to our department on day 3 of life for respiratory distress with heart failure associated with moderate cyanosis and a heart murmur. The transthoracic echocardiogram shown an Ebstein disease type C with a very small functional RV (Gose ratio= 1.2), a patent ductus arteriosus, significant pulmonary regurgitation (PR) with massive tricuspid regurgitation T(R) and an ectasic right atrium (RA). Low dose prostaglandin PGE1 was perfused in order to maintain adequate perfusion of pulmonary arteries. The course was unfortunelty marked by the occurrence of death at day 7 of life because of cardiogenic shock with multiorgan dysfunction. Conclusion: Neonatal revelation of Ebstein’s anomaly is observed in very severe forms of the disease. Physiologically elevated pulmonary vascular resistance at birth worsens the clinical state by aggravating tricuspid regurgitation. The duct shunt and the pulmonary and tricuspid regurgitations create a circular shunt Aorta> Pulmonary artery> RV> RA resulting in low right cardiac output (otherwise called functional pulmonary atresia) which can lead to death. Therapeutic management is very delicate and challenging, having to combine between good pulmonary perfusion on one hand and the avoidance of a severe pulmonary arterial hypertension on the other hand. The majority of these forms are beyond any therapeutic resources and progress to death is generally the rule. Submission ID: 985 MELODY PROSTHESIS: AN INFECTIVE ENDOCARDITITIS ONCE AGAIN GHARDALLOU HOUDA, HAKIM KAOUTHAR, KARMOUS RAHMA, BEN OTHMENE RIHAB, OUAGHLANI KHALIL, EL BARDI MOUADH, BEN DOUDOU MAROUA, FTINI SIRINE, ASSOUFI F ZAHRA, MSAAD HELA, OUARDA FATMA DEPARTMENT OF PRDIATRIC CARDIOLOGY LA RABTA HOSPITAL, TUNISIA Introduction: Percutaneous transcatheter pulmonary valve replacement with Melody® prosthesis changed the prognosis of congenital heart disease with right outflow tract obstructions by reducing the number of surgical interventions in this multi operated population. However, percutaneous transcatheter pulmonary valve (Melody®) has long been recognized as having a higher risk of infective endocarditis compared to surgical valvular replacement. Case presentation: We report the case of a 20-year-old patient with pulmonary atresia and intact inter ventricular septum. He underwent reconstruction of the right outflow tract with an aortic homograft in pulmonary position at the age of 10, which degenerated after 6 years and became severely stenotic. After two failed balloon dilation attempts, he underwent a percutaneous transcatheter valve implantation with Melody ° prosthesis in 2016. He was admitted in 2020 for prolonged fever with weight loss. Investigations concluded to IE of the Melody prosthesis with staphylococcus epidermidis. TTE assessement showed an obstructive vegetation on the pulmonary pathway with peak gradient at 70mmHg. Clinical outcome was favorable under medical treatment with disappearance of the vegetation after 65 days of adequate antibiotic therapy and a decrease of the RV to PA peack gradient to 25 mmHg. Conclusion: The annual incidence of endocarditis on Melody® prosthesis reported in the literature ranges from 1.3 to 9.1% per patient and per year. The technical characteristics of the Melody® valve seem to be more favorable to bacterial aggregation compared to other bioprostheses: the bovine jugular origin of the valve seems to be a contributing factor in vitro, as was attributed by comparing the CONTEGRA® bioprosthesis with the homografts; the empty space between the valve and the stent wall could create rheological disturbances which can lead to micro thrombosis and thus to bacterial graft. Other risk factors for infective endocarditis following percutaneous valve replacement have also been described: male sex, abrupt withdrawal of aspirin, an invasive procedure without antibiotic prophylaxis, and a history of infective endocarditis. Regular clinical follow-up and EI prophylaxis are mandatory in these patients to track in time such a serious complication.
RkJQdWJsaXNoZXIy NDIzNzc=