AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 42 Submission ID: 1046 LUCKILY, WE ENHANCE THE STENT! NOAMEN Aymen, Ben ayed houssem, Chenik sarra, Raddaoui Haythem, Hajlaoui Nadhem, FEHRI Wafa Military Hospital of Tunis, Tunisia Introduction: Stent fracture is an underestimated entity emphasized by the frequent recourse to intravascular imaging tools, rising concerns about it as a potential cause of stent restenosis and thrombosis which can lead to adverse clinical outcomes and underlying the importance to have a clear diagnosis algorithm with a gold standard imaging patterns and consensual therapy Case presentation: a 78-year-old man was admitted with a history of class 3 Canadian cardiovascular society CCs grading of angina seven year after an angioplasty of mid left anterior descending artery with a 2,5x18mm sirolimus drug eluting stent (DES)(Cypher) for unstable angina. Coronary angiography showed focal in-stent restenosis. Drug eluting balloon angioplasty was planned as initial approach motivated by the focal pattern of restenosis in a small diameter stent with thick struts. During this procedure, we performed a digital image enhancement revealing a stent fracture with two fractured segments still maintained contact without definite displacement which was not evident on angiography. So, we opted to deploy a 2.75*20mm DE Zotarolimus DES in the fracture site with a satisfying final result after a postdilattion on angiography and digital image enhancement. Conclusion: We underline through this case the importance to adopt an imaging guided strategy to treat intrastent restenosis in order to choose the appropriate approach. Submission ID: 1048 MYOCARDIAL BRIDGING AND SUDDEN CARDIAC DEATH, DATA FROM THE NORTHERN TUNISIAN SUDDEN CARDIACDEATH REGISTRY BEN AHMED HABIB, Aymen FTINI, Mohamed Salmen AISSA, Mohamed BELLALI, Mehdi Ben KHELIL, Maha SHIMI, Azza BELHADJ, Emna ALLOUCHE, Rabii Razghallah, Leila BEZDAH, Mohamed ALLOUCHE, Moncef Hamdoun Department of Legal Medicine, Charles Nicolle Hospital,Tunis, Tunisia Background: Myocardial bridging (MB) is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to myocardial bridging have been reported including angina, myocardial infarction and coronary spasm, but sudden cardiac death (SCD) has rarely been described. Aim: To describe the relationship between myocardial bridging and sudden cardiac death. Methods: In the northern Tunisian sudden cardiac-death registry, we collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. The macroscopic examination of the heart included the origin and course of the coronary arteries, MB site, length, depth and the distance from vessel origin. We analysed prospectively the macroscopic features of 54 cases of myocardial bridging of the left anterior descending artery (LAD) out of a series of 2302 medico legal autopsy. The study population was divided into two groups. The first group included 13 victims with MB and no other pathology to explain death, the second one contained 41 victims of SCD with obvious macroscopic cause of death in addition to MB (ischemic heart disease, valvulopathy, Hypertrophic cardiomyopathy.) Results: The study population included 44 men and 10 women with a mean age of 56, 7 ± 11, 5 years. Cardiovascular risk factors, Circumstances and symptoms before death were similar in the two groups. SCD in group 2 occurred indoors more often than in group 1 (78% versus 64.1%, P: 0.028). Length and depth were significantly greater among victims with only MB as underlying cause of death (group 1) compared to group 2 with respectively (26,8 ± 8,44 mm, versus 19,7 ± 4,25 mm, P:0.001)and (3 ± 0,9mm versus 2,51 ± 0,63,P:0.036). There were no differences regarding the predominant site of MB, the mid LAD was the most commonly involved coronary artery in the two groups (61.1%). Conclusions: Length and depth of the MB were significantly higher in victims of sudden cardiac death with negative autopsy compared to the one with underlying cardiac disease. Although myocardial bridging is often overlooked as an etiology for sudden cardiac death, this study highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of sudden cardiac death. MODERATED POSTER SESSION 3 We present a case with a 3rd degree IAB in which a late left atrial activation resulted in a pseudo-preexcitation. The case: A 77-year-old man with a history of paroxysmal atrial fibrillation, presented in the emergency care unit with a poorly tolerated widecomplex tachycardia. The ECG showed a regular monomorphic wide QRS tachycardia at a rate of 160 bpm with a right bundle branch block pattern. The tachycardia was successfully terminated by a direct current cardioversion. During sinus rhythm, the ECG showed a 3rd degree IAB with two distinct P waves separated by a short isoelectric segment. The second P wave was started very late and there was a fusion with the beginning of the QRS producing a pseudo delta wave. Significant coronary artery disease was excluded by angiography. He was referred for an electrophysiological study (EPS) which confirmed the interatrial conduction delay and excluded an accessory pathway. The atrial pacing induced an atypical flutter with a tachycardia dependent right bundle branch block, reproducing the clinical tachycardia. Conclusion: 3rd degree IAB is uncommon. It is associated with abnormal atrial excitability leading to atrial fibrillation and other supraventricular arrhythmias. May we speak in this case about an eye artifact pseudo preexcitation syndrome?
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