CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 61 AFRICA MODERATED POSTER SESSION 4 a high risk of recurrent hospitalization and death. The introduction of new drugs and the rigorous implementation of evidencebased recommendations in the guidelines on heart failure has led to a reduction in recent years in mortality and frequency of hospitalizations in patients with heart failure and reduced ejection fraction (HFrEF). Purpose: Our aim was to study the pharmacological management of patient with chronic heart failure in a Tunisian department according to that recommended Methods: A retrospective, descriptive study, carried out at the department of cardiology La Rabta Hospital during the period between 2013 and 2018. We analyzed a record of 250 patients followed for heart failure with ejection fraction < 40%, we were interested on the treatment profile (class of treatment, the name of molecule, doses, tolerance and side effects) Results: A total of 250 patients’ files were analyzed. The most often prescribed medications were intravenous diuretics in 90% then oral presentation. Angiotensin-converting enzyme or angiotensin receptor blocker (ARBs) were prescribed in 88 %, for ramipril the initial dose was 2.5 mg and the maximum tolerated dose was 5 mg. The maximum recommended dose was reached in 10%; 91% of patient were receiving beta blockers (BB); the most used beta blocker was Bisoprolol in all patients. The initial dose was on average 1.87 ± 0.6 mg [1.25; 2.5] and the maximum tolerated dose was 3.68 ± 1.9 mg [1.25; 10]. The Tolerance to this class of treatment was good only in 65% of patients. The main side effects limiting dose optimization were bradycardia in 15%, arterial hypotension in 77% and a transient worsening of dyspnea was noted in 8 % patients. Mineralocorticoid’s receptors antagonists (MRAs) were prescribed in 56%. Triple association of (ARBs+ beta-blocker +MRAs) was present in 48 % of cases. Recently six patients were put on ivabradine (because of fast heart late despite optimal dose of beta blockers. Neprylisin and SGLT2 inhibitors were not prescribed because of their non disponibility. Conclusion: In our study, optimal therapy of heart failure was rarely reached due to several factors specially related to patients. Submission ID: 1232 STENOSIS OF BOTH PULMONARY ARTERIES 3 YEARS AFTER SURGERY ON A TYPE 1 TRUNCUS ARTERIOSUS: DOES PULMONARY ARTERIES STENTING WORKS? sami ouanes, ayoub meddeb, slim mehdi, imen ben ali, aymen el hraiech, rim gribaa, naffeti ilyes Sahloul hospital cardiology department, Tunisia Background: Truncus arteriosus (TA) is a rare, complex congenital heart disease characterized by a single great artery supplying both systemic and pulmonary circulations, as the so called common arterial trunk Aim: Describe a complication during the follow-up of an type 1 truncus arteriosus and the therapeutic ways. Case report: We report the case of a male child, aged 3 years old, operated at the age of 15 days of life on a common arterial trunk diagnosed in front of a table of heart failure. he underwent VSD closure with aortic reconstruction and a Right Ventricular- Pulmonary Artery Submission ID: 1252 SEVERE CORONARY ARTERY DISEASE IN A 12-YEAR-OLD WITH FAMILIAL HYPERCHOLESTEROLEMIA ben ouanes sami, kacem marwen, dardouri safa, dhieb leila, gribaa rym, mehdi slim, mgarrech imen, kortas chokri, ben farhat sameh, aymen el hrayech, elies naffeti Tunisia FH familial hypercholesterolemia; RCA right coronary artery; LMA left main artery Background Coronary artery disease and acute coronary syndromes are very rare in children and adolescents. Still, we may see several acute coronary syndromes generally secondary to vasculitis of the aorta and medium vessels, anomalous coronary artery trajectory, or an array of metabolic diseases such as FH. Type IIa FH is a rare genetic disorder that causes severe elevations in total cholesterol and lowdensity lipoprotein cholesterol (LDLc). these anomalies cause target organ damage especially cardiovascular disease which can have dramatic consequences at an early age. Case presentation A 12-year-old male adolescent with a history of FH (3 first-degree relatives) and sudden cardiac death. He was diagnosed at the age of 4 with FH and was given atorvastatin and aspirin. During initial follow up he remained asymptomatic until 2018 when he presented to the emergency department with typical exertional angina. EKG showed diffuse ST-segment depression and STsegment elevation in AVR.Lab tests showed elevated troponin levels at 580ng/l. transthoracic echocardiography showed no pathological findings. The diagnosis of NSTE-ACS was confirmed, and the patient underwent early coronary angiography via femoral access which showed significant stenosis of the Ostia of the LMA and the RCA. The decision of the heart team was Stenting of the LMA and a differed angioplasty of RCA. The procedure was successfully carried out and he had LMA stenting with a DES. The RCA stenting didn’t take place; the patient remained asymptomatic, and functional stress testing showed no signs of ischemia. One year later the patient presented with recurrent angina, so he was admitted and had coronary angiography showing significant stenosis in the Ostia of the circumflex and RCA and an intra stent restenosis in the LMA. The heart team decision was a coronary artery bypass graft surgery with the saphenous vein graft to RCA, the left internal mammary artery to the left anterior descending artery, and the right internal mammary artery to the circumflex artery. The procedure took place after one month with good results and the patient was discharged after 2 weeks. Conclusion Coronary artery disease in patients with FH is challenging especially in the pediatric population. Such a condition requires optimal medical treatment, even plasmapheresis in addition to percutaneous coronary stenting or surgical treatment. prothetic tube. During follow-up there was a tight bilateral stenosis on echocardiography at the origin of the two pulmonary arteries, confirmed by thoracic CT angiography. The child underwent stenting of the right PA with a 5* 20mm stent and the left PA with an 8* 20mm stent. 1 year later, the child underwent dilation of both stent by two ballons with good results. Conclusion: Detect this lesion as early as possible for the optimal repair and management.
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