CARDIOVASCULAR JOURNAL OF AFRICA • SMC-PAFCIC Abstracts October 2022 63 AFRICA Submission ID: 1729 VENTRICULAR SEPTAL DEFECT POST-MYOCARDIAL INFARCTION: ABOUT 7 CASES EMAD ALDIN MASSRI, NESMASSI MOUNIR, ICHRAQ FADAOUI, OUKERAJ LATIFA, DOGHMI NAWAL, CHERTI MOHAMMED MOROCCO Introduction: Ventricular septal rupture (VSR) is a rare complication of acute myocardial infarction, thanks to the improvement of pharmacology treatment, catheter-based and surgical reperfusion of patients in the past few decades. Nevertheless with the presence of risk factors of VSR, it can happen with a somber prognostic. The objective of our work is to compare risk factors, timing, clinical presentation and the management of 7 cases of VSR, illustrating the prognosis of each case. Methods: Our prospective study consisted of the inclusion of 7 patients in a monocentric study carried out within the cardiology departments B of the Souissi Maternity Hospital in Rabat over a period of one year. The main inclusion criterion is the detection of VSR after Myocardial infarction (MI). Results: The study involved 5 men and 2 women, for a sex ratio of 2.5/1. The median age was 68 years. The most risk factor seen is diabetes and smoking (42.8%) followed by hypertension seen only in one patient, the average timing of detecting the VSR is 8 days varying between 2-18 days, with the clinical manifestation dominated by acute heart failure (3 patients),cardiogenic shock (3 patients) and only one patient was asymptomatic. The detection of VSR was done using Transthoracic echocardiography in all patients, VSR was associated with LV aneurysm in 2 patients (28.5%). Coronarography was done only in 5 patients, 3 of them having multiple vessel lesions. Left anterior descending artery (LAD) lesion was seen in 5 patients followed by left marginal and right coronary arteries (2 patients each). Only 3 of the 7 patients underwent surgical closure, with 3 of them died (2 before surgery and one after). Conclusion: VSR is a rare yet deadly complication of myocardial infarction, varying between asymptomatic to cardiogenic shock manifestation, which can be detected by simple cardiac auscultation. Its management requires a complex procedure involving an interprofessional team, including an interventional cardiologist and cardiothoracic surgeon. Submission ID: 1731 CONCOMITANT CORONARY STENT AND FEMORAL ARTERY THROMBOSIS IN THE SETTING OF HEPARIN-INDUCED THROMBOCYTOPENIA SKANDER BOUCHNAG, MEJDI BEN MESSAOUD, YASSINE KALLELA, NIDHAL BOUCHEHDA, MOHAMED MEHDI BOUSSAADA, MOHAMED MAJED HASSINE, MARWEN MAHJOUB, FETHI BETBOUT, HABIB GAMRA TUNISIA Introduction: Heparin is a commonly used anticoagulant for hospitalized patients, but its use can lead to devastating complications, such as heparininduced thrombocytopenia (HIT). We report the case of a 66-year-old male patient, with a history of smoking, who was admitted to our department for a spontaneously resolved inferior STEMI. The coronary angiogram showed a thrombotic lesion of the distal circumflex. The patient underwent an ad-hoc PCI of the circumflex with a drug-eluting stent. Initial laboratory tests at admission were normal. The patient was discharged after 5 days. Laboratory tests were not controlled during the hospitalization. The discharge treatment included aspirin, clopidogrel, bisoprolol, and atorvastatin. One week later, the patient has referred again to our department for both chest and right lower limb pain. The electrocardiogram showed an inferior STEMI and the physical exam of the right lower limb found ischemic signs with the absence of the femoral pulse. An urgent coronary angiogram showed total thrombosis of the circumflex stent. The patient underwent a successful PCI of the circumflex by a balloon. An urgent lower limb CT scan was performed immediately after the angioplasty, revealing total acute thrombosis of the right common femoral artery. The patient underwent an urgent successful thrombectomy with a Fogarty catheter. Immediate evolution was favorable with total regression of ischemic signs. Laboratory tests showed a marked fall in the platelet count (68,000/L) which was normal (364,000/L) in the previous hospitalization. A diagnosis of concomitant coronary stent and femoral artery thrombosis due to HIT was strongly suspected (4T score = 8). Our therapeutic strategy was immediate discontinuation of low molecular weight heparin, aspirin, and clopidogrel with strict daily control of platelet count. During this period, no alternative anticoagulation was initiated because of the unavailability of direct thrombin inhibitors in our center. Anticoagulation with a vitamin K antagonist (acenocoumarol 4 mg once a day) and dual antiplatelet therapy with aspirin and clopidogrel was initiated at day 3 once platelet count had recovered. The in-hospital outcome was favorable and the patient has discharged on acenocoumarol, aspirin, and clopidogrel. The 3-month follow-up, with controlled blood tests and lower limb contrast-enhanced computed tomography showing total reperfusion of the right femoral artery, was unremarkable. MODERATED POSTER SESSION
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