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International audience; BACKGROUND: Cardiac radioablation (CR) is an innovative treatment to ablate cardiac arrythmia sources by radiation therapy. CR target delineation is a challenging task requiring the exploitation of highly different imaging modalities, including cardiac electro-anatomical mapping (EAM). PURPOSE: In this work, a data integration process is proposed to alleviate the tediousness of CR target delineation by generating a fused representation of the heart, including all the information of interest resulting from the analysis and registration of electro-anatomical data, PET scan and planning computed tomography (CT) scan. The proposed process was evaluated by cardiologists during delineation trials. METHODS: The data processing pipeline was composed of the following steps. The cardiac structures of interest were segmented from cardiac CT scans using a deep learning method. The EAM data was registered to the cardiac CT scan using a point cloud based registration method. The PET scan was registered using rigid image registration. The EAM and PET information, as well as the myocardium thickness, were projected on the surface of the 3D mesh of the left ventricle. The target was identified by delineating a path on this surface that was further projected to the thickness of the myocardium to create the target volume. This process was evaluated by comparison with a standard slice-by-slice delineation with mental EAM registration. Four cardiologists delineated targets for three patients using both methods. The variability of target volumes, and the ease of use of the proposed method, were evaluated. RESULTS: All cardiologists reported being more confident and efficient using the proposed method. The inter-clinician variability in delineated target volume was systematically lower with the proposed method (average dice score of 0.62 vs. 0.32 with a classical method). Delineation times were also improved. CONCLUSIONS: A data integration process was proposed and evaluated to fuse images of interest for CR target delineation. It effectively reduces the tediousness of CR target delineation, while improving inter-clinician agreement on target volumes. This study is still to be confirmed by including more clinicians and patient data to the experiments.

This document contains the results of the requirements analysis and use case specification that has been performed in Task 1.1. The focus in the task was two fold. On the one hand to define a scenario in the healtcare domain that can clearly demonstrate the benefits of data usage in a cross domain manner with edge nodes playing the role of trust anchors. On the other hand to ensure the composition of a rich set of requirements aiming at high ambitious research outcomes that can guarantee that stakeholders in healthcare and complementary sectors have high confidence in engaging with the continuously evolving Data Spaces and federation practices.

Introduction: La coronarographie est une méthode exploratrice et thérapeutique des artères coronaires qui connait depuis quelques années des avancées remarquables, de telle sorte que ses indications peuvent s’étendre à tous les âges en fonction des orientations cliniques. L’objectif de ce travail était de décrire les aspects des artères coronaires chez les patients de moins de 40 ans explorés au CHU Aristide Le Dantec.Patients et Méthodes: Nous avons effectué une étude descriptive qui incluait tous les patients dont l’âge était inférieur ou égal à 40 ans et qui avaient eu une coronarographie suite à un consentement éclairé dans la période du 1er Mai 2014 au 31 Août 2017. Les paramètres étudiés étaient épidémiologiques, cliniques, coronarographique, incluant l’éventuelle angioplastieRésultats: Nous avions inclus 32 patients. L’âge moyen était de 33,84 ± 5,59 ans, avec un minimum de 18 ans. Le genre masculin prédominait avec 27 hommes. Le facteur de risque cardio-vasculaire le plus fréquemment retrouvé était le tabac (28,13%) suivi de la dyslipidémie (25%), de l’hérédité (18,75%) et du surpoids (15,6%). Chez deux patients (6,25%), on a noté une consommation de substance stupéfiante. Les indications de la coronarographie étaient entre autres, le syndrome coronaire aigu (72%) et l’angor d’effort à (19%). La coronarographie était normale chez 11 patients et Pathologique chez les 21 restants, incluant 15 cas (46,87%) avec des lésions serrées. Les atteintes angiographiquement significatives étaient dominées par les atteintes mono-tronculaires dans 50% des cas. L’angioplastie était réalisée avec satisfaction chez 5 patients avec une prédominance de stents nus.Conclusion : Chez le sujet jeune avec syndrome coronarien aigu ou angor d’effort, le facteur de risque le plus fréquent est le tabac et l’atteinte coronaire est le plus souvent mono tronculaire. Introduction: Coronarography have been making remarkable progress in our structure for several years. However, its indications can be extended to all ages depending on the clinicalorientation. The objective of this work was to describe the aspects of the coronary arteries in the young patients explored at Aristide Le Dantec University Hospital.Patients and methods: We performed a retrospective descriptive study that included all patients who were less than or equal to 40 years of age and who had had coronary angiography after informed consent in the period from May 1, 2014 to August 31, 2017. The studied parameters were epidemiological, clinical, coronary as well as angioplasty data including procedure, techniques and results of angioplastyResults: We included 32 patients. The average age was 33.84 years ± 5.59 with a minimum of 18 years. The male gender predominated with 27 men, a sex ratio of 5.4. The most common cardiovascular risk factor was tobacco (28.13%) followed by dyslipidemia (25%) and heredity. (18.75%), overweight was found in 15.6% of cases. In two patients (6.25%) dopant consumption was noted. Indications for coronary angiography included 72% acute coronary syndrome and 19% effort angina. Coronarography was normal in 11 patients and pathological in the remaining 21. The tight lesions were in front of the chart, 15 cases (46.87%). Angiographically significant lesions were dominated by mono-truncal involvement in 50% of cases. Angioplasty was performed satisfactorily in 5 patients with a predominance of elude stents.Conclusion: Coronarography of the young subject is increasingly considered in our countries because of indications that are no longer limited to acute coronary syndrome although it is the first. In this age group the most frequent risk factor is tobacco and the mono-truncal involvement is the most recorded.

Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease. Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes. Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected. The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed. Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28). During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.

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Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, which has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years. Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30 s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06 h 30 min before the COVID-19 pandemic and 42 h06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14 h 30 min before the Covid-19 pandemic and 27 h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.

Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years; men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%; diabetes was 34.27%; dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel; 28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36; 95% CI, 1.05 - 5.29; p = 0.036); male gender (OR, 1.6; 95% CI, 0.72 - 3.57; p = 0.24); diabetes (OR, 2.14; 95% CI, 0.96 - 4.75; p = 0.06) and necrosis Q waves (4.75; CI, 0.98 - 23.09; p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.

International audience; Abstract Plasma-based microwave power limitation in a suspended microstrip transmission line integrating a micro hollow cathode discharge (MHCD) in its centre is experimentally and numerically studied. Transient and steady state microwave power measurements exhibit a limitation threshold of 28 dBm and time responses of 25 microseconds. Intensified charge-coupled device imaging shows that microwave breakdown occurs at the top of the MHCD. The plasma then extends towards the microwave source within the suspended microstrip transmission line. Besides, a self-consistent model is proposed to simulate the non-linear interaction between microwave and plasma. It gives numerical results in agreement with the measurements, and show that the plasma expansion during the transient response is related to a shift between the ionization source term and the electron density maximum. The propagation speed, under the tested conditions, depends mainly on the stepwise ionization from the excited states.

The invention relates to a computer-implemented calculation system for determining a trajectory while minimising the energy consumption of a motor vehicle, the system comprising: a module of dynamics models (M1) and energy consumption models (M2) that is configured to define driving parameters; an optimisation module (M3) that is configured to define driving constraints as a function of the driving parameters, characterised by a module (M4) for determining a trajectory by calculations according to Pontryagin's minimum principle, minimising a so-called Hamiltonian function of said driving parameters. In particular, computer-implemented calculation steps are performed by a motor vehicle battery management system., L’invention concerne un système de calculs mis en œuvre par ordinateur, pour déterminer une trajectoire en minimisant la consommation d’énergie d’un véhicule automobile, le système comprenant :- un module de modèles de dynamique (M1) et de consommation énergétique (M2) configuré pour définir des paramètres de roulage,- un module d’optimisation (M3) configuré pour définir des contraintes de roulage en fonction des paramètres de roulage, caractérisé par- un module de détermination de trajectoire (M4) par calculs selon un principe du minimum de Pontryagin minimisant une fonction dite Hamiltonien desdits paramètres de roulage. En particulier, des étapes de calculs mis en œuvre par ordinateur, sont effectuées par un système de gestion de batterie de véhicule automobile.

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Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

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International audience; Background: A rectal sub-region (SRR) has been previously identified by voxel-wise analysis in the inferior-anterior part of the rectum as highly predictive of rectal bleeding (RB) in prostate cancer radiotherapy. Translating the SRR to patient-specific radiotherapy planning is challenging as new constraints have to be defined. A recent geometry-based model proposed to optimize the planning by determining the achievable mean doses (AMDs) to the organs at risk (OARs), taking into account the overlap between the planning target volume (PTV) and OAR. The aim of this study was to quantify the SRR dose sparing by using the AMD model in the planning, while preserving the dose to the prostate. Material and Methods: Three-dimensional volumetric modulated arc therapy (VMAT) planning dose distributions for 60 patients were computed following four different strategies, delivering 78 Gy to the prostate, while meeting the genitourinary group dose constraints to the OAR: (i) a standard plan corresponding to the standard practice for rectum sparing (STDpl), (ii) a plan adding constraints to SRR (SRRpl), (iii) a plan using the AMD model applied to the rectum only (AMD_RECTpl), and (iv) a final plan using the AMD model applied to both the rectum and the SRR (AMD_RECT_SRRpl). After PTV dose normalization, plans were compared with regard to dose distributions, quality, and estimated risk of RB using a normal tissue complication probability model. Results: AMD_RECT_SRRpl showed the largest SRR dose sparing, with significant mean dose reductions of 7.7, 3, and 2.3 Gy, with respect to the STDpl, SRRpl, and AMD_RECTpl, respectively. AMD_RECT_SRRpl also decreased the mean rectal dose by 3.6 Gy relative to STDpl and by 3.3 Gy relative to SRRpl. The absolute risk of grade ≥1 RB decreased from 22.8% using STDpl planning to 17.6% using AMD_RECT_SRRpl considering SRR volume. AMD_RECT_SRRpl plans, however, showed slightly less dose homogeneity and significant increase of the number of monitor units, compared to the three other strategies. Conclusion: Compared to a standard prostate planning, applying dose constraints to a patient-specific SRR by using the achievable mean dose model decreased the mean dose by 7.7 Gy to the SRR and may decrease the relative risk of RB by 22%.

Aim The aim of this study was to assess of the risk of sudden death in a population of hypertrophic cardiomyopathy patients in Dakar. Methods This was a transverse study at the cardiology clinic of Aristide Le Dantec Hospital from January 2014 to June 2015. We used the European Society of Cardiology risk score to calculate this risk. Results The average age of patients was 53 years. Unexplained syncope was found in two patients and two others had a family history of sudden death. The septal hypertrophy average was 20.9 mm. Seven patients had left intraventricular obstruction. One patient had a high risk of sudden death, three had intermediate risk and 13 had low risk. Competitive sport was not allowed, 13 patients were under medical treatment, one had an implantable cardioverter defibrillator and two had no treatment. Conclusion Our study highlighted a low and intermediate risk of the occurrence of sudden death at five years. One patient had a high risk of sudden death.

Despite the growing interest in athlete’s right ventricle and various work carried out, many uncertainties are remaining. The interest of this work resides in the determination of the particularity in right heart of the black athlete subject. We conducted a prospective study from August to October 2016 in the cardiology department of Aristide Le Dantec University Hospital in Dakar. The included patients were divided according to the sporting practice as enduring, resistant and non-athletes. The parameters studied were electrocardiographic (atrial or ventricular hypertrophies), echocardiographic: dimensions of the right cavities, systolic and diastolic functions of the right ventricle. We included 58 subjects: 38 athletes including 28 endurance and 10 resistance and 20 non-athletes. The average age of the endurance athletes was 21.9 ± 3, 75 years, 26.30 ± 4.64 in resistance ones and 24.10 ± 1.89 in the non-athletic group. Two cases of first-degree atrioventricular block were recorded in athletes. On the echocardiographic point, the atrium surfaces, as well as the transverse diameter, were greater in athletes, especially in the endurance group. The mean diameters of the admission chamber and those of the right ventricular flush chamber were larger in the group of endurance athletes. It was the same for the annular and sagittal basal mean diameters of the RV as well as the RV/LV ratio. The anterior wall of the right ventricle was larger in athletes compared to non-athletes. The vena cava was greater in athletes, the pulmonary arterial pressure higher in resistance ones.

Introduction: Precordial pain is a common reason for admission in cardiology, and has many causes. Acute myocarditis in its pseudo-infarctoid form is sometimes difficult to differentiate from myocardial infarction. Cardiac magnetic resonance imaging (MRI) helps to differentiate these two disease entities. We report the respective cases of two young patients, one presenting with myocarditis whilst the other with myocardial infarction. Case Report: We present the cases of two patients. The first who had a recent history of febrile syndrome is a 23-year-old who stopped smoking 3 months prior to presentation whilst the second is a 22-year-old professional footballer with a history of stress with no other cardiovascular risk factors. They were respectively admitted in our emergency department for a constrictive, intense chest pain. Physical examination was normal. The chest pain in both patients was associated with elevated cardiac markers, primary repolarisation abnormalities on ECG, wall motion abnormalities as well as left ventricular systolic dysfunction on transthoracic echocardiography. Coronary angiograms were normal in both patients. In the first patient, MRI concluded with an acute myocarditis with apical akinesia extending to the anterior wall, a T2 hypersignal indicative of myocardial edema, and uptake of a nodular heterogeneous contrast without affecting the sub-endocardial layers on the late enhancement sequences. In the second patient, MRI showed an appearance consistent with acute extensive infarction in the antero-apical region with severe hypokinesia and late quasi-transmural enhancement, impairment of the anterior papillary muscle of the mitral valve and a reduced left ventricular ejection fraction at 33%. In addition to analgesics, the first patient was treated with perindopril and bisoprolol, and the second patient received antithrombotic and anticoagulant treatment. There was clinical improvement in both patients. Conclusion: Cardiac MRI is a useful diagnostic tool for the precise diagnosis of precordial pain with elevated cardiac enzymes, especially in young patients.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Resume Introduction Les cardiopathies congenitales de l’adulte regroupent les malformations traitees dans l’enfance qui decompensent secondairement et celles qui, asymptomatiques a la naissance, se revelent tardivement. Les objectifs de ce travail etaient d’identifier les cardiopathies congenitales de l’adulte dans un service de cardiologie generale du Senegal et d’etudier les presentations cliniques, les traitements et l’evolution. Methodologie Nous avons mene une etude transversale, descriptive, portant sur les dossiers de patients âges d’au moins 16 ans, suivis pour une cardiopathie congenitale dans le service de cardiologie de l’Hopital General de Grand-Yoff de Dakar entre mai 2003 et mars 2015. Le diagnostic de la cardiopathie etait base sur l’echocardiographie. Resultats Nous avons collige 50 dossiers de patients soit une prevalence de 0,75 %, avec une predominance feminine (64 %). L’âge moyen des patients etait de 36,16 ± 18,4 ans (16–79 ans) et 29,76 ± 22,58 ans au moment du diagnostic. La dyspnee etait le principal signe revelateur (60 %). Les principales malformations etaient la communication inter-auriculaire (38 %), la stenose pulmonaire (14 %), la communication inter-ventriculaire (12 %) et la persistance du canal arteriel (10 %). Selon la classification de Bethesda, la cardiopathie etait de complexite simple (42 %), intermediaire (58 %) ou severe (10 %). Le traitement etait medical chez 43 patients et chirurgical chez 7 patients. Les principales complications etaient l’endocardite infectieuse (10 %), la fibrillation atriale (12 %), l’insuffisance cardiaque (24 %) et l’hypertension arterielle pulmonaire (50 %). Conclusion Les cardiopathies congenitales de l’adulte semblent sous-estimees dans nos regions et la correction chirurgicale y est rare. Il incombe d’assurer une bonne gestion de la transition entre l’âge pediatrique et adulte.

Resume Objectifs Evaluer la prevalence de l’hypertrophie ventriculaire gauche (HVG) electrocardiographique et echographique ainsi que ses corollaires dans une population d’hypertendus vivant en milieu semi-rural au Senegal. Patients et methode Selon l’approche STEPS de l’organisation mondiale de la sante, nous avons mene, en novembre 2012, une enquete transversale et exhaustive chez les sujets âges d’au moins 35 ans et vivant depuis au moins 6 mois, dans la zone semi-rurale de Gueoul. Les facteurs de risque cardiovasculaire ont ete depistes et l’hypertrophie ventriculaire gauche recherchee a l’electrocardiogramme et a l’echocardiographie chez les hypertendus. Les donnees etaient analysees grâce au logiciel SPSS 18.0 et le seuil de significativite fixe pour une valeur de p Resultats Nous avons examine 1411 sujets âges en moyenne de 48,5 ± 12,7 ans. Au total, 654 sujets etaient hypertendus et une hypertrophie ventriculaire gauche a ete la recherche chez 515 sujets parmi eux. Selon l’indice de Sokolow-Lyon, 86 sujets (16,7 %) presentaient une HVG electrocardiographique, plus frequemment chez les hommes (p = 0,002). Selon l’indice de Cornell et le produit de Cornell, elle etait retrouvee respectivement chez 66 (12,8 %) et 52 sujets (10,1 %), avec une predominant feminine (p = 0,0001 ; p = 0,004). Elle etait plus frequente chez les hypertendus en grade 3 quel que soit l’indice. A l’echocardiographie, la prevalence de l’HVG selon la masse ventriculaire gauche etait de 2,5 % (13 cas), de 9,3 % (48 cas) selon la masse ventriculaire gauche indexee a la surface corporelle et de 8,2 % (42 cas) selon la masse ventriculaire gauche indexee a la taille2,7. L’HVG selon la masse ventriculaire gauche indexee a la surface corporelle etait significativement correlee a l’HVG electrocardiographique selon l’indice de Sokolow-Lyon (p Conclusion Bien que rare chez l’hypertendu senegalais vivant en milieu semi-rural, l’hypertrophie ventriculaire gauche est correlee a la severite de l’hypertension arterielle. Un depistage par l’electrocardiogramme permettra un meilleur suivi de ces hypertendus.

Background Cardiovascular complications in Marfan syndrome (MFS) make all its seriousness. Taking as a basis the Ghent criteria, we conducted a family screening from an index case. The objective was to describe the clinical characteristics of MFS anomalies and to detect cardiovascular complications in our patients. Case presentation Six subjects were evaluated. Patients had to be in the same uterine siblings of the index case or be a descendant. The objective was to search for MFS based on the diagnostic criteria of Ghent and, subsequently, detecting cardiovascular damage. The average age was 24 years. The examination revealed three cases of sudden death in a context of chest pain. Five subjects had systemic involvement with a score ≥ 7 that allowed to the diagnosis of MFS. Two patients had simultaneously ectopia lentis and myopia. In terms of cardiovascular damage, there were three cases of dilatation of the aortic root, two cases of aortic dissection of Stanford’s type A with severe aortic regurgitation in one case and moderate in the other. There were three patients with moderate mitral regurgitation with a case by valve prolapse. Conclusion The family screening is crucial in Marfan syndrome. It revealed serious cardiovascular complications including sudden death and aortic dissection.

Patient: Female, 32 Final Diagnosis: Obstructive primary cardiac T-cell lymphoma Symptoms: Right heart failure Medication: — Clinical Procedure: None Specialty: Cardiology Objective: Rare disease Background: Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. Case Report: Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. Conclusions: The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.

Introduction: The Behcet’s disease is deemed to be scarce in Black Africa where data are still scattered. The purpose of our study is to describe the epidemiological, clinical, paraclinic and evolutive particularities of the patients whose presenting symptoms of the Behcet’s diseases were a venous thrombosis. Patients and Methods: It was a descriptive, multicenter, and cross-sectional study lasting 15 months. We brought together all the cases of the Behcet’s disease revealed by venous thrombosis. The diagnosis was based on clinical criteria of the international group of study of the Behcet’s disease in 2007. Results: We have grouped 10 revealing thrombosis cases of the Behcet’s diseases during our study period. The average age was 34. The average wait period between the appearances of the early symptoms and the diagnosis of the very disease was 30 months. The admission motives were the abdominal pain (2 cases), a thrombophlebitis of the lower limb (2 cases), headaches (1 case), coma (1 case), a thrombophlebitis of the upper limb (3 cases). The thrombotic symptoms were exclusively venous-located. The seats of the thrombosis were the vena cava superior in 30% of the cases, the vena cava inferior in 20% of the cases, the veins of the lower limb in 20% of the cases, the cerebral vein in 20% of the cases, and the auxiliary vein in 10% of the cases. The treatment of the deep venous thrombosis consisted in all the cases of an effective anticoagulation associated with the colchicine. Primarily, the corticotherapy with a high dose was used in all the patients. One of them in the comatose stage, manifesting both cerebral thrombophlebitis and aseptic meningitis, had died. Conclusion: Behcet’s disease is a disease of the young adult, but it must be evoked even in old age, with a view to appropriate management, in order to avoid the complications of the disease. Although it is rare in our regions, it should be sought in the etiological assessment of venous thrombosis whatever the location.

Procédé de commande d'un moteur thermique (10) comprenant les étapes consistant à : - estimer, à un instant t du fonctionnement du moteur thermique, une température de gaz d'échappement en une pluralité de points le long du catalyseur (21), - estimer à l'instant t une température de paroi du catalyseur en une pluralité de points le long du catalyseur, en prenant en compte au moins la température de gaz d'échappement le long du catalyseur, - mesurer avec la sonde aval de température (23) à l'instant t, une température de gaz d'échappement en aval du catalyseur, - corriger la température de paroi du catalyseur le long du catalyseur, en prenant en compte la mesure de température de gaz d'échappement en aval du catalyseur.

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

International audience

Les systèmes de réception radiofréquences et microondes sont susceptibles d’être fortement détériorés en cas d’agressions électromagnétiques de forte puissance (HPM). Généralement, l’utilisation de limiteurs de puissance microonde intégrant des diodes PIN ou des MEMS permet leur protection. Cependant, ces composants demeurent fragiles lorsque ces menaces atteignent des puissances trop importantes. Par conséquent, de nouvelles études exploitant les plasmas de décharge comme élément de limitation ont vu le jour. Ces systèmes de limitation à base de plasma reposent sur l’interaction non linéaire entre l’onde électromagnétique incidente et le plasma. Ce type d’interaction a déjà été largement utilisé dans les tubes T/R (Transmission/Réception) en technologie guidée. Dans ces travaux de thèse, nous étudions la possibilité d’utiliser des décharges plasmas localisées à une dizaine de millibars dans l’argon afin de concevoir des systèmes de limitation de puissance microonde en technologie circuit imprimé. Ainsi, après avoir choisi et caractérisé cette décharge localisée, trois limiteurs de puissance microonde ont été étudiés en bande S. Un premier dispositif de test large bande a été conçu en technologie microruban. Au moyen d’une campagne de caractérisation expérimentale, le caractère absorptif du dispositif ainsi que la dynamique temporelle particulière de la décharge ont pu être mis en évidence. Par la suite, un dispositif bande étroite a été conçu en technologie microruban afin de comparer les effets de la résonance microonde sur les caractéristiques de limitation. Ces effets ont alors conduit à un limiteur de type réflectif plus rapide. Enfin, un dispositif additionnel a été conçu en technologie microruban suspendue afin de pouvoir interpréter analytiquement et numériquement les mécanismes observés expérimentalement. Ces analyses ont alors permis de quantifier les paramètres plasma de la décharge et d’obtenir des informations sur le couplage non-linéaire plasma/microonde. When a high power microwave (HPM) threat impinges on typical receiver systems, they can be strongly deteriorated. Microwave power limiters using PIN diodes or MEMS are commonly involved to protect them. However, these integrated components remain fragile when the incident microwave power becomes more important. Recently, limiters based on plasma discharges have been proposed to handle very high power threats. These systems are based on the nonlinear interaction between the plasma and the incident electromagnetic wave. These interactions have already been widely used in T/R (Transmit/Receive) tubes in waveguide technology. Here, we propose to use localized plasma discharges at around ten millibar of argon to design microwave power limiting devices in printed circuit technology. Hence, after having characterized this localized plasma discharge, three microwave power limiters have been studied in the S-band. A first microstrip wideband test device has been designed. Through an experimental campaign, the absorptive behaviour of the device and the particular temporal dynamics of the discharge have been highlighted. Then, a microstrip narrowband device has been designed to compare the effects of microwave resonance on limiting characteristics. It has led to a faster and reflective type limiter. Finally, an additional device has been designed in suspended microstrip technology to compare analytical and numerical results with experimentally data. Plasma parameters of the discharge and valuable information on the non-linear plasma/microwave coupling have thus been obtained.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

Resume Introduction Notre objectif etait d’etudier la prevalence des personnes porteuses de plaques d’atherome carotidiennes en population semi-rurale de Gueoul au Senegal et d’analyser les correlations avec les facteurs de risque et les atteintes vasculaires. Patients et methode Enquete transversale, descriptive durant 1 mois incluant les Senegalais âges d’au moins 35 ans residant depuis plus de 6 mois a Gueoul. La mesure etait faite avec un appareil d’echocardiographie Doppler portable. La plaque carotidienne etait definie notamment par une epaisseur intima media > 1,5 mm. Un seuil de significativite etait retenu pour une valeur de p Resultats Au total, 1411 sujets etaient inclus avec un sex-ratio femmes/hommes de 2,93 et un âge moyen de 48,5 ans. Les facteurs de risque cardiovasculaire etaient la dyslipidemie (61,1 %), la sedentarite (56,2 %), l’obesite abdominale (53,9 %), l’hypertension arterielle (46,4 %), l’obesite (12 %), le diabete (7,2 %) et le tabagisme (2,5 %). La prevalence des plaques d’atherome carotidiennes etait de 6,8 % dont 42,7 % avaient des plaques bilaterales. L’âge avance ( p = 0,001), l’hypertension arterielle ( p = 0,0001), le diabete ( p = 0,004) et le syndrome metabolique ( p = 0,008) etaient significativement correles a ces plaques. Concernant les atteintes vasculaires, 5,2 % des patients porteurs d’atherome carotidien avaient eu un accident vasculaire cerebral ( p = 0,01), 27,1 % avaient eu un infarctus du myocarde ( p = 0,02) et 31,2 % avaient une arteriopathie des membres inferieurs ( p = 0,5). Conclusion La prevalence des porteurs de plaques d’atherome carotidiennes semble faible. Cependant, l’association avec les facteurs de risque cardiovasculaire est a souligner, justifiant l’importance des strategies de prevention des maladies cardiovasculaires.

Resume Introduction Les facteurs de risque cardio-vasculaire sont en nette augmentation dans les pays en voie de developpement. Parmi ces facteurs, la dyslipidemie est souvent retrouvee, cela liee aux changements des habitudes comportementales et alimentaires (OMS, 2006). La dyslipidemie est une « modification pathologique primitive ou secondaire des lipides seriques », c’est une anomalie metabolique et chronique caracterisee par une elevation persistante des TG, du LDL-c et une diminution du HDL (Attias et al., 2013–2014). L’objectif de cette etude etait de determiner la prevalence de la dyslipidemie et de donner le profil lipidique de la population de Gueoul. Patients et methode Nous avons effectue une etude observationnelle, transversale, descriptive exhaustive sur les Senegalais ayant 35 ans ou plus, residant a Gueoul depuis au moins 6 mois. Le bilan lipidique (cholesterolemie totale, triglyceridemie, HDL-cholesterol, LDL-cholesterol) etait systematique. Le prelevement etait fait apres 12 heures de jeune. Resultats La dyslipidemie etait retrouvee dans 61,3 % des cas avec 50 % d’hypercholesterolemie pure ( n = 705). Seuls 20 sujets (2,3 % = 20/864) savaient qu’ils avaient une dyslipidemie. Le taux de depistage etait de 59,8 % ( n = 844). Le type le plus represente etait l’hypoHDLemie (45,6 %) suivie de l’hyperLDLemie (28,8 %). Les triglycerides etaient augmentes dans seulement 2,8 % des cas. Conclusion La prevalence de la dyslipidemie est tres elevee dans nos regions. Elle est souvent associee au genre feminin, a l’HTA, au diabete et a l’obesite. Ses principales causes sont la sedentarite, le changement des habitudes de vie et de comportement alimentaire. Elle est souvent meconnue et sa prise en charge est limitee dans la majorite des cas au regime hypocalorique.

Resume Introduction La recherche de l’atteinte cardiaque chez les patients atteints de polyarthrite rhumatoide permet de prevenir les complications et les place dans une logique de prevention secondaire. L’objectif de cette etude etait d’etudier les parametres electrocardiographiques et echocardiographiques dans une population de patients senegalais atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Patients et methode Nous avons realise une etude transversale descriptive, ayant inclus de facon prospective des patients suivis en ambulatoire dans le service de medecine interne du centre hospitalo-universitaire Aristide Le Dantec de Dakar au Senegal, avec un diagnostic de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Elle a porte sur un echantillon de 73 patients des deux sexes âges d’au moins 18 ans. Apres l’examen clinique, nous avons realise un bilan biologique (CRP, fibrinogene, la VS, les facteurs rhumatoides : Latex et Waaler-Rose, les anti-CCP, les facteurs antinucleaires et les anticorps anti-ENA), un ECG, une echocardiographie standard. Les donnees ont ete analysees selon une etude descriptive des differentes variables avec le calcul des proportions pour les variables categorielles et les parametres de position et de dispersion pour les variables quantitatives. Resultats Au total, 73 patients atteints de polyarthrite rhumatoide sans manifestations cardiaques evidentes remplissant les criteres de definition de l’ACR 1987 ont ete inclus dans l’etude. L’âge moyen etait de 44,17 ± 14,43 ans avec des extremes de 18 et 75 ans. La duree moyenne d’evolution de la PR etait de 5,93 ± 4,78 ans. La notion de rhumatisme inflammatoire familial etait rapportee dans 35,60 % des cas et quasiment un patient sur six presentait au moins un facteur de risque cardiovasculaire (16,96 %). Les anomalies retrouvees a l’echo-doppler cardiaque etaient dominees par une dysfonction diastolique du VG (42,46 %), une augmentation de la masse ventriculaire gauche dans 35,61 %. Des fuites valvulaires de grades variables ont ete mises en evidence touchant tous les orifices mais rarement significatives. Conclusion La realisation de l’echocardiographie chez des patients atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire permet de mettre en evidence des anomalies cardiovasculaires liees a l’evolution naturelle de la maladie.

International audience

Pulmonary embolism and acute aortic dissection are two formidable cardio-vascular emergencies. Their association, although exceptional, is burdened with a heavy mortality in the absence of an early and adapted surgery. We report a case of Standford acute type A aortic dissection associated with fatal pulmonary embolism. This is a 66-years old man with a notion of a long trip received for prolonged chest pain since 3 days, of sudden onset, maximal intensity, tearing, transfixing, migratory, radiating towards the back and the loins, exacerbated by breathing. The examination noted 120 bpm tachycardia, 70% SaO2 desaturation, asymetric blood pressure and asymetric pulse, aortic insufficiency murmur and bilateral crackling rettles at lungs. The chest X-ray showed an enlargement of the upper mediastinum with double-contoured image. The electrocardiogram recorded a regular sinus tachycardia at 132 cycles/min, a lateral sub epicardial ischemia in lateral leads. CT scan revealed total thrombosis of the right branch of the pulmonary artery extending to part of the trunk and an intimal flap from the aortic arch to the abdominal aorta. The evolution was brutally lethal two days after hospitalization. The dissection of the aorta and the pulmonary embolism are medical emergencies whose association poses more difficulties as well on the diagnosis plan but especially therapeutic.

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.

Resume Le faux anevrisme du ventricule gauche est une complication tardive peu frequente de l’infarctus du myocarde. Des formes dites non coronaires ont ete decrites chez le sujet jeune. Dans ce cadre, nous rapportons trois observations. Monsieur M.B., 20 ans, a consulte pour des precordialgies associees a des palpitations. L’examen cardiovasculaire retrouvait une voussure precordiale battante expansive et un souffle systolo-diastolique mesocardiaque. On notait un rythme sinusal avec des extrasystoles ventriculaires a l’ECG. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale de l’arc inferieur gauche. L’echocardiographie-Doppler montrait un volumineux faux anevrisme apical ventriculaire gauche. Mme O.B., 23 ans, a ete admise pour une insuffisance cardiaque globale chez qui l’examen retrouvait un souffle systolique apexien. L’ECG inscrivait une tachycardie sinusale reguliere, une hypertrophie auriculaire gauche et ventriculaire gauche. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale des arcs moyen et inferieur gauches. L’echocardiographie-Doppler revelait un volumineux faux anevrisme apical du ventricule gauche. Monsieur I.S., âge de 24 ans, admis pour la prise en charge d’une insuffisance cardiaque globale. Le patient avait un syndrome inflammatoire non specifique a la biologie, une tachycardie sinusale et des extrasystoles a l’ECG. La radiographie du thorax de face montrait une solution de continuite au niveau de l’arc posterieur de la sixieme cote, une cardiomegalie et une dilatation anevrismale de l’arc inferieur gauche. A l’echocardiographie-Doppler, on notait un volumineux faux anevrisme du ventricule gauche de siege apical.

Congenital heart diseases are one of the major cardiovascular diseases in developing countries. Most prevalence studies were based on clinical examination of children with echocardiographic confirmation of suspected cases and underestimate its prevalence. The objective of this study was to investigate the prevalence of congenital heart disease in "daara" (Koranic schools) in the city of Dakar and its suburbs on the basis of clinical examination and Doppler echocardiography in school children. This cross-sectional survey was carried out from 9(th) August to 24(th) December 2011, and included a population of 2019 school children aged 5 to 18 years in 16 selected "daaras" under the Academic Inspectorate of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were recorded in a validated questionnaire. A p < 0.05 was considered to be statistically significant in bivariate analysis. 2 019 school children were included out of which 60.1% were male (sex-ratio: 0.66). The average age was 9.7 years (± 3.3 years). 18 cases of congenital heart diseases were detected being a prevalence of 8.9 per 1 000 (95 % CI: 1.8 to 7.9). This included 6 cases of inter-atrial septal aneurysm, 5 cases of peri-membranous ventricular septal defects, 4 cases of patent ductusarteriosus and 3 cases of tetralogy of Fallot. Factors correlated with the presence of congenital heart disease were ageless than 8 (p