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Background Unprotected left main coronary artery (ULMCA) disease is seen approximately 4% of patients who undergo angiography. Percutaneous coronary intervention (PCI) is an accepted alternative to surgery for the treatment of this disease. Purpose Aim of our study is to evaluate the results of our experience in ULMCA PCI and assess prognostic factors associated with such procedures. Methods Between January 2005 and August 2016, 109 consecutive procedures of LMCA PCI were assigned retrospectively. Clinical variables, the reasons for cardiac catheterization, therapeutic decisions and clinical evolution in long-term follow-up were analyzed. Results The mean age of our population was 62.27 ± 10.68 years and predominantly male (72%). Diabetes mellitus was found in 63 patients (58%). Presentation on admission was mainly stable angina in 40 patients (37%). True bifurcation lesions (Medina 1-1-1 and 1-0-1) were present in 56 distal LMCA patients (51%). Triple vessel disease was associated in 21 patients (19%). The Syntax score was Conclusion The results of our growing experience in LMCA PCI are encouraging with high rate of procedural success and acceptable medium and long-term results.

Background The persistent ductus arteriosus remains a common congenital pathology. The percutaneous closure has become the main technique for the closure of patent ductus arteriosus. Purpose Evaluate the short-, medium- and long-term results of percutaneous closure of patent ductus arteriosus, performed in Cardiology department of Sahloul University Hospital. Methods Children and adults who underwent percutaneous closure of patent ductus arteriosus in Cardiology department of Sahloul University Hospital, during 13 years between September 2003 and June 2016 were retrospectively included. We studied procedure's Results success rate, type of device, residual shunting, and adverse effects. Results One hundred and fifty-three procedures were realized during the study period. Patient's mean age at the time of procedure was 73.68 months (3 months to 53 years) and the sex ratio was 1.8 female for 1 male. The main circumstance for discovery was dyspnea (56.86%). The average echocardiographic persistent ductus arteriosus diameter was 4.7 mm. The average angiographic persistent ductus arteriosus diameter was 8.7 mm. Ninety-seven patients (63.4%), had a channel A-type, 30 patients (19.6%) had C type and 22 patients (17%) had E type on the Krichenko classification. A device was implanted in 140 cases (91.5%): 8 coils, and 132 Amplatz® devices. The failure rate of the procedure was 2.77%. The complications occurred in 11 patients (7.18%): 3 cases of immediate embolization, 3 cases of pulmonary protrusion, one case of inguinal hematoma and 4 cases of aortic protrusion with risk of aortic subocclusion in one of them. The device was removed immediately in this case. After a device was installed, complete occlusion was obtained in 85.8% at day 1, 90% at a month and 100% at 12 months. The average duration of the procedure 54 min (30 to 121 min). Conclusion Patent ductus arteriosus percutaneous closure gives good results with a low rate of complication.

Background Coronary chronic total occlusion (CTO) are associated with poor prognosis and cardiac death. Successful chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with a clinical benefit. However, in a substantial portion of cases, PCI is not attempted, and patients are treated with optimal medical therapy (OMT). Purpose The aim of this study was to compare long-term outcomes of CTO after OMT versus PCI. Methods Between 2006 to 2017, 144 patients with CTO were included. Patients who underwent coronary artery bypass grafting were excluded. We classified patients into the OMT group (n = 65) or PCI group (n = 62) according to initial treatment strategy. Endpoint of the study was long-term cardiac death. Results The median follow-up duration was 44 (interquartile range: 19–74) months. Baselines characteristics did not significantly differ between the two groups: mean age was 62.16 ± 10 vs. 61.52 ± 9 years; Left-ventricular ejection fraction (LVEF) 48 ± 11% vs. 50 ± 13%; Diabetes 48% vs. 46%; Acute coronary syndrome 52% vs. 48%. In the PCI group, 46 patients (74.2%) underwent successful revascularization. Kaplan–Meier plot with log rank analysis shows cumulative death was significantly lower in the PCI group than in the OMT group (P = 0.023; average follow up duration; PCI vs. OMT group = 131.52 ± 6.8 vs. 96.33 ± 8.2 months). Conclusions As an initial treatment strategy, PCI reduce cardiac death compared with OMT for the treatment of CTO.

Background In patients with left main coronary artery (LMCA) stenosis, PCI with drug-eluting stents may be an acceptable alternative to CABG. However, data from African subcontinent are lacking. Purpose We sought to evaluate trends in treatment strategies of LMCA disease over time in Sahloul University Hospital and to compare early and long-term adverse outcomes of each therapeutic option. Methods From 2005 to 2016, 260 patients with unprotected LMCA were included. In total, 102 patients underwent Surgery, 109 patients underwent PCI and 49 patients were medically treated. Results Over time, the proportion of patients treated with PCI rather than CABG increased substantially. Patients treated with PCI had more anterior ST-segment elevation myocardial infarction (MI) and cardiogenic shock at presentation compared to CABG group. More patients treated with CABG had multivessel disease, more distal LMCA bifurcation and higher SYNTAX scores. All the other baseline variables were similar. After a follow-up of 39 ± 26 months in PCI group and 52 ± 38 months in CABG group, there were no differences between PCI and CABG, at the adjusted analysis, in the rate of myocardial infarction (MI) (HR: 1.75; 95%, CI: 0.55 to 5.50; P = 0.33), cerebrovascular accidents (CVA) (P = 0.69), and the composite of MACCE (HR: 1.04; 95% CI: 0.59 to 1.83; P = 0.88). Compared to PCI group, CABG group has a higher all-cause mortality (P = 0.017) driven exclusively by an elevated incidence of operative mortality (13.7% vs. 6.4%; HR: 0.08; 95% CI: 0.017 to 0.43; P = 0.003). Nevertheless, long-term advantage of CABG over PCI was the less need for repeated revascularization (HR: 3.1; 95% CI: 1.26 to 8.12; P = 0.014). Medically treated patients produced a four–year all cause death rate of 44%. Conclusion Revascularization therapy of LMCA stenosis have evolved remarkably over the last decade in our faculty. PCI and CABG show comparable safety. However, repeat revascularization is more common after PCI.

Background The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure is an attractive alternative to the surgical treatment for infants weighing less than 6 kg. Purpose The objective was to evaluate the efficacy and safety of percutaneous closure in low-weight children. Methods Children weighing less than 6 kg who underwent percutaneous closure of patent ductus arteriosus in Cardiology department of Sahloul University Hospital during 13 years between September 2003 and June 2016 were retrospectively included. Results Eighteen children (mean weight: 5.49 kg [range: 4.2–6]; mean age: 10.9 months [range: 3–85]) were included. The main circumstance for discovery was difficulty in breathing (100%). The average angiographic persistent ductus arteriosus diameter was 3.08 mm [range: 1.12–5.68 mm]. Fifteen children (83.35%) had pulmonary hypertension of cases. Eleven patients (61.2%) had a channel A-type, 5 patients (27.8%) had C type, un patient (5.5%) had D type and un patient (5.5%) had E type on the Krichenko classification. A device was implanted in all cases. The prosthesis was implanted successfully in 94.44 of cases. The only failure was explained by immediate embolization of the device. The average duration of the procedure was 50 ± 10 min. After a device was installed, complete occlusion was obtained in 90% at day 1, 92% at a month and 100% at 12 months. Two complications occurred: pulmonary protrusion in one case and aortic protrusion in another case. No late embolization occurred after 37.5 months of median follow-up [range: 3–138]. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. Conclusion The study shows the feasibility and the efficacy of percutaneous closure in persistent ductus arteriosus in infants weighing less than 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

Background Despite successful repair of aortic coarctation (AoC), changes in the left ventricular (LV) regional myocardial function are reported. The aim of this study was to assess the left ventricular systolic function in patients after the successful repair of aortic coarctation using tissue Doppler imaging (TDI) according to the age of aortic coarctation repair. Methods 31 patients (mean age, 12.0 +/− 4.2 years) followed up after a successful chirurgical repair of aortic coarctation (mean follow up, 8,6 ± 7,6 years) were studied by echocardiography. The study population was divided in two groups: patients repaired at age 2 years (Group 1, n = 17) and patients repaired at age > 2 years (group 2, n = 14). The TDI parameters and the conventional echocardiographic indices of the left ventricular systolic function were analyzed and compared between the two groups. Results Standard echocardiographic studies revealed normal global left ventricular (LV) function. The LV dimensions, LV ejection fraction, LV shortening fraction, indexed LV mass did not differ between the examined groups. Among the studied LV filling parameters, peak early (E wave) transmitral flow velocity, as well as deceleration time DT, was similar between the two groups. The Tei index was also not affected by the age at repair of aortic coarctation. Regarding TDI measures, the early diastolic and the systolic velocities on the lateral side of the mitral annulus were significantly higher in group 1 than in group 2 (Sa: 12,7 ± 2,59 cm/s vs 10,6 ± 1,8 cm/s, p = 0,025; Ea : 20,7 ± 3,4 cm/s vs 17,3 ± 4,7 cm/s, p = 0,03). TDI velocities on the septal side of the mitral annulus and on the right ventricle (RV) free wall side of the tricuspid annulus were not different between early (before 2 years) and late (after 2 years) repair of the aortic coarctation. There were no differences of the TDI or conventional parameters between hypertensive and normotensive patients. Conclusion Left ventricular systolic performance in patients after the surgical repair of aortic coarctation reveals tendency to decrease at follow-up in patients repaired at age > 2 years despite a satisfactory results after surgery.

IntroductionCoarctation of the aorta (CoA) is a stenosis usually located in the isthmus of the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and may present excellent immediate results. However, despite immediate good results, significant residual problems often persist. The aim of the study is to describe the presentation, treatment and long-term evolution of a population of 48 unselected consecutive patients with CoA in a single pediatric cardiology center.MethodsThis was a retrospective study of all patients with isolated CoA associated or not to either atrial or ventricular septal defects. RESULTS: The patients (n = 48, 56,3% male) were diagnosed at a mean age of 84 ± 109 months. The clinical presentation differed between patients aged less or more than two years, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (p < 0.01). Treatment was surgical in all cases (32 end-to-end anastomosis). The mean age of patients was 94 ± 109 months. There was two late deaths, in a mean follow-up of 8,6 ± 7,7 years. Recoarctation occurred in 12 patients (25%). There are patients who currently have hypertension (17 at rest, 2 with effort), their mean age at diagnosis being older than the others (128 vs. 76 months; p < 0.05). Aortic aneurysms occurred in five patients (10,4%). Aneurysm was associated to bicuspid aortic valve in 3 cases.Conclusionsrepaired CoA has a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment.