Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period.MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25 ± 13 years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest.ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n = 2). Morbidity was marked by conduction abnormalities (n = 2), bleeding and hematoma of the residual cavity that required surgical treatment (n = 3). Eleven patients were followed with a mean period of 40.5 ± 19.4 months. At follow-up, neither late deaths nor recurrence have occurred.ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.     

Dissociation des réponses cardiorespiratoires et neuromusculaires à l’exercice à la suite de 4 semaines de réentraînement à l’effort chez des patients cardiaques

Previous studies showed that changes in peak of oxygen uptake value (VO_2peak) with training were poorly related to changes in Maximal Tolerated Power output (MTP) among patients with cardiovascular disease. This result could be due to a difference between cardiopulmonary adaptation to training and the skeletal muscle conditioning.ObjectiveThe aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters.MethodsNine cardiac patients (64.0 ± 3.1 y, 172.9 ± 4.8 cm, 83.4 ± 16.3 kg, BMI: 27.8 ± 4.5) performed an incremental cycling exercise test to determine MTP, VO_2peak and peak values of heart rate, before and after an aerobic training. Ventilatory thresholds were respectively determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (VT₁) and the point at which the ratio of minute ventilation to carbon dioxide output starts to increase (VT₂). EMG_th1 and EMG_th2 were defined as the first and the second breakpoints in the rms-EMG – power output relationship.ResultsShort-term exercise training (23.7 ± 8.8 days) induced a significant increase in VO_2peak (P = 0.004), MTP (P = 0.015), VT₁ (P = 0.001) and VT₂ (P = 0.001). Changes in VO_2peak only attained the survival criteria (3.5 ± 2.9 mL min⁻¹ kg⁻¹). No significant differences (P > 0.05) existed between mean power values of VT₁ and EMG_th1 (60.5 ± 4.1 vs. 59.2 ± 9.6% of MTP, respectively), or between VT₂ and EMG_th2 (78.3 ± 5.7 vs. 80.2 ± 5.2% of MTP). After training, EMG_th1 occurred significantly before VT₁ (60.5 ± 6.2 vs. 64.8 ± 4.8% of MTP, P = 0.049).ConclusionThis might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients.