Archives of Cardiovascular Disease Supplements 15 (2023) 74—87
in the cardiology department of the CHU Ibn Rochd in Casablanca,
Morocco. We analyzed kidney function in all our patients based on
the international classification of chronic kidney disease with GFR
calculation.
Results During the 4 years of study, and out of a total of
630 patients with valvulopathies, 66 patients had impaired renal
function, with GFR of less than 60 mL/min/m2 [51 patients
with a moderate CKD (30 < GFR < 60 mL/min/m2 ), and 7 with
severe CKD (15 < GFR < 30 mL/min/m2 ), and 8 in Terminal CKD
(GFR < 15 mL/min/m2 )]. With regard to age, there is more impair-
ment of renal function in elderly subjects (38 patients are > 60 years
old against 28 patients < 60 years old).
The RAC or the RM represents the dominant valve disease, this is
due to the valve calcifications characterizing this population (29
cases out of the 66 have calcified valves). Thus, we note, 22 cases
(33.3%) with polyvalvular disease, 14 cases (21.2%) have an isolated
RM or MM, 7 cases (10%) an isolated RAC, and 23 cases (35.5%) an
isolated MI.
Conclusion Even controlling for age, gender, and Cardiovascular
risk factors, CKDs have a higher risk of valvulopathy. The hypothe-
sis involves calcification of valves and associated structures that
increase as GFR decreases. For this, several studies will aim to
improve the understanding and management of valvulopathies in
CKD.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2022.10.161
642
SAPIEN valve infective endocarditis after
transcatheter pulmonary valve
replacement: A multicenter international
observational cohort
J.Lourtet-Hascoet 1,∗ , Valdeolmillos 2 ,
E. S.Georgiev 3 ,
A. Houeijeh 4 , M. Kantzis 5 , M. Alvarez-Fuentes 6 ,
M. Bogale Ystgaard 7 , P. Betrian-Blasco 8 , P. Guérin 9 , M. Jones 10 ,
G. Bosser 11 , A. Fraisse 12 , S. Hascoët 2
1 Microbiologie, hôpital Paris Saint-Joseph, Paris
2 Cardiopathies congenitales, hôpital Marie-Lannelongue, Le
Plessis-Robinson
3 Congenital heart diseases, Deutsches Herzzentrum München,
München, Germany
4 Cardiologie pédiatrique, CHU de Lille, Lille
5 Congenital heart diseases, Glenfield Hospital, Leicester, UK
6 Congenital heart diseases, Hospital Ramón y Cajal, Madrid, Spain
7 Congenital heart diseases, Oslo University hospital Ullevål, Oslo,
Norway
8 Congenital heart diseases, hôpital universitaire Vall d’Hebron,
Barcelona, Spain
9 Cardiologie, CHU Nantes, Nantes
10 Congenital heart diseases, Evelina London Children’s Hospital,
Londres, UK
11 Cardiologie pédiatrie et congénitale, CHRU de Nancy, hôpitaux
de Brabois, Vandœuvre-lès-Nancy
12 Pediatric cardiology, Royal Brompton Hospital, Londres, UK
∗ Corresponding author.
E-mail address: hascoets@gmail.com (J. Lourtet-Hascoet)
Introduction Percutaneous pulmonary valve implantation (PPVI)
is safe and effective for treating right ventricle outflow tract (RVOT)
dysfunction in patients with congenital heart disease. The Melody
valve (Medtronic, Minneapolis, MN) used in the majority of cases has
produced good outcomes despite a 2—4/100 patient-years incidence
of infective endocarditis (IE). SAPIEN valves (Edwards Life Sciences,
Irvine, CA) have been used in the pulmonary position since 2006.
IE on SAPIEN valves has rarely been reported, and information on
presentations and outcomes are therefore scant.
85
Objective We aim to report features of IE on SAPIEN valves after
PPVI.
Method We report 8 cases of IE on SAPIEN 3 valves in a retrospec-
tive multicenter cohort (EUROPULMS3, NCT05264181) of more than
700 patients. Two cases of IE after PPVI with SAPIEN XT valves were
also identified.
Results The 10 IE cases occurred in 8 males and 2 females aged
12 to 40 y. Five patients had surgical bioprostheses. Prestenting was
performed in a single patient, with a homograft. No patients had
genetic abnormalities. An increased residual gradient was present in
2 patients, consistent with the large diameters of the SAPIEN valves.
Three patients had a history of IE or mediastinitis and 4 had identi-
fied portals of entry. In 8 patients, IE occurred early, within 6 months
after PPVI. Some cases were diagnosed within a few days after the
procedure. The main causative organisms were gram-positive bac-
teria. Of the three severely ill patients, two had Staphylococcus
aureus and one Staphylococcus epidermidis. A patient with Ente-
rococcus faecalis IE within a few days after PPVI had no history of
gastrointestinal-tract symptoms. Two patients had negative blood
cultures, including one whose samples were collected during antibi-
otic therapy. According to the modified Duke criteria, the diagnosis
of IE was definite in 9 patients and possible in 1 patient. Six patients
had a favorable outcome without relapses or recurrences after
medical management only. Four patients were managed surgically,
and two of them died of postoperative septic shock.
Conclusion IE on SAPIEN valves is a rare but severe complication
that affects valve durability and patient outcomes. Further larger
studies are needed to identify risk factors.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2022.10.162
702
Management of mitral stenosis in pregnancy
M. Drissa ∗ , M. Ben Abdallah , M.A. Guedri , C. Aouji ,
H. Drissa
Cardiologie adulte, hôpital La Rabta, Tunis, Tunisia
∗ Corresponding author.
E-mail address: mba2421996@gmail.com (M. Drissa)
Introduction Valvular heart disease and mainly rheumatic heart
disease complicates about 1% of pregnancies. Among women with
valvular heart disease, those with mitral stenosis (MS) carry the
greatest potential for problems during pregnancy.
Objective The aim of the study is to assess the safety and efficacy
of percutaneous mitral balloon commisurotomy (PMBC) in Tunisian
pregnant women with sever mitral stenosis.
Method We conducted a retrospective descriptive study includ-
ing 50 pregnant women with the diagnosis of mitral stenosis
and admitted in our department for evaluation of hemodynamic
status between 2000 to 2019. We collected epidemiologic preg-
nancy related information and clinical symptoms about women who
were assessed before and 24 hours after the procedure (PMBC) by
transthoracic and trans esophageal echocardiography: Mitral valve
area (MVA), transmitral valve gradient (MVG), mitral valve morphol-
ogy was evaluated before the procedure.
Results The mean age was 28 ± 8 years. The mean gestational
age was 23 ± 7 weeks. Twenty women were presented with acute
pulmonary oedema, 15 patients were on atrial fibrillation. Echocar-
diography showed a severe MS with mean surface area 1 ± 0.2 cm2
and a mean gradient of 16 ± 8 mmHg. No significant mitral regur-
gitation MR (< 2/4 grade), mean systolic pulmonary pressure
43 ± 12 mmHg, no comissural calcification nor auricular thrombus.
Functional Tricuspid regurgitation (TR) were presented in 18 cases.
Aortic regurgitation: mild to moderate in 3 cases. Echocardiographic
findings after PMBC showed a mitral valve area increased from
1 ± 0.2 to 2 ± 0.35 cm2 . Mean gradient MV decreased from 15.5 ± 5.4
 04 — Valvular heart disease
to 3 ± 1.3 mmHg. PAP decreased from 43 ± 12 to 30 ± 15 mmHg.
Residual MR > moderate only in 7 cases. No per procedural compli-
cation and no maternal, fetal death or abortion were observed.
Conclusion During pregnancy, physiological hemodynamic
changes is considered one of the causes of mitral stenosis (MS)
decompensation. PMBC, when it is feasible, is considered now
the preferred method of treatment within pregnant woman with
refractory symptoms.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2022.10.163
281
Correlation between the surface of the
regurgitant orifice of mitral insufficiency
and pulmonary hypertension in patients
with aortic stenosis at UHC Ibn Rochd
Casablanca
M. El Mousaid ∗ , N. Mackonia , R. Habbal
Cardiologie, CHU Ibn Rochd, Casablanca, Morocco
∗ Corresponding author.
E-mail address: meryelmousaid@gmail.com (M. El Mousaid)
Introduction Mitral regurgitation is often associated with pul-
monary hypertension in patients with aortic stenosis, but there are
not enough specific quantitative studies on the amount of mitral
regurgitation related to pulmonary hypertension.
Objective The aim of the study is to evaluate the correlation
between the presence of mitral insufficiency and the occurrence of
pulmonary hypertension in patients with aortic stenosis.
Method This is a retrospective study from January 2016 to March
2022 including all patients with aortic stenosis admitted to the
cardiology department. Effective regurgitation orifice area (ERO)
was obtained using the proximal isovelocity area method. Systolic
pulmonary arterial pressure was calculated by adding right atrial
pressure to the tricuspid regurgitation pressure gradient.
Results The mean age was 58 ± 11 years; average ejection frac-
tion: 53 ± 8%; average area of the aortic valve: 1.03 ± 0.38 cm2 ;
mitral regurgitation was present in 71.9%. The ERO was < 0.20 cm2 in
71.4%, between 0.20 and 0.30 cm2 in 17.4% and greater than 0.3 cm2
in 11.2%. Associations between ERO and systolic pulmonary arterial
pressure were statistically significant (P < 0.0001). This relationship
persisted after multivariate adjustment and in subgroups of patients
with severe aortic stenosis or reduced ejection fraction (P < 0.0001);
2.05 (95% CI: 1.18—3.5); and 3.08 (95% CI: 2.19—6.09), respectively.
Conclusion There is a strong correlation between the severity of
mitral regurgitation and pulmonary hypertension in patients with
aortic stenosis. The presence of mitral stenosis presents a prognos-
tic marker of high-risk for patients with aortic stenosis.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2022.10.164
280
Role of coronary angiography in the context
of acute infective endocarditis requiring
surgical treatment at UHC Ibn Rochd,
Casablanca, Morocco (about 147 cases)
M. El Mousaid ∗ , N. Mackonia , R. Habbal
Cardiologie, CHU Ibn Rochd, Casablanca, Morocco
∗ Corresponding author.
E-mail address: meryelmousaid@gmail.com (M. El Mousaid)
Introduction Preoperative coronary angiography, according to
international guidelines, should be performed in patients at risk
for coronary artery disease with infective endocarditis requiring
86
surgical treatment. Nevertheless, the risks of contrast-induced
nephropathy or vegetation embolization in cases of aortic endo-
carditis must be taken into account.
Objective To assess the safety, therapeutic implications, and
prognostic impact of coronary angiography in patients requiring
surgical treatment for acute infective endocarditis.
Method This retrospective single-center study was conducted in
patients hospitalized at the UHC Ibn Rochd in Casablanca, Morocco
for treatment of endocarditis with a theoretical indication for
surgery between March 2016 and March 2022.
Results In total, 147 patients were included; 64.7% were men, the
mean age was 56.3 ± 12.6 years and the median EuroSCORE II was
6.7%. In total, 101 patients (68.7%) had aortic endocarditis associ-
ated with aortic vegetation in 43 cases (42.5%). Invasive coronary
angiography was performed in 112 patients and 11 patients were
evaluated by coroscanner. Acute renal failure after coronary angiog-
raphy was observed in 9 patients (8.03%), 3 patients (2.8%) had a
stroke within 24 hours of coronary angiography, but none had aor-
tic endocarditis. Among the 112 patients who underwent coronary
angiography, 27 (24.1%) had one or more significant coronary lesions
and 18 (16.07%) had associated coronary artery bypass grafting.
Conclusion Preoperative coronary angiography is an essential tool
in patients with infective endocarditis at the surgical stage.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2022.10.165
688
Epidemiology of surgical valvular heart
diseases in a North African tertiary referral
hospital
W. Ouechtati Ben Attia ∗ , M. Elarbi , H. Ben Jemaa , N. Bengagi ,
F. El Ayech , H. Ben Ahmed , L. Bezdah
Cardiologie, hôpital Charles-Nicolle, Tunis, Tunisia
∗ Corresponding author.
E-mail address: drwejdene@gmail.com (W. Ouechtati Ben Attia)
Introduction The etiology of valvular heart disease (VHD) has
changed dramatically in the last five decades. In the western world,
the significant reduction of acute rheumatic fever and its sequelae,
and the recognition of non-rheumatic causes of VHD induced the
metamorphosis in the etiology of valvular disorders.
Objective The aim of this study was to assess the epidemiological
profile of the patients undergoing valvular surgery in a North African
center of cardiology.
Method A retrospective study involving the 291 last patients hos-
pitalized in our department and proposed for valvular surgery from
January 2012 to May 2022.
Results The mean age was 57 years. One hundred twenty-four
patients were male (42.6%). Before surgery mean LVEF is 60% ± 13.
Among the patients, 10.1% were operated with left ventricular dys-
function (LVEF ≤ 40%). Arterial hypertension, diabetes mellitus and
smoking are respectively present in 29, 65%, 21, 64% and 27, 35%
of the patients. A history of rheumatic fever was present in 60,
36% of rheumatic valvular disease. The rheumatic etiology was the
most important (50.5%). A preoperative coronary angiography was
performed in 63.98% of the patients and coronary artery disease
was associated to the valvular heart disease in 15.22%. Mitral valve
replacement, aortic valve replacement and double valve replace-
ment were respectively performed in 38.1%, 35.9% and 18.93% of
the cases. Bioprothesis were implanted in 5.5% of the cases. One
eighth of the patients underwent coronary artery bypass graft in
addition to the valvular surgery. In 16.7% of the cases it was a redo
surgery.
Conclusion Contemporary epidemiological data show a rise of
the degenerative etiology and associated coronary artery disease.
Surgery offers good results for patients with significant valvular