Background: Rheumatic Mitral Stenosis (MS) remains a frequent valvulopathy in developing countries. Objectives: Our aims were to evaluate the existence of a direct correlation between the Mean Transmitral Gradient (MTG) and the severity of MS in patients with severe or very severe MS, as well as to analyze the different parameters that condition the MTG. Methods and Results: Between January and December 2014, 50 patients (41.7 years of average age, 75% were females) were enrolled for pure and severe or very severe Mitral Stenosis (MS) in the Cardiology department of Ibn Rochd University hospital. All patients underwent complete clinical evaluation with a 12-lead ECG and transthoracic echocardiography. We first studied the correlation between the Mitral Valve Surface (MVS) and the MTG. We then separately analyzed two groups of patients: those with a MTG <10 mmHg (group 1) and those with a MTG≥10 mmHg (group 2). For each group, we performed a univariate correlation of MTG with the clinical, electrocardiographic and echocardiographic data.64% of patients had a severe MS and 36% had a very severe MS. 52% had a MTG <10mmHg and 48% had a MTG≥10mmHg, 80% of patients in group 1 were dyspneic stage II of the NYHA classification and 70% of patients in group 2 were dyspneic stage III (41%) or IV (29%) of the NYHA classification, which means the existence of a significant correlation between MTG and severity of dyspnea. The analytical study of heart rate and the presence of cardiac failure in relation to the MTG showed a significant correlation. The study of sPAP in both groups revealed the existence of a statistically significant correlation (r =0.518 and P <0.001) between sPAP and MTG. Discussion: The MTG is a good indicator of mitral stenosis tolerance, but it is imperfectly reflecting its severity as it depends on several hemodynamic parameters. Authentic severe MS may exist with MTG <10 mmHg, which is why the value of the MTG should never be interpreted alone.
Background: Venous Thrombo Embolism (VTE) is a major public health problem in Morocco. The increase in life expectancy, changes of the epidemiological profile of VTE counteracts the constant efforts made in terms of prevention and disease remains ever. Materials&Methods: Prospective study to host emergency department over a period of 10 months including all Deep Vein Thrombosis (DVT) admitted to the University Hospital of Casablanca. DVT was suspected clinically and retained on the presence of a thrombus in the lower-extremity on venous Doppler. We excluded patients with superficial thrombophlebitis and patients already diagnosed with VTE. Findings: The mean age of our patients was 49 years, with female predominance. A thromboembolic risk factor was found in 88% of patients. The main etiology: immobilization, surgery, heart disease and cancer pathology. Pain and the increase in calf circumference were the signs giving rise to the emergency department visit. The Doppler ultrasound has objectified a proximal localization in 38 patients (47%), distal in 12 patients (15%) and extended to the whole limb in 30 patients (38%). An association to pulmonary embolism was found in 10 patients (12%) and the association with arterial impairment was found in 4 patients (5%). The Wells score was calculated on only 12 patients (15%) and the results of thrombophilia requested in 8 patients (10%). 54 patients (67%) were treated in ambulatory and 26 patients were hospitalized. All patients were started on heparin and 92% have Vitamin K Antagonists (VKA). The causes of non-prescription VKA were: pregnancy in two patients, breakthrough bleeding on cervical cancer, active duodenal ulcer, immune thrombocytopenic purpura and erosive gastritis scalable. Conclusion: DVT remains a topical issue especially with the advent of new anticoagulants. In our current practice, a prospective study in more moroccan university hospital-including large population-is desirable for a better management.
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