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Marfan Syndrome Complicated by Aortic Arch Aneurysm and Aortic Dissection: A Case Report from Congo

World Journal of Cardiovascular Diseases 2022年第10期12卷 463-471页

作者： Solange Flore Ngamami Mongo christian Michel kouala landa Franck Yannis Kouikani Kivié Mou-Moué Ngolo Letomo Rogue Pattern Bakekolo Bertrand Fikahem Ellenga Mbolla Department of Cardiology University Hospital of Brazzaville Brazzaville Republic of the Congo Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Context and Aim: Marfan syndrome is a transmissible genetic disease of the connective tissue that is rarely encountered in Congo and in sub-Saharan African countries. Its cardiovascular complications can be life frightening. The management of that disease is still limited in our country because of a lack of technical capacity in cardiovascular surgery. The aim of this clinical report is to show the interest of echocardiography and especially angioscanner as the main technique in the diagnosis of the severity of this disease, elaborate a literature review, but also to highlight the difficulties encountered in the management of that affection in our countries. Observation: The authors report the medical observation of a 48-year-old adult with a history of cataract of the left eye and a subluxation of the lens for which he underwent surgery in 2016, without any etiology being found. He is a smoker at a rate of 6 packs yearly. He consulted for progressively worsening dyspnea and constrictive mediosternal pain. The clinical examination revealed a moderate alteration of the general state, apyrexia, a blood pressure of 140/90 mmHg, a SPO2 of 97% in ambient air, a respiratory frequency of 32 cycles/min, signs of left ventricular insufficiency, a diastolic murmur of aortic insufficiency of intensity 4/6th, a long-limbed morphotype with a wingspan superior to the height and a kyphoscoliosis. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 58%, a highly dilated and uncoiled aorta, convexity of the left inferior arch, and venocapillary hypertension and a quiet alveolar-interstitial pulmonary oedema. The ECG was in sinus rhythm and showed a poor R-wave progression in anteroseptal leads. Echocardiography showed significant aortic root dilatation up to 72.6 mm and aortic regurgitation grade IV. Angioscanner showed a dissected aortic aneurysm and areas of emphysema located in the lungs. The medical treatment was palliative with beta blocker and angiotensin

关键词： Marfan Syndrome Heart Failure Aortic Aneurysm Aortic Dissection Congo

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Epidemiological and Clinical Profile of Hypertensive Patients with Obstructive Sleep Apnea at CHU-B

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World Journal of Cardiovascular Diseases 2023年第10期13卷 664-673页

作者： Solange Flore Ngamami Mongo Kivie Mou-Moue Ngolo Letomo Arnold Sem Nguia Vel christian kouala landa Franck Yannis Kouikani Rogue Pattern Bakekolo Bertrand Fikahem Ellenga Mbolla Department of Cardiology B University Hospital of Brazzaville Brazzaville Republic of Congo Departement of Medecine Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of Congo Adolphe Cissé Emergency Department Pointe Noire Republic of Congo

Objectives: To detect obstructive sleep apnea syndrome (OSAS) in a population of hypertensive patients, using the Berlin questionnaire and to establish the epidemiological and clinical profile of patients. Patients and Method: This was a cross-sectional and analytical study, carried out from March to August 2019 at the CHU Brazzaville. Included are hypertensive patients followed as outpatients. The diagnosis of the OSAS was based on the answers to the Berlin questionnaire. Results: A total of 315 patients were included, including 210 women (64.9%). Prevalence of OSAS was 75.8% (n = 239). The average age of patients with sleep apnea was 58.5 ± 12.4 years with female predominance (64.9%). In the mixed analysis, the factors associated with (OSAS) were: occupation OR (2.56) 95% CI (1.15 - 5.69), obesity OR 7.50 (1.60 - 35.1) and abdominal obesity OR 2.36 CI 95% (1.36 - 4.08). Living standards were high in 59 cases (18.7 per cent). The medical history of previous hospitalization was present in 209 cases (66.3%), diabetes 95 (30.2%), and heart failure 57 cases (18.1%). Lifestyle patterns were: sedentary (n = 181;57.5%) alcohol consumption (n = 97;30.8%). On physical examination, overweight was noted in 96 cases (30.5%) and obesity in 91 cases (28.8%). The anomalies in the Berlin questionnaire were: snoring (n = 197;62.5%), waking fatigue (n = 127;40.3%), fatigue during the day (n = 97;30.8%). Conclusion: The prevalence of obstructive sleep apnea syndrome is high during arterial hypertension in our setting. Hence the need for sleep exploration through polysomnography, and prevention through the fight against the associated risk factors.

关键词： Hypertension Obstructive Sleep Apnea Syndrome Brazzaville

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Arterial Hypertension and Pregnancy about 72 Cases

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World Journal of Cardiovascular Diseases 2023年第12期13卷 870-878页

作者： Solange Flore Ngamami Mongo Kivié Mou-Moué Ngolo Letomo christian Michel kouala landa Rode Vaclair Kibongui Massinssa Rogue Pattern Bakekolo Franck Yannis Kouikani Bani Aloise Macaire Bertrand Fikahem Ellenga Mbolla Department of Cardiology B University Hospital of Brazzaville Brazzaville Republic of Congo Departement of Medecine Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of Congo Hô pital général de Loandjili Pointe Noire République du Congo

Background: Hypertension is the leading cause of cardiovascular disease worldwide. Hypertensive disorders in pregnancy also constitute a major global health threat. There are different types of hypertension that can occur during pregnancy;with different mechanisms and consequences for mother and fetus. Objectives: To determine the frequency of hypertension (hypertension) during pregnancy. Document the risk factors for pregnancy-related hypertension. Review the material and fetal complications which determine the prognosis. Methods and Patients: This was a retrospective cross-sectional study from January 1 to June 30, 2022 in the Obstetrics and Gynecology Department of the Brazzaville Hospital and University Center. We noted 72 cases of hypertension among 1188 births admitted during the reference period. Hypertension was defined as blood pressure 40/90mmHg. Results: Hypertension was observed in 6% of those giving birth. The average age of the patients was 28 ± 8 years (range 15 to 39 years). The age group of 15 to 34 years was the most affected, 56 cases (778%). The risk factors were young age (15 - 34 years), late transfer of women in labor, 49 cases (68%). Primiparity, 33 cases (45.8%), absence of prenatal consultation, 7 cases (9.7%), hypertension, 8 cases (11%), twinning, 4 cases (5%), fetal macrosomia, one case (1.3%). Maternal complications recorded were: 21 cases of eclampsia (29%), 6 cases of left ventricular failure (8.3%), 5 cases of anemia (6.9%), 2 cases of retroplacental hematoma (2.8%), 1 case of HELLP syndrome, as much renal failure. Fetal and neonatal complications were 23 cases of prematurity (32%), 10 cases of acute fetal distress (14%), 4 cases of hypotrophy (5.6%). Eleven cases of death (15.3%) were: 3 in utero. B in the neonatal period.

关键词： Hypertension Pregnancy Pre-Eclampsia Complications

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Peri-Annular and Septal Abscesses in Infectious Endocarditis. About 3 Cases Observed at the University Hospital of Brazzaville

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World Journal of Cardiovascular Diseases 2022年第2期12卷 94-110页

作者： Solange Flore Mongo Ngamami Armel Landry Batchi-Bouyou Trésor Mavie Eouolo Ndona christian Michel kouala landa Eric Gibrel Kimbally Kaky Jean Joseph Ekwa Sima Bertrand Fikahem Ellenga Mbolla Méo Stéphane Ikama Department of Cardiology University Hospital of Brazzaville Brazzaville Republic of the Congo Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Infectious endocarditis (IE) is a relatively rare but serious condition. We report 3 cases of infectious endocarditis complicated by peri-annular and/or septal abscess. The patients aged 24, 25 and 28 were all male. Global heart failure was observed in 2 cases. Atrioventricular block was noted in 2 cases (complete syncopation: 1 time;2nd degree Mobitz 2 1 time). Transthoracic echocardiography made it possible to diagnose abscess in all cases (aortic and septal peri-annulus: once, septal only: twice). The aortic insufficiency was grade 2 in all cases, mitral insufficiency grade 2 in 1. The front door was found once, with a dental location. Blood cultures were negative in all cases. A bi-probabilistic antibiotic therapy made it possible to control the infectious process in all the patients. Cardiac surgery, indicated in all cases, was performed in 1 case, consisting of flattening the abscesses and then placing a pacemaker in the patient with complete syncopal atrioventricular block. The outcome of all patients was favorable. Return to permanent sinus rhythm, associated with complete left bundle branch block, was noted at the 4th year of development in the pacemaker wearer. The other 2 patients are still awaiting medical evacuation.

关键词： Infectious Endocarditis Peri-Annular and Septal Abscess Echocardiography Treatment

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Cardiac Tamponade: Epidemioclinical, Therapeutic and Evolutionary Aspects at the University Hospital of Brazzaville

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World Journal of Cardiovascular Diseases 2021年第12期11卷 572-582页

作者： Solange Flore Mongo Ngamami Armel Landry Batchi-Bouyou Evariste Pabingui christian Michel kouala landa Bertrand Fikahem Ellenga Mbolla Jean Joseph Ekwa Sima Méo Stéphane Ikama Suzy-Gisèle Kimbally Kaky Department of Cardiology University Hospital of Brazzaville Brazzaville Republic of the Congo Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Objectives: Contribute to improving the management of cardiac tamponade in Congo. Background: Cardiac tamponade is an acute or subacute compression of the heart chambers by pericardial effusion responsible for uncertain prognosis for patients. The objective of this study is to help improve the management of patients with cardiac tamponade. Patients and Methods: We conducted a retrospective and descriptive study at the University Hospital of Brazzaville, from January 2015 to December 31, 2019. Included were all patients hospitalized for cardiac tamponade. Epidemioclinical, therapeutic and evolutionary data were analyzed. Results: An overall of 14 patients were divided into 9 men (64.2%) and 5 women (35.7%), i.e. a sex ratio of 1.8. The mean age of patients was 34.2 ± 15.1 years old (18 years to 64). The most represented comorbidity was hypertension (n = 2;14.3%). The most frequent clinical sign was dyspnea (n = 14;100%). The ECG showed diffuse and concordant repolarization disturbances (n = 14;100%), sinus tachycardia (n = 13;92.8%), microvoltage (n = 12;85.7%). Cardiomegaly was constant (n = 14;100%). In terms of transthoracic ultrasound, we found: diastolic compression of the right ventricle (RV) (n = 12;85.7%), dilation of the inferior vena cava (IVC) (n = 12;85.7%). Treatment consisted of crystalloid vascular filling in all patients, pericardial punc

关键词： Cardiac Tamponade Clinical Presentation Treatment Congo

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Hypertension, diabetes mellitus, overweight and obesity in employees under health transition at the railways company in Congo-Brazzaville

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World Journal of Cardiovascular Diseases 2014年第2期4卷 45-49页

作者： Bertrand Fikahem Ellenga Mbolla Thierry Raoul Alexis Gombet Henri Germain Monabeka Paul Macaire Ossou-Nguiet Solange Flore Mongo-Ngamami christian Michel kouala landa Suzy-Gisèle Kimbally-Kaky Benjamin Longo-Mbenza Department of Cardiology University Hospital of Brazzaville Brazzaville Congo Department of Cardiology University Hospital of Brazzaville Brazzaville Congo Department of Medicine Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Department of Medicine Faculty of Health Sciences Marien Ngouabi University Brazzaville Congo Faculty of Health Sciences Walter Sisulu University Mthatha South Africa

Background and Aim: Cardiovascular risk (CVR) factors, namely hypertension (HT), diabetes mellitus and obesity, are a public health problem in sub-Saharan Africa because of health transition. The additional effect of the social gradient within the railway companies in Congo-Brazzaville on high CVR is not yet established. The aim of this study was to determine the extent of hypertension, diabetes mellitus, overweight, and obesity and to identify the contributing factors of fatness and hypertension. Methods: This was a cross-sectional study conducted in April 2013. A simple random sample of 255 out of all 2550 workers from the railway companies of Congo was examined for epidemiological, clinical and biological variables. Results: Out of the study sample, 231 (90.6%), 79 (31%), and 52 (20.4%) were men, rural dwellers, and senior executives, respectively. The mean age was 45 ± 13 years (range 19 to 63 years). The rates of overweight, hypertension, obesity, and diabetes mellitus were 40.3% (n = 103), 29.4% (n = 75), 7.5% (n = 19), and 3.5% (n = 9), respectively. In univariate analysis, female sex (OR 2.7, 95% CI 1.13 - 6.45, p = 0.01), senior executive (OR 2.4;95% CI: 1.3 - 4.5;p = 0.003) and physical inactivity (OR 2.5;95% CI: 1.5 - 4.2;p < 0.001) were significantly associated with overweight. Female sex (OR 7.5, 95% CI: 2.6 - 21;p < 0.001) and senior executive (OR 3.17;95% CI: 1.2 - 8.3) were also significantly associated with obesity. In logistic regression, overweight (OR = 4.8, 95% CI 2.8 - 11, p < 0.0001), and obesity (OR = 6.8, 95%CI 2.1 - 22, p = 0.01) were identified as the most important and independent determinants of hypertension. Conclusions: Fatness is emerging and it is the most contributing factor of hypertension among workers at the Congolese railway companies. There is also a significant interaction between non-modifiable factors (genetic: females and family history) and modifiable factors (inactivity, fatness) for higher risk of hypertension. Health pr

关键词： Hypertension Diabetes Mellitus Overweight Obesity Workplace Congo Sub-Saharan Africa

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Trends of Cardiovascular Mortality in Blacks Africans from Central African City: Hospital Based Study, Brazzaville (Congo)

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World Journal of Cardiovascular Diseases 2019年第9期9卷 698-705页

作者： Bertrand F. Ellenga-Mbolla Aude Loko-Lemba Solange F. Mongo-Ngamami christian M. kouala-landa Igor Ondze-Kafata Stephane M. Ikama Thierry R. Gombet Gisèle Kimbally-Kaky Department of Cardiology University Teaching Hospital of Brazzaville Brazzaville Congo Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University of Brazzaville Brazzaville Congo

Background: To determine mortality causes and the associated factors. Patients and Method: This cross-sectional study was conducted from June 2014 to May 2015 (1 year) in the department of cardiology at University and teaching Hospital of Brazzaville. Patients admitted for cardiovascular diseases were included. Patients admitted for cardiovascular disease in other departments of the hospital, or without cardiovascular diseases were not included. Results: In total, 1035 patients, 605 women (5804%) were included. Mean age was 57.1 ± 7 years (range: 18 - 85 years). The patients were: elderly (n = 498, 48.1%), educated (n = 809, 78.1%), low-income (n = 253, 24.2%). The medical history of patients was: hypertension (n = 440, 42.5%), diabetes (n = 316, 30.5%), reduced physical activity (n = 154, 14.9%), excessive alcohol intake (n = 56, 5.4%). Heart failure was reported in 386 cases (37.3%). The mortality rate was 8% (n = 83);the mean age of deceased was 61.9 ± 7.3 years (p s in death were dilated cardiomyopathy (n = 37, 44.6%, OR 5, 95%CI 3.1 - 8, p -3.3, p = 0.002), atrial fibrillation (n = 24, 29%, OR 3.6, 95%CI 2.2 - 6, p - 9.8, p = 0.005). The associated death comorbidities were: acute respiratory infection (n = 44, 53%, OR 10.1, 95%CI 6.2 - 16, p - 10 p - 6.8, p Conclusion: Hypertension, heart failure and cardiomyopathies are the leading causes of mortality in the department of cardiology. Prevention and patient education in a low-income environment are essential elements to reduce this morbidity.

关键词： Mortality Cardiovascular Disease Blacks Africans Sub-Saharan Africa

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Hypertensive Emergencies in the Department of Cardiology at the Teaching University Hospital of Brazzaville (Republic of the Congo): Preliminary Study

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World Journal of Cardiovascular Diseases 2019年第1期9卷 1-8页

作者： Solange Flore Mongo Ngamami Bertrand Fikahem Ellenga Mbolla Guénol Barthel Ebinda christian Michel kouala landa Louis I. Ondze Kafata Méo S. Ikama Thierry Raoul Gombet Suzy-Gisèle Kimbally Kaky Department of Cardiology Teaching University Hospital Brazzaville Republic of the Congo Department of Doctoral Studies Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo

Background: Hypertensive emergencies are still a common mode of finding hypertension.?Objective: to determine the epidemiological, clinical and paraclinical characteristics of the hypertensive emergency, and to evaluate the factors associated with poor blood pressure control. Patients and method: cross-sectional and analytical study, conducted from July 2010 to June 2014 (4 years), in the cardiology department of the Brazzaville University Hospital. Included, patients admitted were those systolic blood pressure (BP)?≥ 180 mm Hg, and diastolic BP ≥ 110 mm Hg, with target organ involvement. A minimum biological assessment, an ECG, a chest X-ray, a brain CT-scan and a cardiac ultrasound were required.?Results: Fifty patients were included, including 31 women (62%). The mean age was 53.8?±?13.7 years old, age;?68%), low income?population (n = 23;?46%). Hypertension was often known (n = 49;98%), and poor compliance?(n = 33;67.4%). Associated risk factors were: obesity (n = 13),?and?diabetes (n = 7). The average consultation time was 4.1?±?3.7 days. The reasons for hospitalization were: dyspnea (n = 24;?48%), neuro-sensory signs (n = 24;?48%),?and?functional limb impotence (n = 15;?30%). The major laboratory abnormalities were hyperuricemia (n = 16;?32%) and hyperglycemia (n = 16). Left ventricular hypertrophy was noted at the ECG (n = 29;?58%). Cardiac ultrasound showed a LVEF ?40% (n = 8). The main hypertensive emergencies were: heart failure (n = 23;?46%), stroke (n = 23;?46%), severe renal failure (n = 10;20%), and malignant hypertension (n = 23;46%). The average hospital stay was 11.4?±?5.5 days, and 1 death was recorded. BP was uncontrolled in 38 cases (76%). Factors associated with uncontrolled blood pressure were: female sex (OR 3;?95% CI 0.8 - 11.5) and low-income patient (OR 1.26;?95% CI 0.34 - 4.68).?Conclusion: organs affected during hypertensive emergencies are most often the heart, the brain and the kidney in our context. Early management of hypertension wil

关键词： Emergencies High Blood Pressure Stroke Heart Failure Black African

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Atrial Fibrillation during Cerebral Infarction in Brazzaville: Frequency and Predictive Factors

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World Journal of Cardiovascular Diseases 2019年第12期9卷 891-898页

作者： Stéphane Méo Ikama Yann Luiz Ngouabi Ghislain Mpandzou Paul Macaire Ossou-Nguiet Jospin Makani Thibault Gankama christian kouala-landa Louis Igor Ondze-Kafata Bertrand Fikhaem Ellenga-Mbolla Thierry Raoul Gombet Suzy Gisèle Kimbally-Kaky Department of Cardiology Brazzaville University Hospital Center Brazzaville Congo Department of Neurology Brazzaville University Hospital Center Brazzaville Congo

In order to contribute to the improvement of brain infarction management in Brazzaville, a cross-sectional and analytical study with prospective data collection was conducted in the cardiology and neurology departments of the Brazzaville University Hospital, from February 1 to July 31, 2018. It included patients hospitalized for cerebral infarction confirmed with imaging, and having done an etiological assessment with at least one electrocardiogram at rest and one of long duration. Among these 138 patients included, 11 had atrial fibrillation, equaling?a frequency of 7.9%. The mean age of AF patients was 71 ± 8.8 years. The cardiovascular risk factors found were hypertension in eight cases (72.7%), diabetes in five cases (45.5%), abdominal obesity in four cases (36.4%). AF was permanent in 10 cases (91%), and paroxysmal in one case (9%). It was valvular in three cases (27.3%) and non-valvular in eight cases (72.7%). The cardiopathy involved was hypertensive in seven cases (63.6%), ischemic and valvular in two cases each. The CHA2DS2-VASc score, calculated in eight patients, was an average of 2.2, and ≥2 in more than 80% of patients;HAS-BLED score of 2.4 on average was ≥?3 in more than 72% of patients. Digoxin was prescribed in seven cases (63.6%) and an anti-vitamin K in eight cases (72.7%). In multivariate analysis, age (OR = 20.10, p = 0.023), arterial hypertension (OR = 23.82, p = 0.011), and dyslipidemia (OR = 2.03, p = 0.032) were the predictive factors found. AF is infrequent during brain infarction in Brazzaville. This systematic research raises the problem of age in our context.

关键词： Atrial Fibrillation Cerebral Infarction Frequency Predictive Factors Congo

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Cardiovascular Disorders in Cirrhosis at the Brazzaville Teaching Hospital in 2022

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Open Journal of Gastroenterology 2023年第11期13卷 369-376页

作者： Rody Stéphane Ngami Philestine Clausina Mikolele Ahoui Apendi Relda Itoko Okombi christian kouala landa Marlyse Ngalessami Mouakosso Bénédicte Ahombo Niotsombe Ngala Akoa Itoua-Ngaporo Pérès Mardochée Motoula Latou Jile Florient Mimiesse Monamou Arnaud Mongo-Onkouo Deby Gassaye Blaise Irénée Atipo Ibara Department of Gastroenterology and Internal Medicine University Teaching Hospital Brazzaville Republic of the Congo Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Department of Cardiology and Internal Medicine University Teaching Hospital Brazzaville Republic of the Congo

Cirrhosis is a liver disease that can lead to cardiovascular lesions that are often asymptomatic but potentially fatal. Objective: The aim of this study was to evaluate electrical and echographic cardiovascular abnormalities during cirrhosis at the Brazzaville University Hospital. Patients and Methods: We conducted a cross-sectional analytical study over a 2-year period at the Brazzaville Universitary Hospital. Cirrhotic patients at least 18 years of age who had undergone electrocardiogram and echocardiography were included. Patients with cardiac cirrhosis, hepatocellular carcinoma or spontaneous bacterial peritonitis were excluded. The outcome variables were cardiac electrical and echographic abnormalities. Data were analyzed using Epi info 7.2 software. Pearson’s chi-square, Fisher’s exact and Student’s exact tests were used to compare proportions and means at a significance level of 0.05. Results: A total of 76 cirrhotic patients were recruited out of 186 patients, i.e. 40.9% of cirrhotic patients. There were 48 men and 28 women, for a sex ratio of 1.7. The median age was 56 (IQR 41.5 - 69.0). QTc prolongation, microvoltage and sinus tachycardia were the most frequent electrical disorders, respectively in 19 (29.7%), 11 (17.2%) and 11 (17.2%) cases. Electrical disorders were statistically related to cirrhosis stage (p = 0.0364). The most frequent ultrasound disorders were left ventricular systolic failure 11 (28.9%) and dilated cardiomyopathy 8 (21.1%). Seven (9.2%) patients had high pulmonary arterial pressure. Death, observed in 12 cases (15.8%), was statistically linked to the presence of echocardiographic disorders (p = 0.0089) and congestive heart failure (p = 0.0001). Conclusion: The search for cardiac disorders should be systematic during decompensated cirrhosis to detect potentially fatal abnormalities.

关键词： Cirrhosis ECG Echocardiography Cardiovascular Disorders

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