Le Traitement Chirurgical des Valvulopathies Acquises au Congo: Surgical treatment of acquired valvulopathies in Congo

RESUMEIntroduction. L’objectif de ce travail etait de decrire la prise en charge chirurgicale des patients des congolais ayant une valvulopathie acquise. Patients et methodes. Il s’agit d’une etude transversale retrospective a l’ Hopital Universitaire International Cheikh Zaid et au CHU de Brazzaville. Tout patient congolais evacue et opere dans cet hopital pour valvulopathie acquise entre juin 2016 et decembre 2020 a ete inclus. Les variables d’interet etaient la presentation clinique, les resultats et les aspects therapeutiques. Les criteres de jugements primaires pour les resultats fonctionnels cardiaques etaient les stades de NYHA. Les criteres secondaires etaient fraction d’ejection du ventricule gauche (FEVG), diametre telediastolique (DTD) du VG, pression de ‘l’artere pulmonaire (PAPs). Resultats. Au total 25 patients ont ete operes. Leur âge moyen etait de 34 ± 2.5 ans et le sex-ratio de 0.4. 88% des patients etaient d’un niveau socioeconomique faible. La dyspnee etait le principal symptome et dix-huit (72%) patients etaient au stade III de la NYHA. La FEVG preoperatoire de 42 ± 2.2 %, le DTD moyen de 64 ± 2.3 mm et la PAPs etait a 72 ± 3.2 mm. Le remplacement valvulaire mitral (RVM) a represente 88% des procedures. Le geste associe etait la plastie tricuspide dans 86.3% des cas avec 13.7% d’annuloplastie de De Vega. Douze mois apres la chirurgie, 68% des patients sont passes au stade II vs 12% (p<0.05), la FEVG etait a 54 ± 2.4 vs 42 ± 2.2% (p<0.05). le DTD etaient de 55 ± 2.3 mm et la PAPs etait descendue a 51 ± 2.1 mm Hg vs 64 ± 2.3 mm et 72 ± 3.2 mm Hg (p<0.05). Deux deces par œdeme aigu du poumon chez les patients apres RVM ont ete notes a 18 mois. Conclusion. La chirurgie des valvuloptahies est nereuse, mais les resultats sont encourageants. Il y a necessite de developper des programmes locaux et perennes. ABSTRACTIntroduction. The aim of our study was to review the surgical treatment of Congolese patients with valvulopathies. Patients and methods. This was a cross sectional retrospective study at International University hospital Cheikh Zaid and Brazzaville University Teaching Hospital between June 2016 and December 2020. All Congolese patients operated for acquired valvulopathies in Morocco were included. Our study variables were clinical presentation, paraclinical results, treatment and outcome. Our primary judgment criteria for cardiac function were; NYHA stages and secondary judgment criteria were; values of left ventricular ejection fraction (LVEF), left ventricle diastolic diameter (LVDD), and systolic pulmonary arterial pressure (SPAP) in postoperative period. Results. Twenty-five patients were operated. Their mean age was 34 ± 2.5 years and the sex-ratio was 0.4. Twenty-two patients (88%) had low socioeconomic status. Dyspnea was the most common symptom and eighteen patients (72%) were in stage III of NYHA. Mean preoperative LVEF was 42 %± 2.2 %, mean LVDD was 64 ± 2.3 mm. Mean SPAP was 72 ± 2.3 mm Hg. Mitral valve replacement (MVR) represented 88% of operations. Tricuspid valve repair was the complementary gesture in 86.3% of cases, of which 13.7% were of De Vega technique. Twelve months after surgery, 68% of patients were in stage II against 12% (p<0.05) before surgery. Mean LVEF, LVDD, and SPAP, were respectively 54% ± 2.4, 55 ± 2.3 mm, 51 mm HG ± 2.1 ; against 42% ± 2.2 %, 64 mm ± 2.3 mm, and 72 ± 2.3 mm Hg (p<0.05). Two deaths were reported in the MVR patients. Conclusion. Valvular surgery is costly, but the results are encouraging. There is need to develop local and sustainable programs.