M L Slimane

Faculty of Medecine of Tunis, Tunis-Ville, Tūnis, Tunisia

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Publications (70)6.15 Total impact

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    ABSTRACT: The intracardiac ectopic thyroid tumour is rare. We report the case of a woman who was admitted for exertional dyspnea. The echocardiography revealed an obstructive tumor in the right ventricular outflow tract. Histological examination of the removed tumour showed the ectopic follicular thyroid tissue.
    No preview · Article · Aug 2011 · Annales de Cardiologie et d Angéiologie
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    ABSTRACT: The intracardiac ectopic thyroid tumour is rare. We report the case of a woman who was admitted for exertional dyspnea. The echocardiography revealed an obstructive tumor in the right ventricular outflow tract. Histological examination of the removed tumour showed the ectopic follicular thyroid tissue.
    No preview · Article · Aug 2011 · Annales de cardiologie et d'angeiologie
  • S. Fennira · M.H. Khaldi · M.A. Rejeb · Y. Ellouze · S. Kraiem · M.L. Slimane
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    ABSTRACT: IntroductionPregnancy can precipitate or exacerbate cardiac arrhythmias. Management of those arrhythmias is not very different from that in non-pregnant women.Objective In this review we tried to specify factors which favour arrhythmias in pregnant women and to show their specific management.Methods We carried out a search through PubMed using as keywords: pregnancy, cardiac arrhythmias, antiarrhythmics.ResultsHemodynamic perturbations, direct electrophysiological effects of hormones and underlying heart disease are potential factors that can promote arrhythmias in pregnancy. Usually, no drug therapy is needed for the management of supraventricular or ventricular premature beats but potential promoting factors should be eliminated. In paroxysmal supraventricular tachycardia, vagal maneuvers should be tried firstly. Adenosine could be used if vagal maneuvers are ineffective. In pregnant women with atrial fibrillation, the goal of treatment is the conversion to sinus rhythm or the control of ventricular rate. Ventricular arrhythmias are usually uncommon during pregnancy and often occur in the absence of structural heart disease and are responsive to drug therapy. Symptomatic bradycardia rarely complicates pregnancy and its management does not differ from that in non-pregnant women.
    No preview · Article · Apr 2011 · Annales de cardiologie et d'angeiologie
  • S Fennira · M H Khaldi · M A Rejeb · Y Ellouze · S Kraiem · M L Slimane
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    ABSTRACT: Pregnancy can precipitate or exacerbate cardiac arrhythmias. Management of those arrhythmias is not very different from that in non-pregnant women. In this review we tried to specify factors which favour arrhythmias in pregnant women and to show their specific management. We carried out a search through PubMed using as keywords: pregnancy, cardiac arrhythmias, antiarrhythmics. Hemodynamic perturbations, direct electrophysiological effects of hormones and underlying heart disease are potential factors that can promote arrhythmias in pregnancy. Usually, no drug therapy is needed for the management of supraventricular or ventricular premature beats but potential promoting factors should be eliminated. In paroxysmal supraventricular tachycardia, vagal maneuvers should be tried firstly. Adenosine could be used if vagal maneuvers are ineffective. In pregnant women with atrial fibrillation, the goal of treatment is the conversion to sinus rhythm or the control of ventricular rate. Ventricular arrhythmias are usually uncommon during pregnancy and often occur in the absence of structural heart disease and are responsive to drug therapy. Symptomatic bradycardia rarely complicates pregnancy and its management does not differ from that in non-pregnant women.
    No preview · Article · Jan 2011 · Annales de cardiologie et d'angeiologie
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    ABSTRACT: Rheumatic tricuspid valve dysfunction is the rarest of all valvular disease and is often associated or secondary to left-sided valvular disease. She often realize tricuspid regurgitation. The surgical treatment is generally conservative but also it can be radical generally using bioprotheses. to assess the epidemiology of the rheumatic tricuspid dysfunction, the average diagnoses and its therapeutic. To evaluate the results of the surgical techniques, the factors of prognosis and to determine the therapeutic regarding an in front of important and symptomatic residual tricuspid regurgitation a long time after a valvular surgery first of the left heart. A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. The prevalence of the rheumatic tricuspid dysfunction was 8.42%. 70% of the patients had a tricuspid regurgitation. The average Age of our patients was 40 years. Our population consisted of 65.5% women. 21% of the patients had benefited at least from a percutaneous mitral dilation. 31% of the patients had antecedents of valvular cardiac surgery. 53% of the patients presented clinical signs of preoperative right cardiac failure and 58% of the patients were in permanent auricular fibrillation. The tricuspid regurgitation was major at 12% of the patients, severe at 88% of the patients, organics at 21% of the patients and functional at 31% of the patients. The average of the systolic pulmonary blood pressure was with 55+-16.8 mm Hg. All the patients had an associated left valvulopathy. The average of the ejection fraction of the left ventricle was 56+12.6%. The dilation of the right cavities was noted at 70% of the patients. The patients of our series were subdivided in two distinct groups. The first group gathers 30 patients who were operated of tricuspid in same operational time as the surgery of the left valves. The surgical gesture on the tricuspid was always conservative. 70% of the patients profited from a tricuspid annuloplasty. Hospital mortality is 10%. 26% of the patients presented a significant residual tricuspid regurgitation after 60 months. 26% of the patients presented late cardiac failure. Late mortality was from 30% to 5 years and 43% to 10 years. The second group is represented by 54 patients not operated on the tricuspid. 30 patients (81%) presented one or more episodes of late cardiac failure. 50% of the patients died during the late follow-up. Among operated patients of the tricuspid, the predictive factors of the residual tricuspid regurgitation post operational are the age<35 years and the mitral disease. The stage NYHA=4 was the only predictive factor of hospital mortality. The predictive factors of late right congestive heart failure postoperative are the clinical signs of preoperative right heart failure and the antecedents of mitral replacement. The predictive factors of late total congestive heart failure postoperative l are the functional tricuspid regurgitation and stage 4 of the NYHA. The benefit of a systematic initial correction of a voluminous tricuspid regurgitation and even of average importance realized prematurely in same operation time that the left valvular gesture was largely shown. The late appearance of functional tricuspid regurgitation after mitral valve surgery is a pejorative marker in the evolution of these patients.
    No preview · Article · Nov 2010 · La Tunisie médicale
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    ABSTRACT: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a primary electrical myocardial disease characterized by exercise- and stress-related ventricular lachycardia manifested as syncope and sudden death usually in child and teenager and was rarely described in adults. The management includes betablockade, with the use of implantable cardioverter defibrillators if medical treatment is insufficient. Report a new case of CPVT. We report a case of a 43 years old patient in whom CPVT diagnosis was made during his exploration for palpitations occurring with the effort. Registration Holter ECG revealed several episodes of supraventricular tachycardia and episodes of nocturnal sino-atrial block. The patient had an ICD and betablockade treatment. The TVPC in adult can manifest with attenuated symptoms that can be summarized with palpitations with the exertion. The supraventricular arrhythmias and sinus dysfunction may be at the forefront of Electrocardiographic manifestations. The prognosis of this form seems better than the TVPC of the child. Treatment with betablockade appears to be effective but existing dysfunction sinus facilitates decision to implant the ICD.
    No preview · Article · May 2010 · La Tunisie médicale
  • Y Ben Ameur · O Chaabane · I Zairi · S Longo · K Battikh · M L Slimane
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    ABSTRACT: The use of the antivitamines K for more than 50 years, has largely been the proof of its interest: well shown effectiveness, weak cost. However, these drugs are the cause of complications of which most frequent and most serious are the hemorrhagic accidents. To determine the characteristics of the patients hospitalized for grave bleeding under antivitamins K and identify the predictive factors of these accidents. Retrospective study of pilot case type carried out in the service of cardiology of the hospital Habib Thameur of Tunis during the period going from January 2001 to December 2006. It related to a group of 50 patients admitted for "serious haemorrhage under antivitamines K". This group was compared with a reference group including/understanding 100 patients treated by antivitamines K and not having never presented a haemorrhage. The reserved criteria of gravity are the following ones: the location: intracérébrale, rétro péritonéale, articular, intra-ocular with blindness, muscular, subcutaneous if the nasty bruise is voluminous, hematurie, metrorragie, digestive bleeding (high or low), hemoptysie, hemothorax, hemopéricarde; the deglobulisation (fall of the haemoglobin of 2 g/dl or more) requiring or not a transfusion; the necessity of a surgical haemostatic gesture or endoscopique; the transfer in care unit or death. The Middle Age of the patients was of 55 +/- 14 years, the sex ratio was of 0.85. The intermediate duration of the treatment was of 243 +/- 225 weeks. The most frequent indications were the disorder of the supra-ventricular rate/rhythm (72%) and the mechanical valves cardiac (40%). These indications appeared debatable to us at 16% of the patients. One or more supporting factors the hemorrhagic accident were found at half of the patients, the first cause being medicamentous association (20% of the cases). The hématurie was the most frequent complication (28%). The evolution was favorable in all the cases. An internal injury under unclaimed ignored was found at 24% of the patients. The hepatic dysfonction and medicamentous association were in our study of the risk factors of which has occurred of haemorrhage under antivitamines K. In multivariate analysis, medicamentous association was an independent risk factor (Odds ratio adjusted 4.9). At least 50% of the hemorrhagic accidents under antivitamines K are avoidable with the help of a rigorous evaluation of the benefit ratio/risk and a vigilance with respect to medicamentous associations. The creation of centers of anticoagulation in our country is essential in order to improve quality of the clinical and biological monitoring.
    No preview · Article · Nov 2009 · La Tunisie médicale
  • Y. Ben Ameur · O. Chaabane · I. Zairi · S. Longo · K. Battikh · M.L. Slimane
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    ABSTRACT: Background: The use of the antivitamines K for more than 50 years, has largely been the proof of its interest: well shown effectiveness, weak cost. However, these drugs are the cause of complications of which most frequent and most serious are the hemorrhagic accidents. The evaluation of the benefit report/ratio on risk is necessary. The Goal of our study is to study the characteristics of the patients hospitalized for serious haemorrhage under antivitamines K and to determine the predictive factors of occurred of these accidents. Purpose of the work: study the characteristics of the patients hospitalized for grave bleeding under antivitamins K and determine the predictive factors of arisen these accidents. Methods: Retrospective study of pilot case type carried out in the service of cardiology of the hospital Habib Thameur of Tunis during the period going from January 2001 to December 2006. It related to a group of 50 patients admitted for "serious haemorrhage under antivitamines K". This group was compared with a reference group including/understanding 100 patients treated by antivitamines K and not having never presented a haemorrhage. The reserved criteria of gravity are the following ones: the location: intracérébrale, rétro péritonéale, articular, intra-ocular with blindness, muscular, subcutaneous if the nasty bruise is voluminous, hematurie, metrorragie, digestive bleeding (high or low), hemoptysie, hemothorax, hemopéricarde; The deglobulisation (fall of the haemoglobin of 2g / dl or more) requiring or not a transfusion; the necessity of a surgical haemostatic gesture or endoscopique; the transfer in care unit or death. Results: The Middle Age of the patients was of 55 ± 14 years, the sex ratio was of 0,85. The intermediate duration of the treatment was of 243 ± 225 weeks. The most frequent indications were the disorder of the supra-ventricular rate/rhythm (72%) and the mechanical valves cardiac (40%). These indications appeared debatable to us at 16% of the patients. One or more supporting factors the hemorrhagic accident were found at half of the patients, the first cause being medicamentous association (20% of the cases). The hématurie was the most frequent complication (28%). The evolution was favorable in all the cases. An internal injury under unclaimed ignored was found at 24% of the patients. The hepatic dysfonction and medicamentous association were in our study of the risk factors of which has occurred of haemorrhage under antivitamines K. In multivariate analysis, medicamentous association was an independent risk factor (Odds ratio adjusted 4,9). Conclusion: At least 50% of the hemorrhagic accidents under antivitamines K are avoidable with the help of a rigorous evaluation of the benefit ratio/risk and a vigilance with respect to medicamentous associations. The creation of centers of anticoagulation in our country is essential in order to improve quality of the clinical and biological monitoring.
    No preview · Article · Nov 2009 · La Tunisie médicale
  • S Longo · F B Moussa · S Kraiem · N Annabi · M L Slimane

    No preview · Article · Apr 2008 · La Tunisie médicale
  • Y Ben Ameur · F Baraket · S Longo · N Annabi · L Bouraoui · W Mokni · K Battikh · M L Slimane
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    ABSTRACT: Conductive disorders following open-heart valvular surgery represent serious complications that may require definitive pacemaker implantation. The natural history of these troubles is not well established thus, controversy persist concerning the timing of pacemaker implantation. In this study we identify the predictive factors of permanent conductive disorders in order to assess the optimal time of pacing. Two hundred thirty valvular replacements were done between 1993 and 2003. The mean age of our patients was 42 +/- 13.4 years. Rheumatic valvulopathies accounted for 76% of cases, with 54% of multiple valvulopathies. Twenty-two patients (9,5%) had an early postoperative conductive disorder, 9 of them (4%) were definitively implanted after a mean delay of 31.8 days. Preoperative bifascicular bloc and early installation of postoperative high-grade conduction disturbances and its persistence for more than 48 hours are significantly associated with permanent postoperative conductive disorders (respectively P = 0.04 and = 0.03). Aortic valve surgery and infective endocarditis were more frequent in the implanted group but the difference was not significant. After open-heart valvular surgery; predictive factors of definitive conductive troubles justify an earlier pacemaker implantation. This attitude may accelerate the hospital discharge and decrease the disease cost effectiveness.
    No preview · Article · Jul 2006 · Annales de Cardiologie et d Angéiologie
  • S. Longo · S. Kraiem · F. Mghaieth · M.L. Slimane

    No preview · Article · Dec 2004 · Sang Thrombose Vaisseaux
  • S Kraiem · S Fennira · K Battikh · N Chehaibi · M Hmem · M L Slimane
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    ABSTRACT: A 25-year-old man who was known to have Behçet's syndrome and who has no coronary risk factors suffered an acute anterior wall myocardial infarction which was complicated by a ventricular fibrillation. The diagnosis of Behçet's syndrome was based on recurrent thrombophlebitis, genital and oral aphtoses, posterior uveitis, positive pathergy test and HLAB51. About 20 cases of myocardial infarction were reported in the literature but the etiopathogeny, the causal relationship and the treatment are yet unknown.
    No preview · Article · Apr 2004 · Annales de Cardiologie et d Angéiologie
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    ABSTRACT: The dissection of the descending aorta is a serious affection regarding to its mortality and its complications. It becomes chronic after the 14th day following the first signs of dissection. The authors report the case of a 55 years old patient who has presented a type III dissection diagnosed at the chronic period. The persistance of the pain has indicated the implantation of a stent at the intimal tear. This new endovascular treatement of the aorta diseases is a promising and less invasive alternative to the surgical treatement. It may reduce the morbidity and the mortality of this pathology but it needs an accurate and performant imaging techniques.
    No preview · Article · Apr 2004 · La Tunisie médicale
  • S Kraiem · S Fennira · K Battikh · N Chehaibi · M Hmem · M. L Slimane
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    ABSTRACT: A 25-year-old man who was known to have Behçet’s syndrome and who has no coronary risk factors suffered an acute anterior wall myocardial infarction which was complicated by a ventricular fibrillation. The diagnosis of Behçet’s syndrome was based on reccurent thrombophlebitis, genital and oral aphtoses, posterior uveitis, positive pathergy test and HLAB51. About 20 cases of myocardial infarction were reported in the litterature but the etiopathogeny, the causal relationsheep and the treatment are yet unknown.
    No preview · Article · Mar 2004 · Annales de Cardiologie et d Angéiologie
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    ABSTRACT: High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p < 0.05). Hemodynamic complications like cardiogenic shock due to the extension of the infarction to the right ventricle and left ventricle insufficiency are more frequent (18% versus 3.4%, p < 0.01 and 12% versus 3.5%, p < 0.01 respectively). It appears that the infracted mass of myocardium is larger in case of atrioventricular block, this is assessed by comparing the average value of the peak of creatine Kinase in the two groups with and without atrioventricular block (1534 IU versus 1096 IU, p < 0.02) and by considering the rate of low ejection fraction (EF < 40%) in each group (44.6% versus 16%, p < 0.01). In our study, we note that thrombolysis does not affect the incidence of atrioventricular block (19% and 24% in thrombolyed and not thrombolyzed patients respectively) but it seems that thrombolysis improves the outcome of these patients. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative.
    No preview · Article · Apr 2003 · Annales de Cardiologie et d Angéiologie
  • S Kraiem · S Fennira · S Longo · A Ben Hmida · K Battich · M Hmam · L Bouraoui · M L Slimane
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    ABSTRACT: The aim of this study was to test the relationship between atherosclerotic plaques in the thoracic aorta detected by transesophageal echocardiography and coronary artery disease detected by angiography. A prospective study was carried out in 103 patients who underwent coronary angiography. All patients underwent transesophageal echocardiography with imaging of the thoracic aorta. Aortic intimal changes were classified in 4 grades. The detection of aortic atheroma plaques was the strongest predictor of coronary artery disease. The presence of aortic plaques on transesophageal study had a sensitivity of 97.6% and a specificity of 80% for angiographically proved obstructive coronary artery disease. The positive predictive value of aortic plaque for obstructive coronary artery disease was 95.3% and the negative predictive value was 88.9%. Compared to the other segments, the detection of atherosclerotic plaque in the descending aorta has the highest sensitivity but the specificity was the highest in the ascending aorta. With older age and in women the specificity decreased, while the sensitivity increased.
    No preview · Article · Jan 2003 · Annales de Cardiologie et d Angéiologie
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    ABSTRACT: High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p
    No preview · Article · Jan 2003 · Annales de Cardiologie et d Angéiologie
  • S Kraiem · S Fennira · S Longo · A Ben Hmida · K Battich · M Hmam · L Bouraoui · M. L Slimane
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    ABSTRACT: The aim of this study was to test the relationship between atherosclerotic plaques in the thoracic aorta detected by transesophageal echocardiography and coronary artery disease detected by angiography. A prospective study was carried out in 103 patients who underwent coronary angiography. All patients underwent transesophageal echocardiography with imaging of the thoracic aorta. Aortic intimal changes were classified in 4 grades. The detection of aortic atheroma plaques was the strongest predictor of coronary artery disease. The presence of aortic plaques on transesophageal study had a sensitivity of 97,6% and a specificity of 80% for angiographically proved obstructive coronary artery disease. The positive predictive value of aortic plaque for obstructive coronary artery disease was 95,3% and the negative predictive value was 88,9%. Compared to the other segments, the detection of atherosclerotic plaque in the descending aorta has the highest sensitivity but the specificity was the higest in the ascending aorta. With older age and in women the specificity decreased, while the sensitivity increased.
    No preview · Article · Dec 2002 · Annales de Cardiologie et d Angéiologie
  • M.L. Slimane · Y. Ben Ameur
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    ABSTRACT: 11 cardiac units, among which 5 experienced cardiac pacing are involved in the study. A retrospective analysis of the operated patient is performed. Authors paid particular attention to the following items: indications, etiologies, per operative parameters, complications and programmatic features of the inserted devices. Demographic date: 176 M, 177 F. The mean age of the sample: 58,4 ± 16,25 years. The post operative complications occured in 14% of the patients and were favourable evolution, but the presence of an atrial lead generated the half of the reoperations of wich incidence was around 4%.(2%) have led to leave the DDD mode. The favorable results, as well at the technical level as the evaluating level, witness that the tunisian centers have acquired a sufficient knowledge in the field of the conventional pacing and could now born on other problems, out passing the field of the bradycardias.
    No preview · Article · Oct 2002
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    ABSTRACT: The permanent ventricular tachycardia (PVT) represent a rare and dangerous arrhythmia that causes prognostic and therapeutic difficulties. Three patients admitted during last year for PVT complicating ischemic cardiomyopathy in two cases and idiopathic cardiomyopathy in the last case. These patients were admitted from emergency department for sustained monomorphic ventricular tachycardia. The ECG showed wide QRS tachycardia of ventricular origin. The direct current shock (DCS) has revealed ECG criteria of old myocardial infarction in two cases. The transthoracic echocardiography displayed dilated left ventricule (LV) with 35% mean ejection fraction. It also showed the presence of LV aneurysm in one case. The cardiac catheterization showed proximal left anterior descending artery obstruction in one patient and left circomflex artery stenosis in other patient. There was no indication of revascularization because of the age of myocardial infarction. The follow-up of these patients demonstrated the persistence of the VT for at least 6 days with recurrence after the DCS and resistant to Lidocaïne-Amiodarone association. The sinus rhythm was established by the propranolol-Amiodarone in one patient, Amiodarone added to treatment of congestive heart failure for the patient with ventricular aneurysm. The third patient died after one week of PVT complicated by cardiogenic shock just before a trial of radiofrequency ablation (RFA). We concluded through these cases that PVT is a troublesome arrhythmia for more than one reason. It appears of tewly in patients with advanced cardiomyopathy worsening the hemodynamic conditions oftenly the pharmacological treatment is mostly always difficult. The treatment of choice is RFA for those resistant to medical treatment.
    No preview · Article · Aug 2002 · La Tunisie médicale

Publication Stats

45 Citations
6.15 Total Impact Points

Institutions

  • 2011
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 1991-2004
    • Hopital Habib Thameur
      Tunis-Ville, Tūnis, Tunisia
  • 1990
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia