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Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively. (ECHOCARDIOGRAPHY, Volume 25, November 2008) pseudoaneurysm, mitral valve replacement Left ventricular pseudoaneurysms (LVPA) or false aneurysms are defined as partial cardiac rupture contained by the adherent pericardium or scar tissue resulting in the formation of a false aneurysm that maintains communication with the left ventricular cavity. 1 They constitute an exceptional but dreadful complication after mitral valve replacement potentially evolving to a usually lethal rupture. We report, in this work an unprecedented case of huge LVPA, having been echocardiographically diagnosed 16 days after an uneventful postmitral valve replacement discharge, in a 54-year old woman, and unfortunately yielding fatal issue. Case ReportSK, a 54-year old woman, with a severe and extremely calcified symptomatic mitral stenosis (mitral surface area = 0.8 cm 2 , mean gradient = 24 mmHg) underwent mitral valve replacement (after having benefited from a normal preoperative coronarography) with a bileaflet 29 St. Jude Medical mechanical prosthe-

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BackgroundAtrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited.ObjectiveThe aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial.MethodsA total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points.ResultsResults will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients.ConclusionsThis study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region.Trial RegistrationClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX)Registered Report IdentifierRR1-10.2196/8523