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left ventricular wall was noted, where in 28 patients hypertrophy was asymmetric while 14 had concentric hypertrophy of left ventricle. Left ventricular ejection fraction was depressed in the 21 patients, all with signs of heart failure. Patients in cardiac failure received various combinations of diuretics, B-blockers, ACE inhibitors and aspirin. Surgical intervention was not performed to none of them, despite of clinical and echocardiographic indications. Death occurred in 8 patients, in 4 of them shortly after admission, 3 left Kosovo against medical advice and continued examination in Italy and Germany, and the remaining 32 were followed-up for a mean 42 months, with a range from 5 to 115 months. Recovery was noted in 14 patients but still requiring anti-failure medications. Slightly over two-fifths died. Of those with asymmetric form, 45% died, in half of those presenting in infancy, and 89% of those who presented with signs of cardiac failure. Conclusion: Hypertrophic cardiomyopathy manifested often in severe form in our patients, and the response to standard anti-failure therapy was unsatisfactory. The goals of therapy in HCM are symptoms control and prolongation of survival. In summary, randomized clinical trials would be quite valuable to help define optimal care of children with hypertrophic cardiomyopathy. Significant challenges exist, such as various medical combinations in therapy, surgical intervention and heart transplantation. OP-028 TRANSCORONARY SEPTAL ALCOHOL ABLATION IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY WITH HIGH PRESSURE GRADIENT: UNICENTER SHORT TERM RESULTS 1 1 ¨ 2 , T. Celik A. I˙ yisoy1 , F. Cingoz ¨ 2 , B.S. Oz ¸ , E. Yalcınkaya ¸ , E. Yıldırım1 , 1 1 1 Y. Goko˘ ¨ glan1 , M. Celik ¸ , U.C. ¸ Yuksel ¨ . Department of Cardiology, G¨ ulhane Military Medical Academy, Ankara, Turkey; 2 Department of Cardiovascular Surgery, G¨ ulhane Military Medical Academy, Ankara, Turkey Objective: Surgical myectomy is the choice of therapy for the obstructive hypertrophic cardiomyopathy (OHC) patients who have severe symptoms of heart failure unresponsive to medical treatment. Recently, it has been shown that transcoronary alcohol ablation can be effective in reducing symptoms and outflow obstruction. We aimed to evaluate symptomatic and hemodynamic results of transcoronary septal alcohol ablation in obstructive hypertrophic cardiomyopathy patients with high intraventricular pressure gradient. Methods: Our study group was consisted of 5 patients (3 male; age 40±10 years) who were severe symptomatic on daily lifes with asymetric septal hypertrophy (≥20 mm), high intraventricular pressure gradient (≥80 mmHg) and mitral systolic anterior motion. In functional evaluation, four patients had New York Heart Association (NYHA) heart failure functional class III and 1 patient had NYHA functional class IV. In echocardiographic examination, mean septum thickness was 27.4±2.3 mm; mean resting pressure gradient was 131±9 mmHg and 174±11 mmHg with valsalva maneuver; mean left ventricle EF was 63±4%. All patients underwent coronary angiography and target septal artery was determined. 0.014 guidewire were advanced through guiding catheter. After advancing guidewire to the target septal artery, balloon (2.0×15 mm) were advanced over wire and inflated in the septal artery. Contrast material was used to determine target hypertrophic segment under the guidance of echocardiography. 3 ml ethanol (97%) was injected into septal artery. The procedure was finalized after determination of decrease in intraventricular pressure gradient by echocardiography. Results: In only one patient, percutaneous pacemaker was implanted for 3 days because of complete AV block; subsequently, no permanent pacemeaker was required. No other complication was observed. Mean alcohol injection was 6.4±3.4 ml. Excessive increase in CK-MB level was observed (194±47 U). After procedure, resting mean pressure gradient decreased to 33±19 mmHg and
44±17 mmHg with valsalva. At the 6 month follow-up period, one patient was on functional class II and others were on class I. There occurred no death. Conclusion: Transcoronary alcohol septal ablation in the OHC patients with high pressure ventricular gradient is a highly effective and safe procedure. OP-029 CYANOACRYLATE FOR SEPTAL ABLATION IN HYPERTROPHIC CARDIOMYOPATHY 1 ¸ , H. Yorgun1 , A. Oto1 , K. Aytemir1 , E.B. Kaya1 , M.L. Sahiner 1 2 2 1 U.N. Karakulak , B. Peynircio˘glu , B. Cil ¸ . Hacettepe University Faculty of Medicine Department of Cardiology, Turkey; 2 Hacettepe University Faculty of Medicine Department of Radiology, Turkey Objective: Alcohol septal ablation (ASA) has been shown to be an effective treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are refractory to medical treatment. We describe an alternative approach for septal ablation with glue (cyanoacrylate), which is particularly useful in patients with the collateral formation to the right coronary artery in whom ASA is contraindicated. Methods: In our method left coronary ostium was cannulated with 6–8F guiding catheter. Septal branch was cannulated with a 4F catheter and a microcatheter then cyanoacrylate mixture was instilled into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery, and also into the right coronary artery (RCA) via septal collaterals. Results: Glue septal ablation (GSA) was performed in 41 patients. Immediately after the procedure peak left ventricular outflow (LVOT) gradient reduced significantly both in cardiac catheterization and Doppler echocardiographic measurements. LVOT tract gradient reduction persisted after 12 months followup. There was no significant complication during the procedure and within 12 months follow-up period. Conclusions: GSA seems to be an efficient and safe approach to HOCM. Further experience is needed in order to assess the longterm efficacy and safety of this technique.
OP-030 RELATIONSHIP BETWEEN MEAN PLATELET VOLUME AND CARDIAC MYXOMA 1 M.E. Kalkan1 , M. Sahin ¸ , G. Acar ¸ 1 , G. Alıcı1 , S. Demir1 , T. Akgun ¨ 1, 1 ¨ M.H. Tas¸ 2 , M.M. Tabakcı ¸ 1 , B. Ozkan , M. Yanartas¸ 1 , I˙ . Erden1 , 1 1 M. Akcakoyun ¸ . Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital, Istanbul, Turkey; 2 Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey Objectives: Myxomas are the most common primary tumors of the heart. Thromboembolic events are common and serious
9th Int. Congr. Update Cardiology & Cardiovascular Surgery, Oral Presentations / International Journal of Cardiology 163S1 (2013) S1–S79
complications in these patients. Previous studies have been reported that higher mean platelet volume (MPV) levels reflect an activated platelet function and have been proven as an independent risk factor for cerebrovascular events. The aim of this study was to evaluate any relationship with MPV and myxomas. Methods: In the period of March 2010 and July 2012, The study group 48 consecutive patients with cardiac myxoma (11 men, 37 women, mean age: 51.0±16.8 years) and 30 subjects as control group were included into this retrospective study. Preoperative and postoperative mean platelet volumes of each patient were obtained. Demographic characteristics laboratory and echocardiographic findings of controls and patients with cardiac myxoma are shown in Table 1. Results: The baseline characteristics were similar between groups. Among the patients with cardiac myxoma MPV ranged from 6.5 fL to 11.7 fL (mean 7.9 fL, 9.74±1.30) with higher levels than the control group (9.74±1.30 vs 7.5±0.52, p < 0.001). Also, hematocrit (37.2±5.33 vs 40.1±3.18, p: 0.010), platelet (245.14±74.13 vs 283.93±63.26, p: 0.020) and hemoglobine (12.3±1.64 vs 13.4±1.10, p: 0.003) levels were lower than the control group. Discussion: This is the first study which evaluated the relationship between the mean platelet volume values and cardiac myxomas. Our results showed that MPV levels were significantly higher in patients with cardiac myxomas. Conclusions: Higher MPV levels imply an overactivity of platelet functions in patients with cardiac myxoma. Further studies are needed to confirm this activation of platelets in patients with cardiac myxoma and the possible role of treatments specifically targeting platelet activation.
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in detection of LIMA graft and native vessel distally to anastomosis patency and stenosis. Methods: In this retrospective analysis, we included a total of 154 subjects (68.2% male; mean age 61.8±10.9 years) and evaluated 154 LIMA grafts using dual source 64-slice MDCT scanner. The mean time interval between CABG operation and MDCT was 13.5±7.1 months. The mean interval between MDCT and ICA was 12.4±2.8 days. Significant stenosis was defined as lesions causing ≥50% luminal narrowing. All atherosclerotic lesion components were assessed on per segment basis. Results: All of the 154 LIMA grafts were evaluable, and included in the analysis. For the detection of ≥50% graft stenosis, the sensitivity, specificity, PPV and NPV of MDCT was 96.6%, 100%, 100%, and 99.2%. In detection of graft patency, the sensitivity, specificity, PPV and NPV of MDCT was 100%, 96.6%, 99.2%, and 100%, respectively. Diagnostic accuracy for the detection of both graft patency and critical stenosis was 99.3%, respectively. After evaluation of all the native vessels distal to LIMA anastomosis, MDCT properly identified 121 of the 126 vessels (96%) as described by ICA, whereas extensive calcification and artefacts prevented to detect remaining vessels. Conclusion: The diagnostic accuracy of dual source 64-slice MDCT angiography for evaluating LIMA graft and native vessel distally to anastomosis was high. Dual source 64-slice MDCT can be used for the accurate evaluation of patients after LIMA grafting.
Table 1. Demographic characteristics laboratory and echocardiographic findings of controls and patients with cardiac myxoma
Age [years] Female sex Systolic blood pressure [mmHg] Diastolic blood pressure [mmHg] Heart rate [bpm] LA diameter LVEF [%] Body surface area Hyperlipidemia Diabetes mellitus Hypertension Current smokers Platelet [mm−3 ] Mean platelet volume [fL] White blood cell [103/mL] Hemoglobine [g/dL] Hematocrit
Myxoma (n = 48)
Control (n = 30)
P value
51.04±16.8 37 (77.1%) 114.75±18.20 68.31±10.55 87.89±16.88 40.10±7.29 63.81±5.79 1.72±0.15 3 (6.3%) 5 (10.4%) 17 (35.4%) 17 (35.4%) 245.14±74.13 9.74±1.30 6.03±2.38 12.3±1.64 37.2±5.33
48.16±13.1 21 (70%) 112.60±14.32 69.23±9.35 82.80±11.45 36.23±4.18 63.36±6.83 1.75±0.16 4 (13.3%) 4 (13.3%) 12 (40%) 12 (40%) 283.93±63.26 7.5±0.52 6.46±1.34 13.4±1.10 40.1±3.18
0.430 0.486 0.585 0.697 0.150 0.010 0.759 0.541 0.287 0.695 0.684 0.684 0.020 <0.001 0.375 0.003 0.010
March 21, 2013, Thursday
15:30–17:00
Mastering in Cardiac Imaging OP-031 DIAGNOSTIC ACCURACY OF DUAL SOURCE 64-SLICE COMPUTED TOMOGRAPHY FOR DETECTION OF ARTERIAL GRAFT AND ANASTOMOTIC NATIVE VESSEL PATENCY IN CORONARY BYPASS PATIENTS 3 ¨ U. Canpolat1 , H. Yorgun1 , T. Hazırolan2 , H. Sunman1 , A. Ulgen , 1 E. Demiri1 , L. Sahiner ¸ , E.B. Kaya1 , L. Tokgozo˘ ¨ glu1 , G. Kabakcı ¸ 1, A. Oto1 , K. Aytemir1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Department of Radiology, Hacettepe University, Ankara, Turkey; 3 Cardiology Clinics, Kayseri Education and Training Hospital, Kayseri, Turkey Background: The aim of this study was to evaluate the diagnostic accuracy of 64-slice multidetector computed tomography (MDCT)
Figure 1.
OP-032 TRANSTHORACIC TISSUE DOPPLER STUDY OF LEFT VENTRICULAR FUNCTIONS IN PATIENTS WITH NON ALCHOLIC FATTY LIVER DISEASE ¨ ¨ uk A. Bekler1 , K. Karaa˘gac¸ 2 , T. Peker2 , O.A. Ozl ¨ 2 , F. Vatansever2 , M. Yılmaz2 . 1 Department of Cardiology, Esentepe Special Hospital, ˙ Bursa, Turkey; 2 Department of Cardiology, Bursa Ihtisas Training and Research Hospital, Bursa, Turkey Objective: This study was designed to assess left ventricular systolic and diastolic functions with conventional and tissue Doppler echocardiography in patients with the non alcholic fatty liver disease (NAFLD). Methods: Thirty-two patients (15 males, 17 females; mean age 50±9 years) non alcholic fatty liver disease and twenty-two patients (11 males, 11 females; mean age 50±10 years) were included in the study. Left ventricular systolic and diastolic functions were assessed by conventional and tissue Doppler echocardiography. Results: There were no statistically significant charasteristics difference between the patients and control groups. There were no significant differences in left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVSD), left atrium (LA), right atrium (RA), right ventricule (RV), and ejection fraction (EF) betwen the two groups. There were no significant differences