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PP-131 COEXISTENCE OF DISCRETE SUBAORTIC STENOSIS AND UNRUPTURED SINUS VALSALVA ANEURYSM OBSTRUCTING RIGHT VENTRICULAR OUTFLOW TRACT
S144
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-131 COEXISTENCE OF DISCRETE SUBAORTIC STENOSIS AND UNRUPTURED SINUS VALSALVA ANEURYSM OBSTRUCTING RIGHT VENTRICULAR OUTFLOW TRACT Z. Isilak, O. Uz, E. Kardesoglu, M. Uzun. Department of Cardiology, GATA Haydarpasa Training and Research Hospital, Istanbul, Turkey Objective: A 19-year-old male patient was admitted to our department with complaints of exertional dyspnea. The physical examination revealed a grade 3/6 systolic murmur best heard at the mesocardiac area. The electrocardiography showed normal sinusal rhytm with left ventricular hypertrophy. The transthoracic echocardiography (TTE) revealed a biventricular hypertrophy, a discrete subaortic membrane, 56 mmHg peak gradient through the left ventricular outflow tract, severe aortic regurgitation, a sinus of valsalva aneurysm protruding to the right ventricular outflow tract (Figure 1), 55 mmHg peak gradient through right ventricular outflow tract (RVOT) and a ventricular septal defect (VSD) adjacent to the sinus of valsalva aneurysm. Transesophageal echocardiography confirmed the TTE findings. Sinus of valsalva aneurysm (SVA) is a rare cardiac entity, occurring in 0.14–0.96% of patients who have undergone open heart surgical procedures. It is most frequently associated with VSD, atrial septal defect (ASD), bicuspid aortic valve and aortic coarctation. Unruptured sinus of Valsalva aneurysm (SVA) is usually asymptomatic. In ruptured SVA with patients, the major symptoms are coughing, dyspnea, chest pain, and fatigability. The onset may be acute or insidious. After the rupture, a temporary improvement in symptoms may be seen, however, it is followed by deterioration. Rarely, the earliest symptom is sudden death. The SVA is most frequently concomitant with VSD. This concomitance have been reported to be between 12–78% in different series. The concomitance with aortic valve prolapsus and bicuspid aorta have been reported to be less than 10%. The less frequent concomitances are ASD, patent ductus arteriosus, aortic coarctation, pulmonary or subaortic stenosis. The choice of treatment for ruptured SVA is surgery. If not ruptured, accompanying coronary ostial stenosis, outflow tract obstruction or infection are indications for surgical intervention. We recommended operation to the patient but he refused.
PP-132 A RARE CASE: THROMBI SIMULTANEOUSLY AT BOTH ATRIAL APPENDAGES IN A PATIENT WITH PAROXYSMAL ATRIAL FIBRILLATION Z. Isılak, O. Uz, M. Yalcın, O. Yiginer, M. Uzun, E. Kardesoglu. Gulhane Military Medical Academy, Haydarpasa Hospital, Department Of Cardiology, Istanbul, Turkey A 67 year-old patient was admitted to the emergency clinics for atrial fibrillation with high ventricular response which had an indefinite time of onset. In history, hypertension, which had been diagnosed 20 years ago, and two attacks of atrial fibrillation within the last year were remarkable. The patient was hospitalized in coronary care unit and was performed transesophageal echocardiography (TEE). There was spontaneous echo-contrast in left atrium. There were thrombi at the entrance of the left atrial appendage, seen at 60° angle at midesophageal level (Figures A,D); in the right atrial appendage, seen at 120° angle at midesophageal level (Figure B). Both thrombi are seen at 0° at midesophageal level (Figure C). Due to concerns about potential thromboembolic events, we started warfarin therapy. The patient is on regular follow up.
Figure: (A,D) Thrombi at the entrance of the left atrial appendage, seen at 60° angle at midesophageal level TEE. (B) Thrombi in the right atrial appendage, and adjacent to the septum in the left atrium, seen at 120° angle at midesophageal level. (C) Both thrombi seen at 0° at midesophageal level. LV, left ventricle; LA, left atrium; RA, right atrium; RV, right ventricle; RAA, right atrial appendage; LAA, left atrial appendage; IAS, interatrial septum; THR, thrombus.
Figure 1. TEE showing a sinus valsalva aneurysm.
PP-133 THE DELAYED DIAGNOSIS OF COMPLETE GUIDEWIRE LOSS DURING CENTRAL VENOUS CATHETERIZATION: A CASE REPORT AND REVIEW OF THE LITERATURE Y. Gund ¨ uz ¨ 1 , M.B. Vatan2 , A. Osken2 , M.A. Cakar2 , R. Akdemir3 . 1 Sakarya University Medical Faculty, Deparment of Radiology, Sakarya, Turkey; 2 Sakarya Education and Research Hospital, Deparment of Cardiology, Sakarya, Turkey; 3 Sakarya University Medical Faculty, Deparment of Cardiology, Sakarya, Turkey Objective: Central venous catheterisation allows delivery of medications, intravenous fluids, parenteral nutrition, and hemodialysis and monitoring of hemodynamic variables. the
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-131 COEXISTENCE OF DISCRETE SUBAORTIC STENOSIS AND UNRUPTURED SINUS VALSALVA ANEURYSM OBSTRUCTING RIGHT VENTRICULAR OUTFLOW TRACT Z. Isilak, O. Uz, E. Kardesoglu, M. Uzun. Department of Cardiology, GATA Haydarpasa Training and Research Hospital, Istanbul, Turkey Objective: A 19-year-old male patient was admitted to our department with complaints of exertional dyspnea. The physical examination revealed a grade 3/6 systolic murmur best heard at the mesocardiac area. The electrocardiography showed normal sinusal rhytm with left ventricular hypertrophy. The transthoracic echocardiography (TTE) revealed a biventricular hypertrophy, a discrete subaortic membrane, 56 mmHg peak gradient through the left ventricular outflow tract, severe aortic regurgitation, a sinus of valsalva aneurysm protruding to the right ventricular outflow tract (Figure 1), 55 mmHg peak gradient through right ventricular outflow tract (RVOT) and a ventricular septal defect (VSD) adjacent to the sinus of valsalva aneurysm. Transesophageal echocardiography confirmed the TTE findings. Sinus of valsalva aneurysm (SVA) is a rare cardiac entity, occurring in 0.14–0.96% of patients who have undergone open heart surgical procedures. It is most frequently associated with VSD, atrial septal defect (ASD), bicuspid aortic valve and aortic coarctation. Unruptured sinus of Valsalva aneurysm (SVA) is usually asymptomatic. In ruptured SVA with patients, the major symptoms are coughing, dyspnea, chest pain, and fatigability. The onset may be acute or insidious. After the rupture, a temporary improvement in symptoms may be seen, however, it is followed by deterioration. Rarely, the earliest symptom is sudden death. The SVA is most frequently concomitant with VSD. This concomitance have been reported to be between 12–78% in different series. The concomitance with aortic valve prolapsus and bicuspid aorta have been reported to be less than 10%. The less frequent concomitances are ASD, patent ductus arteriosus, aortic coarctation, pulmonary or subaortic stenosis. The choice of treatment for ruptured SVA is surgery. If not ruptured, accompanying coronary ostial stenosis, outflow tract obstruction or infection are indications for surgical intervention. We recommended operation to the patient but he refused.
PP-132 A RARE CASE: THROMBI SIMULTANEOUSLY AT BOTH ATRIAL APPENDAGES IN A PATIENT WITH PAROXYSMAL ATRIAL FIBRILLATION Z. Isılak, O. Uz, M. Yalcın, O. Yiginer, M. Uzun, E. Kardesoglu. Gulhane Military Medical Academy, Haydarpasa Hospital, Department Of Cardiology, Istanbul, Turkey A 67 year-old patient was admitted to the emergency clinics for atrial fibrillation with high ventricular response which had an indefinite time of onset. In history, hypertension, which had been diagnosed 20 years ago, and two attacks of atrial fibrillation within the last year were remarkable. The patient was hospitalized in coronary care unit and was performed transesophageal echocardiography (TEE). There was spontaneous echo-contrast in left atrium. There were thrombi at the entrance of the left atrial appendage, seen at 60° angle at midesophageal level (Figures A,D); in the right atrial appendage, seen at 120° angle at midesophageal level (Figure B). Both thrombi are seen at 0° at midesophageal level (Figure C). Due to concerns about potential thromboembolic events, we started warfarin therapy. The patient is on regular follow up.
Figure: (A,D) Thrombi at the entrance of the left atrial appendage, seen at 60° angle at midesophageal level TEE. (B) Thrombi in the right atrial appendage, and adjacent to the septum in the left atrium, seen at 120° angle at midesophageal level. (C) Both thrombi seen at 0° at midesophageal level. LV, left ventricle; LA, left atrium; RA, right atrium; RV, right ventricle; RAA, right atrial appendage; LAA, left atrial appendage; IAS, interatrial septum; THR, thrombus.
Figure 1. TEE showing a sinus valsalva aneurysm.
PP-133 THE DELAYED DIAGNOSIS OF COMPLETE GUIDEWIRE LOSS DURING CENTRAL VENOUS CATHETERIZATION: A CASE REPORT AND REVIEW OF THE LITERATURE Y. Gund ¨ uz ¨ 1 , M.B. Vatan2 , A. Osken2 , M.A. Cakar2 , R. Akdemir3 . 1 Sakarya University Medical Faculty, Deparment of Radiology, Sakarya, Turkey; 2 Sakarya Education and Research Hospital, Deparment of Cardiology, Sakarya, Turkey; 3 Sakarya University Medical Faculty, Deparment of Cardiology, Sakarya, Turkey Objective: Central venous catheterisation allows delivery of medications, intravenous fluids, parenteral nutrition, and hemodialysis and monitoring of hemodynamic variables. the