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PP-177 PRIMARY PERCUTANEOUS CORONARY INTERVENTION OF AN ANOMALOUS RIGHT CORONARY ARTERY ARISING FROM A SEPARATE OSTIUM IN THE LEFT SINUS OF VALSALVA
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
atrium and right ventricle were also enlarged. We diagnosed noncompaction of the biventricular myocardium and stenotic bicuspid aortic valve (Figures 1A,B). Conclusions: The patient was treated with oxygen therapy, betablocker, angiotensin-converting enzyme inhibitor, diuretic, digitalis, anticoagulation therapy and antithrombotics. After one weeks of treatment, he was clinically stable, without breathlessness at rest. After discharge, he was referred for further treatment and eventually heart transplantation in a specialized center. Although association between NVM and bicuspid aortic valve described in previous case reports, this is the first case coexisting noncompaction of biventricular myocardium and bicuspid aortic valve with severe aortic stenosis.
Figure 1. Noncompaction of ventricular myocardium in a patient with bicuspid aortic valve.
PP-176 CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES AND EXERCISE-INDUCED MYOCARDIAL ISCHEMIA AND NON SUSTAINED VENTRICULAR TACHYCARDIA T. Tavli1 , V. Tavlı2 . 1 Department of Cardiology, Celal Bayar University, Manisa, Turkey; 2 Department of Pediatric Cardiology, Behcet Uz Pediatric Disease Education Hospital, Izmir, Turkey Objective: Congenitally corrected transposition of the great arteries (CCTGA) is an uncommon condition. Few patients survive past 50 years of age, because of associated congenital defects, systemic (morphological right) ventricular dysfunction, atrioventricular valvular insufficiency or complete heart block. A unique case is presented of exercise-induced myocardial ischemia and nonsusteined ventricular tachycardia. Methods: A woman aged 50 years, a farmer who had lived all her life in the countryside, an uneducated mother, came to our hospital for a cardiological evaluation because of chest pain she had felt for a mounth. She was referred by a private general practitioner because of the above problem and auscultation findings. The patient reported no dyspnea, palpitation, or lower limb oedema. Her family history contained no reports of heart disease (congenital or acquired), nor any sudden death at a young age. On physical examination, her body temperature was 36.8’C, blood pressure 100/70 mmHg, and pulse rate was 74 beats/minute. Cardiac oscultation, revealed a single loud mecanic sound, a 2–3/6 systolic murmur at the apex and left parasternal diastolic murmur. Results: Electrocardiography showed a QS morphology in leads V1, 2, a missing Q on the left precordial leads with ST segment depression and an asymmetric T wave on the same leads, and an rS morphology in lead III. The chest X-ray showed an elevated cardiac index and a narrow aorticopulmonary trunc. Blood chemistry and biochemical exeminations were also normal. Echocardiography revealed the following: Normal position of atria, connection of the morphological right atrium via the right atrioventricular valve which had mitral valve morphology, to the morphological left ventricle, which was on the right. There was
S157
a normal function prostatic tricuspit valve, to the morrphological right ventricle, which was on the left. On the 24-hour Holter ECG the basic rhythm was sinus rhythm. Some interval has pace maker rhythm. There were occasional atrial and unifocal ventricular extrasystoles and nonsustained ventricular tachycardia. The maximum heart rate was 146 and the minumum 45 beats/minute. Myocardial Perfusion study showed that apical and inferoseptal myocardial ischemia. We recommended that the patient should undergo cardiac catheterisation. Coronary angiography revealed normaly epicardial coronary arteries. She was put on medication with converting enzyme inhibitors and spirinolactone and betablocer and was advised to have annual cardiac check up with echocardiography and Holter. Conclusions: Congenitally corrected transposition of the great arteries in olderly age must be distinguished from coronary artery disease. PP-177 PRIMARY PERCUTANEOUS CORONARY INTERVENTION OF AN ANOMALOUS RIGHT CORONARY ARTERY ARISING FROM A SEPARATE OSTIUM IN THE LEFT SINUS OF VALSALVA 2 3 H. Sim ¸ sek ¸ 1 , M. I˙ slek ¸ , M. Sahin ¸ , M.A. Akıl1 , A. Dogan4 . 1 Department of Cardiology, Medical Park Hospital, Van, Turkey; 2 Department of Cardiology, Osmaniye Yeni Hayat Hospital, Osmaniye, Turkey; 3 Department of Cardiology, Yuzuncu Yil University, Van, Turkey; 4 Department of Cardiology, Osmaniye State Hospital, Osmaniye, Turkey Objective: An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva is a congenital abnormality with an incidence of 0.1% in patients studied angiographically. Patient and Methods: A 65-year-old man presented to the emergency room with complained of severe chest pain. Physical examination was normal. He had only hypertension as risk factors for atherosclerosis. On his initial electrocardiogram, there were ST segment elevations in leads II, III and aVF. The patient was referred for emergency coronariography due to acut miyocardial infarction. The left coronary sinus was cannulated without difficulty but any coronary artery ostium was not cannulated on the right sinus of Valsalva using conventional catheters. The anomalous origin of the right coronary arteries was identified by using semiselective injections of contrast in the left sinus of Valsalva, which confirmed that both coronary arteries arose from this left sinus. Coronary angiography showed total occlusion of the right coronary artery just proximal to the right ventricle branch (Figure B) and critical lesion in the left anterior desending artery (Figure A). The selective cannulation of anomalous arteries is a challenge and a good point of support is needed for vascular interventions. Cannulation of the RCA was achieved with Judkins right 5.0-cm curve guiding catheter and a long stent was implanted succesfully (Figure C). Conclusions: PCI of anomalous coronary arteries greatly relies on optimal guiding catheter seating and backup support. Each case may require a slightly different approach.
atrium and right ventricle were also enlarged. We diagnosed noncompaction of the biventricular myocardium and stenotic bicuspid aortic valve (Figures 1A,B). Conclusions: The patient was treated with oxygen therapy, betablocker, angiotensin-converting enzyme inhibitor, diuretic, digitalis, anticoagulation therapy and antithrombotics. After one weeks of treatment, he was clinically stable, without breathlessness at rest. After discharge, he was referred for further treatment and eventually heart transplantation in a specialized center. Although association between NVM and bicuspid aortic valve described in previous case reports, this is the first case coexisting noncompaction of biventricular myocardium and bicuspid aortic valve with severe aortic stenosis.
Figure 1. Noncompaction of ventricular myocardium in a patient with bicuspid aortic valve.
PP-176 CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES AND EXERCISE-INDUCED MYOCARDIAL ISCHEMIA AND NON SUSTAINED VENTRICULAR TACHYCARDIA T. Tavli1 , V. Tavlı2 . 1 Department of Cardiology, Celal Bayar University, Manisa, Turkey; 2 Department of Pediatric Cardiology, Behcet Uz Pediatric Disease Education Hospital, Izmir, Turkey Objective: Congenitally corrected transposition of the great arteries (CCTGA) is an uncommon condition. Few patients survive past 50 years of age, because of associated congenital defects, systemic (morphological right) ventricular dysfunction, atrioventricular valvular insufficiency or complete heart block. A unique case is presented of exercise-induced myocardial ischemia and nonsusteined ventricular tachycardia. Methods: A woman aged 50 years, a farmer who had lived all her life in the countryside, an uneducated mother, came to our hospital for a cardiological evaluation because of chest pain she had felt for a mounth. She was referred by a private general practitioner because of the above problem and auscultation findings. The patient reported no dyspnea, palpitation, or lower limb oedema. Her family history contained no reports of heart disease (congenital or acquired), nor any sudden death at a young age. On physical examination, her body temperature was 36.8’C, blood pressure 100/70 mmHg, and pulse rate was 74 beats/minute. Cardiac oscultation, revealed a single loud mecanic sound, a 2–3/6 systolic murmur at the apex and left parasternal diastolic murmur. Results: Electrocardiography showed a QS morphology in leads V1, 2, a missing Q on the left precordial leads with ST segment depression and an asymmetric T wave on the same leads, and an rS morphology in lead III. The chest X-ray showed an elevated cardiac index and a narrow aorticopulmonary trunc. Blood chemistry and biochemical exeminations were also normal. Echocardiography revealed the following: Normal position of atria, connection of the morphological right atrium via the right atrioventricular valve which had mitral valve morphology, to the morphological left ventricle, which was on the right. There was
S157
a normal function prostatic tricuspit valve, to the morrphological right ventricle, which was on the left. On the 24-hour Holter ECG the basic rhythm was sinus rhythm. Some interval has pace maker rhythm. There were occasional atrial and unifocal ventricular extrasystoles and nonsustained ventricular tachycardia. The maximum heart rate was 146 and the minumum 45 beats/minute. Myocardial Perfusion study showed that apical and inferoseptal myocardial ischemia. We recommended that the patient should undergo cardiac catheterisation. Coronary angiography revealed normaly epicardial coronary arteries. She was put on medication with converting enzyme inhibitors and spirinolactone and betablocer and was advised to have annual cardiac check up with echocardiography and Holter. Conclusions: Congenitally corrected transposition of the great arteries in olderly age must be distinguished from coronary artery disease. PP-177 PRIMARY PERCUTANEOUS CORONARY INTERVENTION OF AN ANOMALOUS RIGHT CORONARY ARTERY ARISING FROM A SEPARATE OSTIUM IN THE LEFT SINUS OF VALSALVA 2 3 H. Sim ¸ sek ¸ 1 , M. I˙ slek ¸ , M. Sahin ¸ , M.A. Akıl1 , A. Dogan4 . 1 Department of Cardiology, Medical Park Hospital, Van, Turkey; 2 Department of Cardiology, Osmaniye Yeni Hayat Hospital, Osmaniye, Turkey; 3 Department of Cardiology, Yuzuncu Yil University, Van, Turkey; 4 Department of Cardiology, Osmaniye State Hospital, Osmaniye, Turkey Objective: An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva is a congenital abnormality with an incidence of 0.1% in patients studied angiographically. Patient and Methods: A 65-year-old man presented to the emergency room with complained of severe chest pain. Physical examination was normal. He had only hypertension as risk factors for atherosclerosis. On his initial electrocardiogram, there were ST segment elevations in leads II, III and aVF. The patient was referred for emergency coronariography due to acut miyocardial infarction. The left coronary sinus was cannulated without difficulty but any coronary artery ostium was not cannulated on the right sinus of Valsalva using conventional catheters. The anomalous origin of the right coronary arteries was identified by using semiselective injections of contrast in the left sinus of Valsalva, which confirmed that both coronary arteries arose from this left sinus. Coronary angiography showed total occlusion of the right coronary artery just proximal to the right ventricle branch (Figure B) and critical lesion in the left anterior desending artery (Figure A). The selective cannulation of anomalous arteries is a challenge and a good point of support is needed for vascular interventions. Cannulation of the RCA was achieved with Judkins right 5.0-cm curve guiding catheter and a long stent was implanted succesfully (Figure C). Conclusions: PCI of anomalous coronary arteries greatly relies on optimal guiding catheter seating and backup support. Each case may require a slightly different approach.