- Email: [email protected]
AS-218: Echocardiographic Study of Truncus Arteriosus
Wednesday, April 22 - Friday, April 24, 2009 (E-Poster Abstract Zone) Methods: There were 33 men and 12 women. Mean age was 43 ⫾ 17.5 years. Rheumatic heart disease was seen in 15 (32%), congenital heart disease in 12 (26%), and mitral valve prolapse in 10 (21%); 8 had developed IE postoperatively. Fever in 34 (72%) and dyspnea in 25 (53%) patients were common symptoms. Clinical signs were pallor in 30 (64%), splenomegaly in 14 (30%), clubbing in 13 (28%), congestive heart failure in 7 (15%), and icterus in 8 (17%) patients. Investigations revealed an increased erythrocyte sedimentation rate in 34 (72%), leukocytosis in 27 (57%), anemia with proteinuria in 25 (53%), increased serum creatinine in 11 (23%), and microscopic hematuria in 7 (15%) patients. Blood culture was positive in 17 (36%) patients, of which 10 (22%) had Staphylococcus aureus, 6 (13%) had streptococcal infections, and 1 (2%) had Pseudomonas. Vegetations were observed in 40 (89%) cases: 20 (45%) on the mitral valve, 18 (40%) on the aortic valve, 2 (4%) on the tricuspid valve, 1 (2%) on the right ventricular outflow tract, and 1 (2%) on the pulmonary valve. Complications seen were 27 (57%) hematologic, 6 (13%) neurologic, and 7 (15%) others; 10 (21%) patients died, and 2 (4%) were lost to follow-up. Old age, low platelet count, and renal dysfunction were associated with fatal cases. We compared our study with a previous Indian study published in 2005. Results: Culture positivity (36% vs 56%, p ⫽ 0.02) and clinical signs, such as clubbing (28% vs 58%, p ⫽ 9. 993) and splenomegaly (30% vs 61%, p ⫽ 0.001), were significantly reduced in our study. Right-sided endocarditis was seen in 8% of our cases. IE was more often seen in the elderly patients and the mitral valve was more frequently involved. In all, 4 patients with IE were treated with add-on Rifampicin, over and above the culture-guided treatment, which significantly improved the clinical outcome in IE. Controlled studies are, however, required for further evaluation. Culture negativity was often seen and S. aureus was the most common organism. Conclusion: Old age and renal dysfunction were associated with high mortality.
AS-218 Echocardiographic Study of Truncus Arteriosus. Sameer Dani, Jayesh Prajapati, Sharad Jain, Hasit Joshi, Sunil Thanvi, Kamal Sharma, Anand Shukla, Bhavesh Thakkar, Jay Shah, Hitesh Shah, Milind Kharche, Tarun Madan, Rutwik Trivedi, Vishal Poptani. U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India. Background: Cases of truncus arteriosus constitute 1%–2% of congenital heart diseases. Methods: A review of results from electrocardiography performed in 3,000 patients with congenital heart disease during the past 3 years in our institute revealed truncus arteriosus in 24 (0.8%) patients. Results: Most patients were male (70%), and the mean age was 2.2 ⫾ 1.0 years (range, 5 days to 18 years). Type I truncus arteriosus was the most common (90%), and type II (4%) and type III (6%) were infrequently seen. Subtruncal ventricular septal defect was large and nonrestrictive in all patients except in 1. Truncal valve (TV) was tricuspid in most (80%); a quadricuspid (18%) or bicuspid (2%) valve was present in the remaining patients. Regurgitation of the TV was present in 70% of the patients, and was reported as mild in 35%, moderate in 25%, and severe in 4%. Most (95%) patients had developed pulmonary hypertension (mean age, 9 months) at presentation. However, pulmonary stenosis was uncommon (5%). Only 2 patients had a PDA. Associated anomalies included a left superior vena cava in 3 patients and common atrium or a single ventricle in 1 patient each. Conclusion: A review of our echocardiographic database suggests that truncus arteriosus is a relatively rare congenital heart disease. The only limitation of echocardiography was the suboptimal delineation of pulmonary arteries, which suggests the need for an additional imaging modality, such as angiocardiography.
AS-219 Profile of Aortoiliac Disease in Patients with Multivessel Coronary Artery Disease. Rajesh Vijayvergiya, Pawan Poddar, Arunanchu Behra, Anupam Lal. Postgraduate Institute of Medical Education & Research, Chandigarh, India. Background: Peripheral arterial disease (PAD) of the aortoiliac vessels is common in patients with concomitant severe multivessel coronary artery disease (CAD). Contrast angiography of these vessels at the time of coronary angiography may detect the occult stenosis, which has clinical implications. We studied the prevalence of symptomatic or asymptomatic aortoiliac disease in patients with multivessel CAD. Methods: From January to September 2008, 30 consecutive patients with severe multivessel CAD on coronary angiography underwent simultaneous descending abdominal aortography and selective angiography of both the renal and mesenteric arteries. A stenosis of ⬎50% was considered significant. Results: A total of 30 consecutive patients, comprising 20 men and 10 women (mean age, 62.13 years) were included: 16 patients had acute coronary syndrome, 12 had chronic stable angina, and 2 were asymptomatic but had electrocardiographic changes suggestive of ischemia. In all, 6 patients had associated lower limb claudication. The atherosclerotic risk profile showed diabetes mellitus (n ⫽ 14), hypertension (n ⫽ 21), smoking (n ⫽ 11), and dyslipidemia (n ⫽ 22). Impaired renal function was present in 3 patients. On clinical examination, abdominal bruit and absent lower limb pulses were present in 5 patients each. Coronary angiography revealed left main with triple-vessel disease in 11, severe triple-vessel disease in 15, and double-vessel disease in 4 patients. Also, 13 patients had a left ventricular ejection fraction ⬍0.50. Among 30 patients with CAD, 21 had significant PAD of the abdominal iliac vessels. Significant renal artery stenosis was present in 15 patients: 9 had bilateral and 6 had unilateral stenosis; none of them had impaired renal function. Mesenteric artery and iliac artery stenosis was present in 12 and 6 patients, respectively; 1 patient had an abdominal aortic aneurysm. Conclusion: Patients with multivessel CAD and PAD have a more adverse risk profile for conventional atherosclerotic risk factors compared with CAD patients without PAD. Patients with severe multivessel CAD have a high prevalence of PAD of the aortoiliac vessels. Hence, a comprehensive evaluation for PAD is required for appropriate management in these patients.
AS-220 Comparison of the Effect of Different Atorvastatin Therapy Doses on Plasma Hepatocyte Growth Factor Concentration in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Zhong Chen, Genshan Ma, Yi Feng. The Affiliated ZhongDa Hospital of Southeast University, Department of Cardiology, Nanjing, China. Background: The hepatocyte growth factor (HGF) is a multifunctional growth factor implicated in wound healing and angiogenesis and is increased under the pathogenesis of endothelial dysfunction. Stent implantation induces vascular and endothelial damage, and statin administration has been extensively shown to improve clinical survival among patients with coronary artery disease (CAD). This study evaluated the influence of atorvastatin on plasma HGF concentration among stable CAD patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 93B
EP O S T E R A B S T R A C T S
AS-218 Echocardiographic Study of Truncus Arteriosus. Sameer Dani, Jayesh Prajapati, Sharad Jain, Hasit Joshi, Sunil Thanvi, Kamal Sharma, Anand Shukla, Bhavesh Thakkar, Jay Shah, Hitesh Shah, Milind Kharche, Tarun Madan, Rutwik Trivedi, Vishal Poptani. U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India. Background: Cases of truncus arteriosus constitute 1%–2% of congenital heart diseases. Methods: A review of results from electrocardiography performed in 3,000 patients with congenital heart disease during the past 3 years in our institute revealed truncus arteriosus in 24 (0.8%) patients. Results: Most patients were male (70%), and the mean age was 2.2 ⫾ 1.0 years (range, 5 days to 18 years). Type I truncus arteriosus was the most common (90%), and type II (4%) and type III (6%) were infrequently seen. Subtruncal ventricular septal defect was large and nonrestrictive in all patients except in 1. Truncal valve (TV) was tricuspid in most (80%); a quadricuspid (18%) or bicuspid (2%) valve was present in the remaining patients. Regurgitation of the TV was present in 70% of the patients, and was reported as mild in 35%, moderate in 25%, and severe in 4%. Most (95%) patients had developed pulmonary hypertension (mean age, 9 months) at presentation. However, pulmonary stenosis was uncommon (5%). Only 2 patients had a PDA. Associated anomalies included a left superior vena cava in 3 patients and common atrium or a single ventricle in 1 patient each. Conclusion: A review of our echocardiographic database suggests that truncus arteriosus is a relatively rare congenital heart disease. The only limitation of echocardiography was the suboptimal delineation of pulmonary arteries, which suggests the need for an additional imaging modality, such as angiocardiography.
AS-219 Profile of Aortoiliac Disease in Patients with Multivessel Coronary Artery Disease. Rajesh Vijayvergiya, Pawan Poddar, Arunanchu Behra, Anupam Lal. Postgraduate Institute of Medical Education & Research, Chandigarh, India. Background: Peripheral arterial disease (PAD) of the aortoiliac vessels is common in patients with concomitant severe multivessel coronary artery disease (CAD). Contrast angiography of these vessels at the time of coronary angiography may detect the occult stenosis, which has clinical implications. We studied the prevalence of symptomatic or asymptomatic aortoiliac disease in patients with multivessel CAD. Methods: From January to September 2008, 30 consecutive patients with severe multivessel CAD on coronary angiography underwent simultaneous descending abdominal aortography and selective angiography of both the renal and mesenteric arteries. A stenosis of ⬎50% was considered significant. Results: A total of 30 consecutive patients, comprising 20 men and 10 women (mean age, 62.13 years) were included: 16 patients had acute coronary syndrome, 12 had chronic stable angina, and 2 were asymptomatic but had electrocardiographic changes suggestive of ischemia. In all, 6 patients had associated lower limb claudication. The atherosclerotic risk profile showed diabetes mellitus (n ⫽ 14), hypertension (n ⫽ 21), smoking (n ⫽ 11), and dyslipidemia (n ⫽ 22). Impaired renal function was present in 3 patients. On clinical examination, abdominal bruit and absent lower limb pulses were present in 5 patients each. Coronary angiography revealed left main with triple-vessel disease in 11, severe triple-vessel disease in 15, and double-vessel disease in 4 patients. Also, 13 patients had a left ventricular ejection fraction ⬍0.50. Among 30 patients with CAD, 21 had significant PAD of the abdominal iliac vessels. Significant renal artery stenosis was present in 15 patients: 9 had bilateral and 6 had unilateral stenosis; none of them had impaired renal function. Mesenteric artery and iliac artery stenosis was present in 12 and 6 patients, respectively; 1 patient had an abdominal aortic aneurysm. Conclusion: Patients with multivessel CAD and PAD have a more adverse risk profile for conventional atherosclerotic risk factors compared with CAD patients without PAD. Patients with severe multivessel CAD have a high prevalence of PAD of the aortoiliac vessels. Hence, a comprehensive evaluation for PAD is required for appropriate management in these patients.
AS-220 Comparison of the Effect of Different Atorvastatin Therapy Doses on Plasma Hepatocyte Growth Factor Concentration in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Zhong Chen, Genshan Ma, Yi Feng. The Affiliated ZhongDa Hospital of Southeast University, Department of Cardiology, Nanjing, China. Background: The hepatocyte growth factor (HGF) is a multifunctional growth factor implicated in wound healing and angiogenesis and is increased under the pathogenesis of endothelial dysfunction. Stent implantation induces vascular and endothelial damage, and statin administration has been extensively shown to improve clinical survival among patients with coronary artery disease (CAD). This study evaluated the influence of atorvastatin on plasma HGF concentration among stable CAD patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 93B
EP O S T E R A B S T R A C T S