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OP-008 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF PATENT FORAMEN OVALE
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
for a patient with 1, 2 and >3 of the above risk factors was 5%, 33%, and 62%, respectively. Neonatal complications occurred in 35 completed pregnancies (16.8%). Neonatal events included premature birth (24;68%), late time of delivery (10; 28%), intra uterus growth reduced (6;17%), small-for-gestational-age birth weight (19;54%), and Apgar Score less than 7 (10;28%). Yet, obesity (p<0.0001) and hypertension (p<0.0001) were predictive of neonatal events. Conclusions: Pregnancy in women with clusters of cardiovascular risk factors is associated with significant cardiac and neonatal morbidity. Pregnancy should be screened for during assessment of a woman’s overall risk profile for cardiovascular disease.
April 16, 2010 / 08:30–10:00 New Methods in Coronary and Non-Coronary Percutaneous Interventions
OP-007 APPROACH FOR SEPTAL ABLATION IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY BY CYANOACRYLATE Ali Oto, Kudret Aytemir, Sercan Okutucu, Bora Peynircioglu, Barbaros Cil, Ali Deniz, Hakan Aksoy, Hikmet Yorgun, Ergun Baris Kaya, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Alcohol septal ablation has been shown to be an effective treatment in hypertrophic obstructive cardiomyopathy (HOCM) patients who are refractory to medical treatment. We describe another successful technique for septal ablation with glue (cyanoacrylate) which is particularly useful in patients with the collateral formation to the right coronary artery in whom alcohol ablation is contraindicated. Methods: In our method left coronary ostium was cannulated with 6-8 F guiding catheter. A 0.014-in. Guide wire was introduced through the catheter, and advanced into the septal branch. Septal branch was cannulated with a 4 F catheter and a microcatheter. Cyanoacrylate mixture was instilled through the microcatheter into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery and also to the right coronary artery via septal collaterals. Results: Glue septal ablation was performed in 16 patients (4 patients had collateral branches to right coronary artery). After the procedure peak left ventricular outflow gradient were reduced significantly both in cardiac catheterization (64.4±15.4 vs. 14.6±5.9 mmHg, p<0.001) and Doppler echocardiographic measurements (76.2±21.1 vs.19.0±9.1 mmHg, p<0.001). There was no major complication (complete heart block, ventricular arrhythmias and distant infarction) during and after the procedure. Mean NYHA functional class (3.1±0.3 vs. 2.2±0.4, p<0.001) and interventricular septum thickness (20.2±3.2 mm vs. 17.5±3.7 mm, p=0.035) decreased significantly after 6 months. During 6 month follow-up, reduction of peak LVOT gradient detected by Doppler echocardiography persists. Conclusions: Glue septal ablation seems to be an efficient and safe approach in HOCM, especially in patients with the collateral formation. Further experience is needed in order to assess the long-term efficacy and safety of this technique.
S3
in our institution. The patients were less than 59 years old with at least two episodes of transient ischemic attack (TIA) or stroke, or with multiple ischemic gliotic lesions showed by cranial MRI. All other causes of TIA or stroke were excluded, and the patients were shown to have PFO by transesophageal echocardiography. Results: Nienty nine patients (n=99) were enrolled in the study (56 males, 43 females; age between 19-59 ages). All interventions were successfully completed without any complications. The patients were followed and there was any recurrent cerebrovascular accidents (CVA) encountered in this medium-term follow-up period,but only one patient had bilateral renal embolic event. Conclusions: Transcatheter closure of PFOs by PFO occluder devices may be a feasible, safe, and effective treatment for the prevention of CVA recurrence.
OP-009 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF ATRIAL SEPTAL DEFECTS Ali Oto 1 , Kudret Aytemir 1 , Hilmi Ozkutlu 1 , Suheyla Ozkutlu 2 , Baris Kaya 1 , Ahmet Hakan Ates 1 , Hikmet Yorgun 1 , Giray Kabakci 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: Transcatheter septal occluder devices (SOD) for closure of atrial septal defects (ASDs) has been known to be a treatment modality alternative to surgery. The aim of our study is to evaluate the effectiveness and safety of the SOD in the treatment of ostium secundum ASD. Methods: Retrospective cohort study was conducted between May 2004 and January 2010 involving 114 ostium secundum ASD transcatheter occlusion procedures in our institution. The patients with ASD were evaluted with transoesophageal echocardiography (TEE) before the procedure. Ostium secundum ASDs with the size of 32 mm in the largest radius, and with enough rim length for device attachment were considered to be suitable for transcatheter occlusion. All procedures were conducted in the hemodynamic laboratory under general anesthesia with the guidance of TEE. Results: One hundred fourteen patients (n=114) were enrolled in the study (64 males, 50 females; age between 17-78 years). All interventions were successfully completed without complications except in one case, in whom the device dropped into the left atrium, and then went into the abdominal aorta. The device was extracted with the help of snare from the femoral artery, and the ASD was occluded with a larger device. In another case, two SOD’s were used for two separate ASDs. The patients were followed and there were no any complications encountered in this medium-term followup period.Only in one case the patient had paroxismal atrial fibrillation and In two cases, after implantatiion of devices, thrombus formation was shown and treated with unfractioned heparine. Conclusions: Transcatheter closure of ASDs by SOD may be a feasible, safe, and effective alternative to surgery whenever the size and the location of ASD is suitable.
OP-010 PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS IN ADULTS: A SINGLE CENTER EXPERIENCE Cem Barcin, Hurkan Kursaklioglu, Oben Baysan, Mutlu Gungor, Sedat Kose Gulhane Military Medical Academy, Ankara, Turkey
OP-008 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF PATENT FORAMEN OVALE Ali Oto 1 , Kudret Aytemir 1 , Hilmi Ozkutlu 1 , Suheyla Ozkutlu 2 , Baris Kaya 1 , Ahmet Hakan Ates 1 , Hikmet Yorgun 1 , Giray Kabakci 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: A patent foramen ovale (PFO) has been reported to be significantly more frequent in young stroke patients than in matched control subjects. The suggested mechanism of stroke is paradoxical embolism. The aim of our study is to evaluate the effectiveness and safety of the PFO occluder devices in the treatment of PFO. Methods: Retrospective cohort study was conducted between May 2004 and January 2010 involving 100 PFO transcatheter occlusion procedures
Objective: Percutaneous transcatheter closure of atrial septal defects (ASDs) almost completely replaced surgery. Selection of the proper cases for transcatheter closure is of paramount importance in order to prevent complications. We aimed to evaluate efficacy and safety of percutaneous closure of ASD in our institute. Methods: A total of 44 adults who underwent transcatheter closure of ostium secundum type ASD were evaluated. Inclusion criteria were having Qp/Qs>1.5 or being symptomatic. Insufficient rim lengths, defect size >38 mm, thrombus in the atria, known allergy to nickel were the exclusion criteria. All the procedures were performed under general anesthesia and Transesophageal (TEE) guidance. Defect sizes were defined by 2D (and 3D when needed) TEE. Results: The age was 27±7 with the male female ratio 31/13. The defect size was 14±6 mm. The lengths of total interatrial septum, anteriorsuperior rim, anterior-inferior rim, posterior rim, superior caval rim and
for a patient with 1, 2 and >3 of the above risk factors was 5%, 33%, and 62%, respectively. Neonatal complications occurred in 35 completed pregnancies (16.8%). Neonatal events included premature birth (24;68%), late time of delivery (10; 28%), intra uterus growth reduced (6;17%), small-for-gestational-age birth weight (19;54%), and Apgar Score less than 7 (10;28%). Yet, obesity (p<0.0001) and hypertension (p<0.0001) were predictive of neonatal events. Conclusions: Pregnancy in women with clusters of cardiovascular risk factors is associated with significant cardiac and neonatal morbidity. Pregnancy should be screened for during assessment of a woman’s overall risk profile for cardiovascular disease.
April 16, 2010 / 08:30–10:00 New Methods in Coronary and Non-Coronary Percutaneous Interventions
OP-007 APPROACH FOR SEPTAL ABLATION IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY BY CYANOACRYLATE Ali Oto, Kudret Aytemir, Sercan Okutucu, Bora Peynircioglu, Barbaros Cil, Ali Deniz, Hakan Aksoy, Hikmet Yorgun, Ergun Baris Kaya, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Alcohol septal ablation has been shown to be an effective treatment in hypertrophic obstructive cardiomyopathy (HOCM) patients who are refractory to medical treatment. We describe another successful technique for septal ablation with glue (cyanoacrylate) which is particularly useful in patients with the collateral formation to the right coronary artery in whom alcohol ablation is contraindicated. Methods: In our method left coronary ostium was cannulated with 6-8 F guiding catheter. A 0.014-in. Guide wire was introduced through the catheter, and advanced into the septal branch. Septal branch was cannulated with a 4 F catheter and a microcatheter. Cyanoacrylate mixture was instilled through the microcatheter into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery and also to the right coronary artery via septal collaterals. Results: Glue septal ablation was performed in 16 patients (4 patients had collateral branches to right coronary artery). After the procedure peak left ventricular outflow gradient were reduced significantly both in cardiac catheterization (64.4±15.4 vs. 14.6±5.9 mmHg, p<0.001) and Doppler echocardiographic measurements (76.2±21.1 vs.19.0±9.1 mmHg, p<0.001). There was no major complication (complete heart block, ventricular arrhythmias and distant infarction) during and after the procedure. Mean NYHA functional class (3.1±0.3 vs. 2.2±0.4, p<0.001) and interventricular septum thickness (20.2±3.2 mm vs. 17.5±3.7 mm, p=0.035) decreased significantly after 6 months. During 6 month follow-up, reduction of peak LVOT gradient detected by Doppler echocardiography persists. Conclusions: Glue septal ablation seems to be an efficient and safe approach in HOCM, especially in patients with the collateral formation. Further experience is needed in order to assess the long-term efficacy and safety of this technique.
S3
in our institution. The patients were less than 59 years old with at least two episodes of transient ischemic attack (TIA) or stroke, or with multiple ischemic gliotic lesions showed by cranial MRI. All other causes of TIA or stroke were excluded, and the patients were shown to have PFO by transesophageal echocardiography. Results: Nienty nine patients (n=99) were enrolled in the study (56 males, 43 females; age between 19-59 ages). All interventions were successfully completed without any complications. The patients were followed and there was any recurrent cerebrovascular accidents (CVA) encountered in this medium-term follow-up period,but only one patient had bilateral renal embolic event. Conclusions: Transcatheter closure of PFOs by PFO occluder devices may be a feasible, safe, and effective treatment for the prevention of CVA recurrence.
OP-009 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF ATRIAL SEPTAL DEFECTS Ali Oto 1 , Kudret Aytemir 1 , Hilmi Ozkutlu 1 , Suheyla Ozkutlu 2 , Baris Kaya 1 , Ahmet Hakan Ates 1 , Hikmet Yorgun 1 , Giray Kabakci 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: Transcatheter septal occluder devices (SOD) for closure of atrial septal defects (ASDs) has been known to be a treatment modality alternative to surgery. The aim of our study is to evaluate the effectiveness and safety of the SOD in the treatment of ostium secundum ASD. Methods: Retrospective cohort study was conducted between May 2004 and January 2010 involving 114 ostium secundum ASD transcatheter occlusion procedures in our institution. The patients with ASD were evaluted with transoesophageal echocardiography (TEE) before the procedure. Ostium secundum ASDs with the size of 32 mm in the largest radius, and with enough rim length for device attachment were considered to be suitable for transcatheter occlusion. All procedures were conducted in the hemodynamic laboratory under general anesthesia with the guidance of TEE. Results: One hundred fourteen patients (n=114) were enrolled in the study (64 males, 50 females; age between 17-78 years). All interventions were successfully completed without complications except in one case, in whom the device dropped into the left atrium, and then went into the abdominal aorta. The device was extracted with the help of snare from the femoral artery, and the ASD was occluded with a larger device. In another case, two SOD’s were used for two separate ASDs. The patients were followed and there were no any complications encountered in this medium-term followup period.Only in one case the patient had paroxismal atrial fibrillation and In two cases, after implantatiion of devices, thrombus formation was shown and treated with unfractioned heparine. Conclusions: Transcatheter closure of ASDs by SOD may be a feasible, safe, and effective alternative to surgery whenever the size and the location of ASD is suitable.
OP-010 PERCUTANEOUS CLOSURE OF ATRIAL SEPTAL DEFECTS IN ADULTS: A SINGLE CENTER EXPERIENCE Cem Barcin, Hurkan Kursaklioglu, Oben Baysan, Mutlu Gungor, Sedat Kose Gulhane Military Medical Academy, Ankara, Turkey
OP-008 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF PATENT FORAMEN OVALE Ali Oto 1 , Kudret Aytemir 1 , Hilmi Ozkutlu 1 , Suheyla Ozkutlu 2 , Baris Kaya 1 , Ahmet Hakan Ates 1 , Hikmet Yorgun 1 , Giray Kabakci 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: A patent foramen ovale (PFO) has been reported to be significantly more frequent in young stroke patients than in matched control subjects. The suggested mechanism of stroke is paradoxical embolism. The aim of our study is to evaluate the effectiveness and safety of the PFO occluder devices in the treatment of PFO. Methods: Retrospective cohort study was conducted between May 2004 and January 2010 involving 100 PFO transcatheter occlusion procedures
Objective: Percutaneous transcatheter closure of atrial septal defects (ASDs) almost completely replaced surgery. Selection of the proper cases for transcatheter closure is of paramount importance in order to prevent complications. We aimed to evaluate efficacy and safety of percutaneous closure of ASD in our institute. Methods: A total of 44 adults who underwent transcatheter closure of ostium secundum type ASD were evaluated. Inclusion criteria were having Qp/Qs>1.5 or being symptomatic. Insufficient rim lengths, defect size >38 mm, thrombus in the atria, known allergy to nickel were the exclusion criteria. All the procedures were performed under general anesthesia and Transesophageal (TEE) guidance. Defect sizes were defined by 2D (and 3D when needed) TEE. Results: The age was 27±7 with the male female ratio 31/13. The defect size was 14±6 mm. The lengths of total interatrial septum, anteriorsuperior rim, anterior-inferior rim, posterior rim, superior caval rim and