- Email: [email protected]
PM250 Aneurysm of the Right Coronary Artery. Case Report
POSTER ABSTRACTS
region of acute myocardial infarction) longitudinal strain assessed with AFI were still greater than or equal to 12%.
Conclusion: Post-arrest cardiac dysfunction after circulatory failure is clinical problem which increases the risk of adverse events so detailed knowledge of cardiac function is therefore needed in decision making. Global longitudinal strain with automated function imaging allows measurements of deformation and could be non-invasive and accessible bedside tool for early risk stratification in patients after successful ECMO-cardiopulmonary resuscitation. Disclosure of Interest: None Declared
Introduction: Transesophageal echocardiography (TEE) complication rate is low, with bleeding complications rarely accountable for interruption of this examination. While thrombocytopenia is considered a relative contraindication for TEE, data is lacking on the safety and complications of TEE in thrombocytopenic patients, with no studies establishing optimal strategies for giving prophylactic platelet transfusions in this situation. Objectives: Given the potential for TEE to cause injury to the orogastric mucosa, we sought to evaluate TEE safety in severely thrombocytopenic patients. Methods: We surveyed six thrombocytopenic patients (blood platelets < 50,000 /microL) of distinct etiologies referred for TEE. Methods: We surveyed six thrombocytopenic patients (blood platelets < 50,000 /microL) of distinct etiologies referred for TEE. We assessed the presence of major (bleeding requiring surgical repair or transfusion) and minor (mucosal bleeding, epistaxis, melena) bleeding complications during TEE and up to 24 hours after the procedure. Platelet infusions (random donor pooled platelets) were given prophylactically before TEE to prevent spontaneous and TEE–related bleeding, as indicated for low risk diagnostic procedures. Results: Five patients were male, aged 63 11 years. The underlying condition responsible for the patient’s thrombocytopenia was bone marrow transplantation (one patient), liver transplantation (one patient) and neoplasia (four patients), . Referral for TEE was due to endocarditis diagnosis (four patients), intracardiac mass (one patient) and shock (one patient). Platelet count ranged from 9000 to 42000/microL). Sedation was undertaken under the anesthesiologist’s assistance in five patients and with midazolam/fentanyl in one patient. Probe insertion was successfully accomplished in all patients, without technical difficulties. No patient had major bleeding; minimal oral mucosa bleeding was observed in one patient. Conclusion: TEE can be safely performed in severely thrombocytopenic patients after platelet infusion, with minimal bleeding complications; however, a great deal of caution is needed during probe manipulation to avoid mucosal injury. Disclosure of Interest: None Declared PM250
PM245 Aneurysm of the Right Coronary Artery. Case Report Correlation of Right Ventricle Free Wall Strain and Right Heart Catheterization in Pulmonary Arterial Hypertension H. S. Kemal*1, M. Kayikcioglu2, L. Can2, S. Nalbantgil2, O. Vuran3, N. Mogolkoc4, H. Kultursay2 1 Cardiology, Near East University Hospital, Nicosia, Cyprus, 2Cardiology, Ege University Hospital, Izmir, 3Cardiology, Manisa Alasehir National Hospital, Manisa, 4Pulmonology, Ege University Hospital, Izmir, Turkey Introduction: Right heart catheterization (RHC) is required to confirm the diagnosis of pulmonary arterial hypertension (PAH) and assess the severity of hemodynamic impairment and to evaluate the effect of specific treatment at routine follow-up. RHC is an invasive and technically demanding procedure limiting the use of it. 2D speckle tracking echocardiography derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. Objectives: The aim of this study was to evaluate the correlation of RV free wall strain with RHC parameters in patients with PAH on specific treatment. Methods: Nineteen patients with PAH (3 idiopathic PAH, 9 congenital heart disease associated PAH, 6 chronic thromboembolic pulmonary hypertension and 2 connective tissue disease associated PAH) were included. RHC was performed as recommended by guidelines and 2D speckle tracking echocardiography derived from RV-free wall strain was calculated by averaging each 3 regional peak systolic strain values and also conventional echocardiographic parameters were evaluated. RHC was performed on the day following of echocardiographic evaluation. Results: The mean age of the study group was 43,619 years, 68,4% was female. Mean RV-free wall global strain was -13,26.2%. RHC mean values were as followed: mean pulmonary artery pressure (mPAP) 59,817,8 mmHg, right atrium pressure (RAP) 10,35,1 mmHg, cardiac index (CI) measured with Fick method was 3,120,9 l/min/m2 and pulmonary vascular resistance (PVR) was 10,04,5 Wood units. There was a significant negative correlation between RV-free wall global strain and RV fractional area change (r¼ -0,722, p¼0,0001) and TAPSE (r¼ -0,566, p¼0,01) and Tricuspid S (r¼ -0,512, p¼0,02). No significant correlation was detected between RV-free wall global strain and mPAP, RAP, CI, PVR. Conclusion: RV-free wall global strain is a useful, non-invasive tool for estimating RV performance and correlates well with conventional RV echocardiographic parameters. But larger studies are needed to determine whether it can replace RHC. Disclosure of Interest: None Declared
A. D. Ibarra-Torres*1, E. Vallejo- Venegas1, J. J. Lozoya-Del Rosal1, J. Valdés-Flores1, L. R. Alvarez-Contreras1 1 Departamento de Cardiología, American British Cowdray Medical Center, Distrito Federal, Mexico Introduction: Coronary artery aneurysms (CAA) are localized dilatations exceeding the diameter of adjacent normal coronary segments, this a rare condition. We report the case of a 66-year-old male patient with a thrombosed giant aneurysm of the right coronary artery, and giant ectasic arteries in the left system with active thrombosis.The patient has a history of heavy smoking, hypertension, abdominal aortic aneurysm treated by endovascular surgery and acute myocardial infarction with ST elevation not reperfused. Objectives: The case presentation is am extremly rare scenario of an uncommon association. Methods: We documented the case through all the images available; the use of coronary CT scann identified deeply the anatomic characteristics of this disease. Results: The presented case is unique as there has been no description of alike cases. The advancement of the different cardiac imaging techniques increases the positive identification of this pathology.
PM247 Safety of Transesophageal Echocardiography in Severe Thrombocytopenic Patients: A Case Series Study A. C. Rodrigues*1, M. C. Vieira1, E. Lira1, C. Monaco1, E. Damilnello1, A. Cordovil1, C. Fischer1, W. Oliveira1, S. Morhy1 1 Echocardiography, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
POSTER ABSTRACTS
Conclusion: Giant CAA associated with giant coronary ectasia and aortic syndromes is a unique pathology. Coronary CT scann identifies correctly the anatomic considerations and it is and aid in the clinical desicion process. The incidence reported in the literature is variable; the CASS study with 20,087 patients undergoing coronary angiography, showed aneurysms in 4.9% of the studies. The most common location is the middle and proximal segment of the right coronary artery, followed by the left anterior descending and circumflex artery. Risk factors include diabetes mellitus, smoking and dyslipidemia. It is associated with atherosclerosis in 50% of cases and 20-30% are congenital. Most cases coexists with coronary artery disease, 1020% is associated with inflammatory or connective tissue diseases. Up to 30% is associated with aortic aneurysms. Coronary angiography was performed in a 64-channel multidetector tomography. Right Coronary Artery: calcium deposits (249 UA) were demonstrated. The first 6 mm proximal permeable identified only with a diameter of 4.1x 4.3 mm without damage. Subsequently, to the cross there is no coronary heart flow. Diffuse aneurysmal dilatation of the right coronary artery. The diameter of the proximal third is 44x45 mm, 51x43 mm middle third and distal third of 8.5 x 10.2 mm. CAA remain a rare pathology, and their management should be individualized depending on size, location, and clinical context. The patient is stable and asymptomatic, with conservative medical management. Disclosure of Interest: None Declared PM251 Diagnostic Modality in Differentiating Primary Left Ventricle Noncompaction Cardiomyopathy From Pseudo-Noncompaction: A Case Report
Conclusion: Cardiovascular magnetic resonance imaging is a useful diagnostic modality in differentiating primary LVNC from pseudo-noncompaction. Disclosure of Interest: None Declared
A. S. Awaloei*1, H. B. Calleja1 1 Heart and Vascular Institute, St. Luke’s Medical Center, Quezon City, Philippines
PM252
Introduction: Left ventricle noncompaction cardiomyopathy (LVNC) is a rare and unique primary genetic cardiomyopathy, that is currently categorized as unclassified cardiomyopathy according to the American Heart Association classification. It differs from pseudo-noncompaction which is an acquired form of cardiomyopathy that leads to noncompaction-like abnormalities. Absence of co-existing cardiac abnormality is one of the LVNC diagnosis criteria. Objectives: The aim of this study is to determine diagnostic modality in differentiating primary LVNC from pseudo-noncompaction. Methods: We report a case of a 46 years old Filipino female presented with exertional dyspnea and heart failure related symptoms. She had a history of rheumatic carditis when she was 20 years old, which were associated with pericardial effusion, elevated erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and antistreptolysin O titer. Present transthoracic echocardiography showed global left ventricle hypokinesia with depressed ejection fraction of 31%, trabeculation in the mid to apex of the left ventricle, and blood flow into deep intertrabecular recesses by color doppler (figure 1). Subsequent cardiovascular magnetic resonance imaging revealed dilated left ventricle; hypertrabeculation with deep intertrabecular recesses at the subendocardial layer of the mid to apical anterior, inferior and lateral left ventricle wall; ratio of non compacted to compacted myocardium during diastole is 3:1 and 2.8:1 during systole (figure 2); late gadolinium enhancement at the mid-wall interventricular septum suggestive of fibrosis; and normal coronary arteries. Results: Noncompacted to compacted layer ratio of >2.3 during diastole is a valuable parameter to distinguish primary LVNC from pseudo-noncompaction cardiomyopathy (sensitive of 86% and specificity of 99%), that can be due to previous carditis. Mid-wall interventricular septum is the most common location of the late gadolinium enhancement that can be found among patients with primary LVNC. These findings support diagnosis of primary LVNC in our patient.
Evaluation of Subclinical Atherosclerosis With Myocardial Blood Flow Measured by 13N-Ammonia Positron Emission Tomography
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
E. A. Berríos-Bárcenas*1, A. Gallardo-Grajeda2, A. Monroy_Gonzalez3, R. Martínez-Tapia2, V. Gómez-Johnson2, S. Canales-Albarran2, C. Guizar2, N. Canseco2, S. Hernández2, E. Alexanderson-Rosas2,4 1 Cardiology, Hospital Español de México, 2Nuclear Cardiology, Instituto Nacional de Cardiologia Ignacio Chávez, México D.F., Mexico, 3University Medical Center Groningen, Groningen, Netherlands, 4Phisiology, FACMED, UNAM, México D.F., Mexico Introduction: Sub-clinical atherosclerosis has been traditionally considered when Coronary Artery Disease (CAD) is present with less than 50% of stenosis in a vessel. Recent studies with Coronary Computed Tomography Angiography (CCTA) have shown a worse prognosis in this group of patients when compared to those without CAD. On the other hand, Positron Emission Tomography (PET) is able to quantify Myocardial Blood Flow (MBF), demonstrating prognostic implications when diminished. However, there is limited evidence showing an alteration of MBF in sub-clinical atherosclerosis. Objectives: To determine a difference of MBF during rest and stress measured by 13NAmmonia/PET among patients with sub-clinical atherosclerosis. Methods: We retrospectively studied 142 patients with an intermediate likelihood of CAD. All patients underwent 13N-ammonia/PET for quantification of MBF during rest and pharmacologic stress with adenosine. Obstructive CAD (> 50%) was ruled out by CCTA. In a per vessel analysis we studied group 1 (1-50% stenosis) and group 2 (without stenosis). Results: In our population mean age was 6211 y.o., 54% were male, 64% hypertensive, 57% dyslipidemic, 34% active smokers and 15% diabetic. Group 1 showed higher age than
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region of acute myocardial infarction) longitudinal strain assessed with AFI were still greater than or equal to 12%.
Conclusion: Post-arrest cardiac dysfunction after circulatory failure is clinical problem which increases the risk of adverse events so detailed knowledge of cardiac function is therefore needed in decision making. Global longitudinal strain with automated function imaging allows measurements of deformation and could be non-invasive and accessible bedside tool for early risk stratification in patients after successful ECMO-cardiopulmonary resuscitation. Disclosure of Interest: None Declared
Introduction: Transesophageal echocardiography (TEE) complication rate is low, with bleeding complications rarely accountable for interruption of this examination. While thrombocytopenia is considered a relative contraindication for TEE, data is lacking on the safety and complications of TEE in thrombocytopenic patients, with no studies establishing optimal strategies for giving prophylactic platelet transfusions in this situation. Objectives: Given the potential for TEE to cause injury to the orogastric mucosa, we sought to evaluate TEE safety in severely thrombocytopenic patients. Methods: We surveyed six thrombocytopenic patients (blood platelets < 50,000 /microL) of distinct etiologies referred for TEE. Methods: We surveyed six thrombocytopenic patients (blood platelets < 50,000 /microL) of distinct etiologies referred for TEE. We assessed the presence of major (bleeding requiring surgical repair or transfusion) and minor (mucosal bleeding, epistaxis, melena) bleeding complications during TEE and up to 24 hours after the procedure. Platelet infusions (random donor pooled platelets) were given prophylactically before TEE to prevent spontaneous and TEE–related bleeding, as indicated for low risk diagnostic procedures. Results: Five patients were male, aged 63 11 years. The underlying condition responsible for the patient’s thrombocytopenia was bone marrow transplantation (one patient), liver transplantation (one patient) and neoplasia (four patients), . Referral for TEE was due to endocarditis diagnosis (four patients), intracardiac mass (one patient) and shock (one patient). Platelet count ranged from 9000 to 42000/microL). Sedation was undertaken under the anesthesiologist’s assistance in five patients and with midazolam/fentanyl in one patient. Probe insertion was successfully accomplished in all patients, without technical difficulties. No patient had major bleeding; minimal oral mucosa bleeding was observed in one patient. Conclusion: TEE can be safely performed in severely thrombocytopenic patients after platelet infusion, with minimal bleeding complications; however, a great deal of caution is needed during probe manipulation to avoid mucosal injury. Disclosure of Interest: None Declared PM250
PM245 Aneurysm of the Right Coronary Artery. Case Report Correlation of Right Ventricle Free Wall Strain and Right Heart Catheterization in Pulmonary Arterial Hypertension H. S. Kemal*1, M. Kayikcioglu2, L. Can2, S. Nalbantgil2, O. Vuran3, N. Mogolkoc4, H. Kultursay2 1 Cardiology, Near East University Hospital, Nicosia, Cyprus, 2Cardiology, Ege University Hospital, Izmir, 3Cardiology, Manisa Alasehir National Hospital, Manisa, 4Pulmonology, Ege University Hospital, Izmir, Turkey Introduction: Right heart catheterization (RHC) is required to confirm the diagnosis of pulmonary arterial hypertension (PAH) and assess the severity of hemodynamic impairment and to evaluate the effect of specific treatment at routine follow-up. RHC is an invasive and technically demanding procedure limiting the use of it. 2D speckle tracking echocardiography derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. Objectives: The aim of this study was to evaluate the correlation of RV free wall strain with RHC parameters in patients with PAH on specific treatment. Methods: Nineteen patients with PAH (3 idiopathic PAH, 9 congenital heart disease associated PAH, 6 chronic thromboembolic pulmonary hypertension and 2 connective tissue disease associated PAH) were included. RHC was performed as recommended by guidelines and 2D speckle tracking echocardiography derived from RV-free wall strain was calculated by averaging each 3 regional peak systolic strain values and also conventional echocardiographic parameters were evaluated. RHC was performed on the day following of echocardiographic evaluation. Results: The mean age of the study group was 43,619 years, 68,4% was female. Mean RV-free wall global strain was -13,26.2%. RHC mean values were as followed: mean pulmonary artery pressure (mPAP) 59,817,8 mmHg, right atrium pressure (RAP) 10,35,1 mmHg, cardiac index (CI) measured with Fick method was 3,120,9 l/min/m2 and pulmonary vascular resistance (PVR) was 10,04,5 Wood units. There was a significant negative correlation between RV-free wall global strain and RV fractional area change (r¼ -0,722, p¼0,0001) and TAPSE (r¼ -0,566, p¼0,01) and Tricuspid S (r¼ -0,512, p¼0,02). No significant correlation was detected between RV-free wall global strain and mPAP, RAP, CI, PVR. Conclusion: RV-free wall global strain is a useful, non-invasive tool for estimating RV performance and correlates well with conventional RV echocardiographic parameters. But larger studies are needed to determine whether it can replace RHC. Disclosure of Interest: None Declared
A. D. Ibarra-Torres*1, E. Vallejo- Venegas1, J. J. Lozoya-Del Rosal1, J. Valdés-Flores1, L. R. Alvarez-Contreras1 1 Departamento de Cardiología, American British Cowdray Medical Center, Distrito Federal, Mexico Introduction: Coronary artery aneurysms (CAA) are localized dilatations exceeding the diameter of adjacent normal coronary segments, this a rare condition. We report the case of a 66-year-old male patient with a thrombosed giant aneurysm of the right coronary artery, and giant ectasic arteries in the left system with active thrombosis.The patient has a history of heavy smoking, hypertension, abdominal aortic aneurysm treated by endovascular surgery and acute myocardial infarction with ST elevation not reperfused. Objectives: The case presentation is am extremly rare scenario of an uncommon association. Methods: We documented the case through all the images available; the use of coronary CT scann identified deeply the anatomic characteristics of this disease. Results: The presented case is unique as there has been no description of alike cases. The advancement of the different cardiac imaging techniques increases the positive identification of this pathology.
PM247 Safety of Transesophageal Echocardiography in Severe Thrombocytopenic Patients: A Case Series Study A. C. Rodrigues*1, M. C. Vieira1, E. Lira1, C. Monaco1, E. Damilnello1, A. Cordovil1, C. Fischer1, W. Oliveira1, S. Morhy1 1 Echocardiography, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
e112
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
POSTER ABSTRACTS
Conclusion: Giant CAA associated with giant coronary ectasia and aortic syndromes is a unique pathology. Coronary CT scann identifies correctly the anatomic considerations and it is and aid in the clinical desicion process. The incidence reported in the literature is variable; the CASS study with 20,087 patients undergoing coronary angiography, showed aneurysms in 4.9% of the studies. The most common location is the middle and proximal segment of the right coronary artery, followed by the left anterior descending and circumflex artery. Risk factors include diabetes mellitus, smoking and dyslipidemia. It is associated with atherosclerosis in 50% of cases and 20-30% are congenital. Most cases coexists with coronary artery disease, 1020% is associated with inflammatory or connective tissue diseases. Up to 30% is associated with aortic aneurysms. Coronary angiography was performed in a 64-channel multidetector tomography. Right Coronary Artery: calcium deposits (249 UA) were demonstrated. The first 6 mm proximal permeable identified only with a diameter of 4.1x 4.3 mm without damage. Subsequently, to the cross there is no coronary heart flow. Diffuse aneurysmal dilatation of the right coronary artery. The diameter of the proximal third is 44x45 mm, 51x43 mm middle third and distal third of 8.5 x 10.2 mm. CAA remain a rare pathology, and their management should be individualized depending on size, location, and clinical context. The patient is stable and asymptomatic, with conservative medical management. Disclosure of Interest: None Declared PM251 Diagnostic Modality in Differentiating Primary Left Ventricle Noncompaction Cardiomyopathy From Pseudo-Noncompaction: A Case Report
Conclusion: Cardiovascular magnetic resonance imaging is a useful diagnostic modality in differentiating primary LVNC from pseudo-noncompaction. Disclosure of Interest: None Declared
A. S. Awaloei*1, H. B. Calleja1 1 Heart and Vascular Institute, St. Luke’s Medical Center, Quezon City, Philippines
PM252
Introduction: Left ventricle noncompaction cardiomyopathy (LVNC) is a rare and unique primary genetic cardiomyopathy, that is currently categorized as unclassified cardiomyopathy according to the American Heart Association classification. It differs from pseudo-noncompaction which is an acquired form of cardiomyopathy that leads to noncompaction-like abnormalities. Absence of co-existing cardiac abnormality is one of the LVNC diagnosis criteria. Objectives: The aim of this study is to determine diagnostic modality in differentiating primary LVNC from pseudo-noncompaction. Methods: We report a case of a 46 years old Filipino female presented with exertional dyspnea and heart failure related symptoms. She had a history of rheumatic carditis when she was 20 years old, which were associated with pericardial effusion, elevated erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and antistreptolysin O titer. Present transthoracic echocardiography showed global left ventricle hypokinesia with depressed ejection fraction of 31%, trabeculation in the mid to apex of the left ventricle, and blood flow into deep intertrabecular recesses by color doppler (figure 1). Subsequent cardiovascular magnetic resonance imaging revealed dilated left ventricle; hypertrabeculation with deep intertrabecular recesses at the subendocardial layer of the mid to apical anterior, inferior and lateral left ventricle wall; ratio of non compacted to compacted myocardium during diastole is 3:1 and 2.8:1 during systole (figure 2); late gadolinium enhancement at the mid-wall interventricular septum suggestive of fibrosis; and normal coronary arteries. Results: Noncompacted to compacted layer ratio of >2.3 during diastole is a valuable parameter to distinguish primary LVNC from pseudo-noncompaction cardiomyopathy (sensitive of 86% and specificity of 99%), that can be due to previous carditis. Mid-wall interventricular septum is the most common location of the late gadolinium enhancement that can be found among patients with primary LVNC. These findings support diagnosis of primary LVNC in our patient.
Evaluation of Subclinical Atherosclerosis With Myocardial Blood Flow Measured by 13N-Ammonia Positron Emission Tomography
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
E. A. Berríos-Bárcenas*1, A. Gallardo-Grajeda2, A. Monroy_Gonzalez3, R. Martínez-Tapia2, V. Gómez-Johnson2, S. Canales-Albarran2, C. Guizar2, N. Canseco2, S. Hernández2, E. Alexanderson-Rosas2,4 1 Cardiology, Hospital Español de México, 2Nuclear Cardiology, Instituto Nacional de Cardiologia Ignacio Chávez, México D.F., Mexico, 3University Medical Center Groningen, Groningen, Netherlands, 4Phisiology, FACMED, UNAM, México D.F., Mexico Introduction: Sub-clinical atherosclerosis has been traditionally considered when Coronary Artery Disease (CAD) is present with less than 50% of stenosis in a vessel. Recent studies with Coronary Computed Tomography Angiography (CCTA) have shown a worse prognosis in this group of patients when compared to those without CAD. On the other hand, Positron Emission Tomography (PET) is able to quantify Myocardial Blood Flow (MBF), demonstrating prognostic implications when diminished. However, there is limited evidence showing an alteration of MBF in sub-clinical atherosclerosis. Objectives: To determine a difference of MBF during rest and stress measured by 13NAmmonia/PET among patients with sub-clinical atherosclerosis. Methods: We retrospectively studied 142 patients with an intermediate likelihood of CAD. All patients underwent 13N-ammonia/PET for quantification of MBF during rest and pharmacologic stress with adenosine. Obstructive CAD (> 50%) was ruled out by CCTA. In a per vessel analysis we studied group 1 (1-50% stenosis) and group 2 (without stenosis). Results: In our population mean age was 6211 y.o., 54% were male, 64% hypertensive, 57% dyslipidemic, 34% active smokers and 15% diabetic. Group 1 showed higher age than
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