- Email: [email protected]
PP-010 BALL SHAPED THROMBUS IN ATRIAL SEPTAL ANEURYSM, EXTENDING FROM THE LEFT ATRIUM TO THE RIGHT ATRIUM VIA PFO
Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
PP-010 BALL SHAPED THROMBUS IN ATRIAL SEPTAL ANEURYSM, EXTENDING FROM THE LEFT ATRIUM TO THE RIGHT ATRIUM VIA PFO 1 1 2 M. Gencaslan ¸ , P.T. Bayır1 , S. Cakal ¸ , B. Cakal ¸ , T.H. Efe1 , Z. Bayram1 . 1 2 Mus State Hospital, Turkey; Artvin State Hospital, Turkey A 56-year-old man with a history of hypertension and type 2 diabetes mellitus presented with palpitation for two months. Electrocardiography revealed atrial fibrillation with rapid ventricular response. After slowing the heart rate with intravenous metoprolol succinate, transthoracic echocardiography (TTE) was performed. In apical four chamber view; spontaneous echo contrast in the left atrium and echogenic mass adherent to the atrial septal aneurysm, were seen. Transesophageal echocardiography (TEE) was performed and an aneurysm of the interatrial septum with a patent foramen ovale (PFO) which was resulted left to right shunt, was seen. TEE revealed a large (1.57×1.71 cm), hyperechogenic thrombus attached to the atrial septal aneurysm and protruded into the right atrium via PFO during valsalva maneuver. There were spontaneous echo contrast in the left atrium and 10×11 mm thrombus formation in the left atrial appendage in the course of atrial fibrillation. The patient had no symptoms or signs suggestive of cryptogenic stroke or pulmonary embolism. The patient underwent a successful removal of atrial thrombi with closure of the PFO. Concomitant heparin and warfarin therapy were started. A therapeutic INR range was achieved and he was discharged from hospital without any complication. Although atrial thrombi have been reported in the presence of PFO previously, this unusual occurrence of thrombus in atrial septal aneurysm in the course of atrial fibrillation, go across a PFO is rare. This clinical case is an example of the left atrial thrombosis, extending to the right atrium via a PFO.
S85
an MCV of 98.3 fL. Platelet count was 134,000/mL. Erythrocyte sedimentation rate was 71 mm/hour. 2D and 3D Transthoracic echocardiography (TTE) (IE33 Matrix probe, Philips Medical systems, Bothell, WA, USA) revealed a mean left ventricular ejection fraction (EF) of 65%, Left heart chambers were in normal size. TTE detected a floopy mass arising from the anterior leaflet of the mitral valve and moderate mitral regurgitation at apical 4-chamber and parasternal long-axis windows (Figure 1) A subsequent real-time three dimensional transesophageal echocardiography (3D-RT TEE) also conducted for precise anatomic definition. Suprisingly 3D-RT revealed a 25×27 mm floppy vegetation on the posterior annulus of the mitral valve with moderate to severe mitral regurgitation (Figure 2). There was no additional cardiac abnormality. The patient was diagnosed as infective endocarditis. Treatment with intravenous amipisilin plus gentamisin was initially started. His serial blood culture results were persistently negative. On day 7 the patient developed dyspnea suggestive of heart failure therefore, the patient was referred to cardiac surgery after the medical therapy has been revised to intravenous vancomycin plus gentamisin. Vegetation was succesfully removed with surgery and after 6 weeks of antibiotic therapy the patient was discharged with total cure. In this case, realtime 3D echocardiography helped the cardiologist understand the morphologic characteristics and the precise localization and the attachment point of the vegetation.
Figure 1. (A) Parasternal long-axis window of TTE demonstrates a floopy vegetation; (B) TEE image from 100 degree midesophageal level revealed the vegetation; (C) TEE image from 120 degree midesophageal level showed vegetation and moderatesevere mitral regurgitation by color doppler echocardiography; (D) TEE image from X-plain 120 degree midesophageal level showed vegetation. Figure 2. (A) 3D-RT TTE with mitral valve vegetation (arrow). (B) 3D-RT TTE from left atrial perspective with the mitral valve vegetation (arrow); (C,D) 3D-RT TEE from left atrial perspective with vegetation (2.5×2.7 cm) involving the posterior annulus of the mitral valve (arrow).
Figure: Transesophageal echocardiography views of a large (1.57×1.71 cm) thrombus in atrial septal aneurysm.
PP-011 AN UNUSUAL CASE OF INFECTIVE ENDOCARDITIS: ANNULUS VEGETATION 1 O.S. Deveci1 , Z. Isılak ¸ , M. Yalcın ¸ 1 , M. Atalay2 , M. Uzun1 . 1 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Kardiyoloji Anabilim Dalı, Turkey; 2 Merzifon Askeri Hastanesi Kardiyoloji B¨ ol¨ um¨ u, Turkey A 24-year-old man without any known cardiac disease was admitted to our hospital because of fever and general fatigue. On physical examination, his blood pressure was 125/75 mmHg, pulse was 100 beats per minute, temperature 39 degrees, the respiratory rate 20 breaths per minute, and the oxygen saturation 97% while he was breathing ambient air. The cardiovascular examination revealed a 3/6 holosystolic murmur in the left fourth intercostal space radiating to the axilla. The remainder of the examination was normal. Electrocardiography was sinus tachycardia. Laboratory data obtained on the admission revealed a white blood cell (WBC) count of 14,800/mL with 88% neutrophils, 10% lymphocytes, and 2% monocytes. Hemoglobin was 12.1 mg/dL with
PP-012 AN ADULT PATIENT WITH PATENT DUCTUS ARTERIOSUS: MULTIMODALITY DIAGNOSTIC APPROACH 1 , O.S. Deveci1 , M. Yalcın ¸ 1 , M. Atalay3 , M. I˙ ncedayı2 , Z. Isılak ¸ M. Uzun1 . 1 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Kardiyoloji Anabilim Dalı, Turkey; 2 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Radyoloji Anabilim Dalı, Turkey; 3 Merzifon Askeri Hastanesi Kardiyoloji B¨ ol¨ um¨ u, Turkey A 20-year-old man was admitted to the hospital with exertional dyspnea (NYHA Class 2). Auscultation of his chest revealed a harsh, grade 3/6 continuous murmur which was loudest at the second left intercostal space; there were no signs suggestive of volume overload, ventricular failure, or raised pulmonary pressures. Chest X-ray demonstrated mild cardiomegaly with normal pulmonary vasculature, and electrocardiogram revealed normal sinus rhythm with no features of ventricular strain or atrial enlargement. Transthoracic echocardiography (TTE) (IE33 Matrix probe, Philips Medical Systems, Bothell, WA, USA) revealed a mean left ventricular ejection fraction (EF) of 60%. Left heart chambers and pulmonary artery were dilated. Initial TTE showed a presence of a large (1.65 cm2) window-like patent ductus arteriosus (PDA) in the suprasternal notch view. Color floor M-mode echocardiography demonstrated a continious left to right shunting from the aorta into the left pulmonary artery
PP-010 BALL SHAPED THROMBUS IN ATRIAL SEPTAL ANEURYSM, EXTENDING FROM THE LEFT ATRIUM TO THE RIGHT ATRIUM VIA PFO 1 1 2 M. Gencaslan ¸ , P.T. Bayır1 , S. Cakal ¸ , B. Cakal ¸ , T.H. Efe1 , Z. Bayram1 . 1 2 Mus State Hospital, Turkey; Artvin State Hospital, Turkey A 56-year-old man with a history of hypertension and type 2 diabetes mellitus presented with palpitation for two months. Electrocardiography revealed atrial fibrillation with rapid ventricular response. After slowing the heart rate with intravenous metoprolol succinate, transthoracic echocardiography (TTE) was performed. In apical four chamber view; spontaneous echo contrast in the left atrium and echogenic mass adherent to the atrial septal aneurysm, were seen. Transesophageal echocardiography (TEE) was performed and an aneurysm of the interatrial septum with a patent foramen ovale (PFO) which was resulted left to right shunt, was seen. TEE revealed a large (1.57×1.71 cm), hyperechogenic thrombus attached to the atrial septal aneurysm and protruded into the right atrium via PFO during valsalva maneuver. There were spontaneous echo contrast in the left atrium and 10×11 mm thrombus formation in the left atrial appendage in the course of atrial fibrillation. The patient had no symptoms or signs suggestive of cryptogenic stroke or pulmonary embolism. The patient underwent a successful removal of atrial thrombi with closure of the PFO. Concomitant heparin and warfarin therapy were started. A therapeutic INR range was achieved and he was discharged from hospital without any complication. Although atrial thrombi have been reported in the presence of PFO previously, this unusual occurrence of thrombus in atrial septal aneurysm in the course of atrial fibrillation, go across a PFO is rare. This clinical case is an example of the left atrial thrombosis, extending to the right atrium via a PFO.
S85
an MCV of 98.3 fL. Platelet count was 134,000/mL. Erythrocyte sedimentation rate was 71 mm/hour. 2D and 3D Transthoracic echocardiography (TTE) (IE33 Matrix probe, Philips Medical systems, Bothell, WA, USA) revealed a mean left ventricular ejection fraction (EF) of 65%, Left heart chambers were in normal size. TTE detected a floopy mass arising from the anterior leaflet of the mitral valve and moderate mitral regurgitation at apical 4-chamber and parasternal long-axis windows (Figure 1) A subsequent real-time three dimensional transesophageal echocardiography (3D-RT TEE) also conducted for precise anatomic definition. Suprisingly 3D-RT revealed a 25×27 mm floppy vegetation on the posterior annulus of the mitral valve with moderate to severe mitral regurgitation (Figure 2). There was no additional cardiac abnormality. The patient was diagnosed as infective endocarditis. Treatment with intravenous amipisilin plus gentamisin was initially started. His serial blood culture results were persistently negative. On day 7 the patient developed dyspnea suggestive of heart failure therefore, the patient was referred to cardiac surgery after the medical therapy has been revised to intravenous vancomycin plus gentamisin. Vegetation was succesfully removed with surgery and after 6 weeks of antibiotic therapy the patient was discharged with total cure. In this case, realtime 3D echocardiography helped the cardiologist understand the morphologic characteristics and the precise localization and the attachment point of the vegetation.
Figure 1. (A) Parasternal long-axis window of TTE demonstrates a floopy vegetation; (B) TEE image from 100 degree midesophageal level revealed the vegetation; (C) TEE image from 120 degree midesophageal level showed vegetation and moderatesevere mitral regurgitation by color doppler echocardiography; (D) TEE image from X-plain 120 degree midesophageal level showed vegetation. Figure 2. (A) 3D-RT TTE with mitral valve vegetation (arrow). (B) 3D-RT TTE from left atrial perspective with the mitral valve vegetation (arrow); (C,D) 3D-RT TEE from left atrial perspective with vegetation (2.5×2.7 cm) involving the posterior annulus of the mitral valve (arrow).
Figure: Transesophageal echocardiography views of a large (1.57×1.71 cm) thrombus in atrial septal aneurysm.
PP-011 AN UNUSUAL CASE OF INFECTIVE ENDOCARDITIS: ANNULUS VEGETATION 1 O.S. Deveci1 , Z. Isılak ¸ , M. Yalcın ¸ 1 , M. Atalay2 , M. Uzun1 . 1 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Kardiyoloji Anabilim Dalı, Turkey; 2 Merzifon Askeri Hastanesi Kardiyoloji B¨ ol¨ um¨ u, Turkey A 24-year-old man without any known cardiac disease was admitted to our hospital because of fever and general fatigue. On physical examination, his blood pressure was 125/75 mmHg, pulse was 100 beats per minute, temperature 39 degrees, the respiratory rate 20 breaths per minute, and the oxygen saturation 97% while he was breathing ambient air. The cardiovascular examination revealed a 3/6 holosystolic murmur in the left fourth intercostal space radiating to the axilla. The remainder of the examination was normal. Electrocardiography was sinus tachycardia. Laboratory data obtained on the admission revealed a white blood cell (WBC) count of 14,800/mL with 88% neutrophils, 10% lymphocytes, and 2% monocytes. Hemoglobin was 12.1 mg/dL with
PP-012 AN ADULT PATIENT WITH PATENT DUCTUS ARTERIOSUS: MULTIMODALITY DIAGNOSTIC APPROACH 1 , O.S. Deveci1 , M. Yalcın ¸ 1 , M. Atalay3 , M. I˙ ncedayı2 , Z. Isılak ¸ M. Uzun1 . 1 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Kardiyoloji Anabilim Dalı, Turkey; 2 G¨ ulhane Askeri Tıp Akademisi Haydarpasa E˘gitim Hastanesi Radyoloji Anabilim Dalı, Turkey; 3 Merzifon Askeri Hastanesi Kardiyoloji B¨ ol¨ um¨ u, Turkey A 20-year-old man was admitted to the hospital with exertional dyspnea (NYHA Class 2). Auscultation of his chest revealed a harsh, grade 3/6 continuous murmur which was loudest at the second left intercostal space; there were no signs suggestive of volume overload, ventricular failure, or raised pulmonary pressures. Chest X-ray demonstrated mild cardiomegaly with normal pulmonary vasculature, and electrocardiogram revealed normal sinus rhythm with no features of ventricular strain or atrial enlargement. Transthoracic echocardiography (TTE) (IE33 Matrix probe, Philips Medical Systems, Bothell, WA, USA) revealed a mean left ventricular ejection fraction (EF) of 60%. Left heart chambers and pulmonary artery were dilated. Initial TTE showed a presence of a large (1.65 cm2) window-like patent ductus arteriosus (PDA) in the suprasternal notch view. Color floor M-mode echocardiography demonstrated a continious left to right shunting from the aorta into the left pulmonary artery