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PP-047: SIMULTANEOUS PRESENCE OF CORONARY ATHEROSCLEROSIS AND FISTULA AS CAUSE OF ANGINA PECTORIS
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Poster Discussions / International Journal of Cardiology 147S2 (2011) S103–S130
PP-047 SIMULTANEOUS PRESENCE OF CORONARY ATHEROSCLEROSIS AND FISTULA AS CAUSE OF ANGINA PECTORIS U. Canpolat, H. Sunman, H. Yorgun, M.U. Yalcin, A.H. Ates, A. Taher, L. Sahiner, E.B. Kaya, G. Kabakci, L. Tokgozoglu, K. Aytemir, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Coronary artery fistulae (CAF) are rare group of coronary artery abnormalities in which blood flow is shunted away from coronary network to cardiac chambers, great vessels or other structures. Although the diagnosis of those abnormalities are unusual, clinical importance is due to the risk of several complications including heart failure, infective endocarditis, myocardial ischemia and dysrhythmias. This abnormality can be diagnosed in any age mainly as an incidental finding on coronary angiography, echocardiography or MDCT coronary angiography. Methods: This report describes a 51-year-old male patient who was presented to the our department due to typical chest pain for 3 months. His past medical history revealed hypertension and hyperlipidemia. Electrocardiogram showed sinus rhythm with no ischemic changes. Treadmill exercise test revealed abnormal result with ischemic changes and chest pain during the test. Results: He underwent conventional coronary angiography which showed two coronary artery fistulae originating from the circumflex artery and draining into the main pulmonary artery and significant coronary artery lesion in right coronary artery (RCA). We decided to perform percutaneous treatment of both pathologies. Initially coronary artery fistulae were closed by coil embolization with no complication. Also 2 bare metal stent implantation (2.5 × 23 mm and 2.5 × 18 mm) was performed for RCA mid segment lesion. The patient had postprocedural atrial fibrillation which converted with medical cardioversion. He discharged uneventfully from the hospital. He had no symptom during follow-up visits (at 37 month follow-up visit). Conclusions: Concomitant presence of coronary artery fistulae and coronary atherosclerosis at different arteries is very rare pathology. This case report describes a patient with this anomaly and important aspects of the treatment of these pathologies by percutaneous techniques at the same session.
Figure 1. (A) Left anterior oblique view of the right coronary artery mid segment lesion (B) Angiographic view after 2 bare metal stent implantation to the distal and mid segments of the right coronary artery (C) Coronary fistulae is originating from circumflex artery and after coil embolization there were no residual flow (D).
PP-049 INCIDENTALLY DIAGNOSED LEFT VENTRICULAR DIVERTICULUM IN A SIXTY YEAR OLD PATIENT WITH UNSTABLE ANGINA PECTORIS F. Ozyurtlu1 , H. Acet1 , M.Z. Bilik1 , F. Ertas2 , M.S. Ulgen3 . 1 Department of Cardiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey; 2 Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey; 3 Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey Congenital left ventricular diverticulum is characterized by a local embryological development failure of the ventricular muscle. It is a rare cardiac malformation in an elderly patient. It frequently is associated with other cardiac or non-cardiac congenital malformations (usually associated with midline thoracoabdominal defects) and it is most commonly diagnosed during early childhood. Clinically, it has been reported that it can lead to chest pain, arrhythmias, cardiac rupture, and sudden death, although frequently the course is asymptomatic. We present a symptomatic elderly patient congenital left ventricular diverticulum with coronary artery desease in the absence of either midline defects or congenital heart disease. 60-year- old female patient was admitted to cardiology clinic with typical chest pain. Physical examination was normal. In ECG tehere were nonspesifical changes in precordial leads Cardiac biomarkers were normal, so patient was regarded as unstabil angina pectoris. In corronary angiography these was 70% long lesion in proximal LAD and 70% lesion mid LAD. A not contracted narrownecked apical divertikulum was showed by ventriculography. Diverticulum that originated from the apical wall imaged by thransthoracic echocardiography too. The patient was referred to bypass surgery. Diverticulum exploration was performed during coronary artery bypass surgery. The patient was discharged on the fifth posoperative day and she was followed up clinically and echocardiography. PP-050 ADULT COMPLETE ATRIOVENTRICULAR CANAL DEFECT H. Degirmenci, E.M. Bakirci, S. Arslan, H. Hamur, S. Sevimli. Department of Cardiology, Ataturk University, Erzurum, Turkey Objective: The terms “endocardial cushion defect”, “atrioventricular septal defect”, “common AV septal defect” are interchangeable in describing defects in the formation of the AV valves, the anterior portion of the atrial septum and the posterior portion of the ventricular septum. Depending on the size of the ventricular septal communication and the competence of the AV valve or AV valves, patients with AV canal defects may become symptomatic early in life or may remain relatively asymptomatic until young adulthood. We report a case of complete common atrioventricular canal with longevity. Methods: A 30-year-old-woman presented with signs of moderate congestive heart failure. Since childhood, she suffered from dyspnea and cyanosis. On physical examination, his respiratory rate 23/min, pulse was 102/min (regular), and blood pressure 110/70 mmHg. On cardiac oscultation showed a splitting of a second cardiac sound and a 3/6 L systolic murmur. The electrocardiogram demonstrated a first degree atrioventricular block with complete right bundle branch block and left anterior hemiblock. The thoracic roentgenograms revealed an enlarged main pulmonary arterial segment and an increased vasculature. Transthoracic echocardiography showed a common atrioventricular canal of a complete type. It also showed cleft mitrale. In the transthoracic echocardiography, left ventricular dimension and the functions were normal, the ejection fraction was 60%; the view was consistent with right heart dilatation, moderate tricuspid regurgitation, pulmonary hypertension (60 mmHg). Results: This condition is commonly associated with death in infancy and in only exceptional cases the patient survives to the adult life. However, recommended cardiac surgery could not
Poster Discussions / International Journal of Cardiology 147S2 (2011) S103–S130
PP-047 SIMULTANEOUS PRESENCE OF CORONARY ATHEROSCLEROSIS AND FISTULA AS CAUSE OF ANGINA PECTORIS U. Canpolat, H. Sunman, H. Yorgun, M.U. Yalcin, A.H. Ates, A. Taher, L. Sahiner, E.B. Kaya, G. Kabakci, L. Tokgozoglu, K. Aytemir, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Coronary artery fistulae (CAF) are rare group of coronary artery abnormalities in which blood flow is shunted away from coronary network to cardiac chambers, great vessels or other structures. Although the diagnosis of those abnormalities are unusual, clinical importance is due to the risk of several complications including heart failure, infective endocarditis, myocardial ischemia and dysrhythmias. This abnormality can be diagnosed in any age mainly as an incidental finding on coronary angiography, echocardiography or MDCT coronary angiography. Methods: This report describes a 51-year-old male patient who was presented to the our department due to typical chest pain for 3 months. His past medical history revealed hypertension and hyperlipidemia. Electrocardiogram showed sinus rhythm with no ischemic changes. Treadmill exercise test revealed abnormal result with ischemic changes and chest pain during the test. Results: He underwent conventional coronary angiography which showed two coronary artery fistulae originating from the circumflex artery and draining into the main pulmonary artery and significant coronary artery lesion in right coronary artery (RCA). We decided to perform percutaneous treatment of both pathologies. Initially coronary artery fistulae were closed by coil embolization with no complication. Also 2 bare metal stent implantation (2.5 × 23 mm and 2.5 × 18 mm) was performed for RCA mid segment lesion. The patient had postprocedural atrial fibrillation which converted with medical cardioversion. He discharged uneventfully from the hospital. He had no symptom during follow-up visits (at 37 month follow-up visit). Conclusions: Concomitant presence of coronary artery fistulae and coronary atherosclerosis at different arteries is very rare pathology. This case report describes a patient with this anomaly and important aspects of the treatment of these pathologies by percutaneous techniques at the same session.
Figure 1. (A) Left anterior oblique view of the right coronary artery mid segment lesion (B) Angiographic view after 2 bare metal stent implantation to the distal and mid segments of the right coronary artery (C) Coronary fistulae is originating from circumflex artery and after coil embolization there were no residual flow (D).
PP-049 INCIDENTALLY DIAGNOSED LEFT VENTRICULAR DIVERTICULUM IN A SIXTY YEAR OLD PATIENT WITH UNSTABLE ANGINA PECTORIS F. Ozyurtlu1 , H. Acet1 , M.Z. Bilik1 , F. Ertas2 , M.S. Ulgen3 . 1 Department of Cardiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey; 2 Department of Cardiology, Kiziltepe State Hospital, Mardin, Turkey; 3 Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey Congenital left ventricular diverticulum is characterized by a local embryological development failure of the ventricular muscle. It is a rare cardiac malformation in an elderly patient. It frequently is associated with other cardiac or non-cardiac congenital malformations (usually associated with midline thoracoabdominal defects) and it is most commonly diagnosed during early childhood. Clinically, it has been reported that it can lead to chest pain, arrhythmias, cardiac rupture, and sudden death, although frequently the course is asymptomatic. We present a symptomatic elderly patient congenital left ventricular diverticulum with coronary artery desease in the absence of either midline defects or congenital heart disease. 60-year- old female patient was admitted to cardiology clinic with typical chest pain. Physical examination was normal. In ECG tehere were nonspesifical changes in precordial leads Cardiac biomarkers were normal, so patient was regarded as unstabil angina pectoris. In corronary angiography these was 70% long lesion in proximal LAD and 70% lesion mid LAD. A not contracted narrownecked apical divertikulum was showed by ventriculography. Diverticulum that originated from the apical wall imaged by thransthoracic echocardiography too. The patient was referred to bypass surgery. Diverticulum exploration was performed during coronary artery bypass surgery. The patient was discharged on the fifth posoperative day and she was followed up clinically and echocardiography. PP-050 ADULT COMPLETE ATRIOVENTRICULAR CANAL DEFECT H. Degirmenci, E.M. Bakirci, S. Arslan, H. Hamur, S. Sevimli. Department of Cardiology, Ataturk University, Erzurum, Turkey Objective: The terms “endocardial cushion defect”, “atrioventricular septal defect”, “common AV septal defect” are interchangeable in describing defects in the formation of the AV valves, the anterior portion of the atrial septum and the posterior portion of the ventricular septum. Depending on the size of the ventricular septal communication and the competence of the AV valve or AV valves, patients with AV canal defects may become symptomatic early in life or may remain relatively asymptomatic until young adulthood. We report a case of complete common atrioventricular canal with longevity. Methods: A 30-year-old-woman presented with signs of moderate congestive heart failure. Since childhood, she suffered from dyspnea and cyanosis. On physical examination, his respiratory rate 23/min, pulse was 102/min (regular), and blood pressure 110/70 mmHg. On cardiac oscultation showed a splitting of a second cardiac sound and a 3/6 L systolic murmur. The electrocardiogram demonstrated a first degree atrioventricular block with complete right bundle branch block and left anterior hemiblock. The thoracic roentgenograms revealed an enlarged main pulmonary arterial segment and an increased vasculature. Transthoracic echocardiography showed a common atrioventricular canal of a complete type. It also showed cleft mitrale. In the transthoracic echocardiography, left ventricular dimension and the functions were normal, the ejection fraction was 60%; the view was consistent with right heart dilatation, moderate tricuspid regurgitation, pulmonary hypertension (60 mmHg). Results: This condition is commonly associated with death in infancy and in only exceptional cases the patient survives to the adult life. However, recommended cardiac surgery could not