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PP-051 AORTIC REGURGITATION DUE TO QUADRICUSPID AORTIC VALVE
Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
Methods: 98 patients with COPD and 40 healthy controls were included in this study. We have divided the patients into groups with respect to fractional area changes (RVFAC) in order to evaluate right ventricular functions. Subgroup analysis was performed according to degree of RVSD in patients with COPD (RVFAC <17%, 25% to 31% or 32% to 60%).
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4.1±0.77 mm in patients with severe RVSD and 5.48±1.28 mm in patients with mild RVSD (p < 0.001). EFT/BMI ratio were measured in each group by dividing EFT to BMI in order to show EFT in each group is independently from body mass index (BMI) values. EFT/BMI was found 0.25±0.03 in control group. However its value in severe RVSD group was found 0.173±0.38 and mild RVSD group (0.22±0.04). Difference between three groups (p = 0.001) was significant. Conclusion: EFT decreases in patients with COPD who have a RVSD. Epicardial fat thickness would be a predictor for the degree of RVSD. PP-050 PRIMARY INTRACARDIAC MASS CAUSING LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ¸ G. Acar. D.E. Cabio˘glu, A.B. Nacar, M. Akkoyun, I˙ . Dırnak, A. Akcay, ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey Primary tumors of the heart are extremely rare. Among these, about 75 percent of all primary cardiac tumors are regarded as benign neoplasms. Primary cardiac tumors are capable of pruducing a myriad of cardiac, embolic, and systemic symptomatologies, sometimes with fatal consequences. In this paper, we describe a patient with primary intracardiac mass obstructing the left ventricular outflow tract. A 69-year-old male was admitted to our outpatient cardiology department for exertional dyspnea. On physical examination, cardiac auscultation revealed an ejection systolic murmur at the right parasternal border. On transthoracic and transesophageal echocardiography, a large intracardiac mass, 54×33 mm in size and attached to the basal interventricular septum, were seen (Figure 1). Also, there was moderately left ventricular outflow obstruction with mean gradient 32 mmHg. The patient was diagnosed with a primary cardiac tumor and was recommended surgically removal of the mass; however, the patient refused this procedure.
Figure: Analysis of epicardial fat thicknes in patients with severe and mild right ventricul systolic dysfunction (RVSD) compared to controls. (A) Analysis of epicardial fat thickness in patients with severe and mild right ventricular systolic dysfunction (RVSD) compared to controls. (B) Epicardial fat thickness corrected for body mass index in patients with severe and mild right ventricular systolic dysfunction (RVSD) compared to controls.
Table: Baseline characteristics, right ventricle parameters and epicardial fat tissue of patients with COPD and controls
Age Gender, female/male BMI, kg/m2 Diabetes, n (%) Dyslipidemia, n (%) Hypertension, n (%) Smoker, n (%) TAPSE MPI IVA sPAP EFT EFT/BMI
COPD (n = 98)
Control (n = 40)
P value
67±9.8 35/63 24±3 4 (4%) 4 (4%) NS 4 (4%) 57 (58%) 20±3.4 0.60±0.14 2.3±0.5 46.1±20 4.92±1.2 0.20±0.04
70±5.5 15/25 25±3.2 0 4 (10%) 0 9 (22%) 25.2±2.1 0.46±0.1 2.6±0.4 23.8±2.6 6.35±1.1 0.25±0.03
NS NS NS NS NS NS 0.001 0.001 0.001 0.002 0.001 0.001 0.001
MPI: Myocardial performance index; IVA: Isovolumic acceleration time; TAPSE: Tricuspid annular plane systolic excursion; EFT: Epicardial fat tissue; sPAP: Systolic pulmonar arterial pressure; BMI: Body mass index; NS: nonsignificant.
Results: EFT decreased (4.92±1.2 vs 6.35±1.1 p = 0.001) in patients with COPD compared to control group. Mean EFT were
Figure 1. (A) Transthoracic and (B) transesophageal echo view showing the large intracardiac mass obstructing the left ventricular outflow tract.
PP-051 AORTIC REGURGITATION DUE TO QUADRICUSPID AORTIC VALVE M. Akgung ¨ or, ¨ A.B. Nacar, M. Akkoyun, I˙ . Dırnak, G. Acar. ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey A 42-year-old woman was admitted to our hospital for severe symptomatic aortic regurgitation revealed by symptoms of progressive dyspnea and congestive heart failure. Her medical history was unremarkable. On physical examination, blood pressure was 140/70 mmHg, heart rate 85 b.p.m., cardiac auscultation showed a shortly early diastolic murmur along the left sternal border. There was no sign of congestive heart failure. The electrocardiogram showed normal sinus rhythm, but the chest radiogram showed
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Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
cardiomegaly. Transthoracic echocardiography showed left ventricular enlargement (end-diastolic diameter: 65 mm, end-systolic diameter: 45 mm), left ventricular ejection fraction was 50%. Also, transthoracic echocardiography showed a quadricuspid aortic valve in the short-axis view (Figure 1A). Transesophageal echocardiography showed a quadricuspid aortic valve with four equal cusps in the short-axis view (Figure 1B) and a central severe aortic regurgitation in the long axis view. Aortic valve replacement was recommended by reason of symptomatic severe aortic valve insufficiency. Severe aortic insufficiency due to quadricuspid aortic valve is a rare entity. It is responsible for regurgitation more often than stenosis. Transoesophageal echocardiography is helpful for the diagnosis and the precise description of the mechanism of the regurgitation.
Figure 1. (A) Transthoracic and (B) transesophageal echocardiograms showing a quadricuspid aortic valve in the short-axis view.
PP-052 A RARE CORONARY ANATOMY COMPRISING AN ANOMALOUS SEPTAL PERFORATOR ARTERY ORIGINATING FROM THE LEFT MAIN CORONARY ARTERY AND DUAL LEFT CIRCUMFLEX ARTERY M. Akkoyun1 , I˙ . Dırnak1 , A.B. Nacar1 , C. Zencir2 , G. Acar1 . 1 ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey; 2 Department of Cardiology, Necip Fazil State Hospital, Kahramanmaras,¸ Turkey Septal perforator artery originating from left main coronary artery is an extremely rare congenital coronary artery anomaly. A 55 year-old man presented our cardiology department with chest pain during exercise for 3 months. He underwent coronary angiography for detection of hypokinesia in the antero-apical wall of the left ventricle in transthoracic echocardiography. Left coronary angiography showed a significant stenotic lesion in the mid segment of left anterior descending artery. Also, there was a focal stenosis in the distal segment of left main coronary artery. There was non-significant plaque in the left circumflex artery. Additionally, in left coronary angiography, a septal perforator artery originating from left main coronary artery was showed (Figure 1A).
coronary artery stenosis. The patient was symptomless in the sixth month of treatment. We presented a patient with two separate vessels having different origins supplying the circumflex coronary artery distribution. Additionally, we demonstrated a septal perforator artery originating from left main coronary artery in the same patient. This coronary anomaly has not been previously described in large coronary anomaly series. PP-053 AN UNUSUAL CASE OF GIANT LEFT MAIN CORONARY ARTERY ANEURYSM: APICAL PSEUDOANEURYSM DETECTED BY CARDIAC MRI 2 C. Sekuri1 , M. Tum ¨ ukl ¨ u¨ 1 , A. Yuksel ¨ , A. Sa˘gcan1 , Z. Danao˘glu1 . 1 ˙ Department of Cardiology, Kent Hospital, Izmir, Turkey; 2 Department ˙ of Radiology, Kent Hospital, Izmir, Turkey Aneurysms of the left main coronary artery are very rare (0.1%) and the majority of cases related to atherosclerotic aethiologies. Morphologically, these aneurysms may be saccular or fusiform, single or multiple. Such lesions are generally defined as aneurysmal coronary dilation which exeed the diameter of normal segments by 1.5 to 2 times. The primary complication is myocardial ischemia and infarction due to thrombus formation and distal embolisation. A 71-year-old woman was admitted to our cardiology department with a medical history notable for type II diabetes mellitus, hypertension and combined hyperlipidemia. She had a 3 weeks history of a progressive exertional dyspnea and stable angina. On physical examination, there was a grade 1/6 systolic murmer on the apex. The electorcardiogram showed sinus rhythm with QS formation and inverted T wave in the anterior derivations. Diagnostic coronary angiography revealed that 18×21 mm saccular aneurysm originating from the distal left main coronary extended into the left anterior descending with slow flow and diffuse circumflex and right coronary artery plaque and ectasia with no significant stenosis (video 3). Left ventriculography revealed an ejection fraction of 0.54 and apical diverticular aneurysm (video 4). Cardiac morphologic and viability MRI assessment showed akinetic anteroseptal, apical and inferior wall motion abnormalities and transmural scar in LAD territory. Also, tubular narrowing of apical segment supported an apical pseudoaneurysm (Figures 1–3). Therapeutic options are controversial. Our patient was discharged in anticouagulation therapy added to aggresive medical treatments with close follow-up periods.
Figures: LMC aneurysm.
Figure 1. (A) Left coronary angiogram showing the septal perforator artery originating from left main coronary artery (arrow). (B) Coronary angiogram of the right coronary injection showing the right coronary artery and left circumflex coronary artery (arrow).
Right coronary artery had diffusely ectasic. Also, in right coronary angiography, another circumflex artery was detected originating from the proximal right coronary artery (Figure 1B). Coronary artery bypass grefting was recommended due to significant left main
PP-054 AN UNUSUAL CAUSE OF CHEST PAIN S. Koro˘ ¨ glu1 , B. Sen2 , N. Havan3 , A. Suner4 , E. Aksu5 , N. Aydın6 . 1 Department of Cardiology, Afsin State Hospital, Kahramanmaras, Turkey; 2 Department of Chest Disease, Afsin State Hospital, Kahramanmaras, Turkey; 3 Department of Radiology, Afsin State Hospital, Kahramanmaras, Turkey; 4 Department of Cardiology, Adiyaman University, Adiyaman, Turkey; 5 Department of Cardiology, Necip Fazil City Hospital, Kahramanmaras, Turkey; 6 Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey A seventy-seven years old man with a history of CABG six years ago admitted to cardiology clinic with penetrating chest
Methods: 98 patients with COPD and 40 healthy controls were included in this study. We have divided the patients into groups with respect to fractional area changes (RVFAC) in order to evaluate right ventricular functions. Subgroup analysis was performed according to degree of RVSD in patients with COPD (RVFAC <17%, 25% to 31% or 32% to 60%).
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4.1±0.77 mm in patients with severe RVSD and 5.48±1.28 mm in patients with mild RVSD (p < 0.001). EFT/BMI ratio were measured in each group by dividing EFT to BMI in order to show EFT in each group is independently from body mass index (BMI) values. EFT/BMI was found 0.25±0.03 in control group. However its value in severe RVSD group was found 0.173±0.38 and mild RVSD group (0.22±0.04). Difference between three groups (p = 0.001) was significant. Conclusion: EFT decreases in patients with COPD who have a RVSD. Epicardial fat thickness would be a predictor for the degree of RVSD. PP-050 PRIMARY INTRACARDIAC MASS CAUSING LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ¸ G. Acar. D.E. Cabio˘glu, A.B. Nacar, M. Akkoyun, I˙ . Dırnak, A. Akcay, ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey Primary tumors of the heart are extremely rare. Among these, about 75 percent of all primary cardiac tumors are regarded as benign neoplasms. Primary cardiac tumors are capable of pruducing a myriad of cardiac, embolic, and systemic symptomatologies, sometimes with fatal consequences. In this paper, we describe a patient with primary intracardiac mass obstructing the left ventricular outflow tract. A 69-year-old male was admitted to our outpatient cardiology department for exertional dyspnea. On physical examination, cardiac auscultation revealed an ejection systolic murmur at the right parasternal border. On transthoracic and transesophageal echocardiography, a large intracardiac mass, 54×33 mm in size and attached to the basal interventricular septum, were seen (Figure 1). Also, there was moderately left ventricular outflow obstruction with mean gradient 32 mmHg. The patient was diagnosed with a primary cardiac tumor and was recommended surgically removal of the mass; however, the patient refused this procedure.
Figure: Analysis of epicardial fat thicknes in patients with severe and mild right ventricul systolic dysfunction (RVSD) compared to controls. (A) Analysis of epicardial fat thickness in patients with severe and mild right ventricular systolic dysfunction (RVSD) compared to controls. (B) Epicardial fat thickness corrected for body mass index in patients with severe and mild right ventricular systolic dysfunction (RVSD) compared to controls.
Table: Baseline characteristics, right ventricle parameters and epicardial fat tissue of patients with COPD and controls
Age Gender, female/male BMI, kg/m2 Diabetes, n (%) Dyslipidemia, n (%) Hypertension, n (%) Smoker, n (%) TAPSE MPI IVA sPAP EFT EFT/BMI
COPD (n = 98)
Control (n = 40)
P value
67±9.8 35/63 24±3 4 (4%) 4 (4%) NS 4 (4%) 57 (58%) 20±3.4 0.60±0.14 2.3±0.5 46.1±20 4.92±1.2 0.20±0.04
70±5.5 15/25 25±3.2 0 4 (10%) 0 9 (22%) 25.2±2.1 0.46±0.1 2.6±0.4 23.8±2.6 6.35±1.1 0.25±0.03
NS NS NS NS NS NS 0.001 0.001 0.001 0.002 0.001 0.001 0.001
MPI: Myocardial performance index; IVA: Isovolumic acceleration time; TAPSE: Tricuspid annular plane systolic excursion; EFT: Epicardial fat tissue; sPAP: Systolic pulmonar arterial pressure; BMI: Body mass index; NS: nonsignificant.
Results: EFT decreased (4.92±1.2 vs 6.35±1.1 p = 0.001) in patients with COPD compared to control group. Mean EFT were
Figure 1. (A) Transthoracic and (B) transesophageal echo view showing the large intracardiac mass obstructing the left ventricular outflow tract.
PP-051 AORTIC REGURGITATION DUE TO QUADRICUSPID AORTIC VALVE M. Akgung ¨ or, ¨ A.B. Nacar, M. Akkoyun, I˙ . Dırnak, G. Acar. ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey A 42-year-old woman was admitted to our hospital for severe symptomatic aortic regurgitation revealed by symptoms of progressive dyspnea and congestive heart failure. Her medical history was unremarkable. On physical examination, blood pressure was 140/70 mmHg, heart rate 85 b.p.m., cardiac auscultation showed a shortly early diastolic murmur along the left sternal border. There was no sign of congestive heart failure. The electrocardiogram showed normal sinus rhythm, but the chest radiogram showed
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Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
cardiomegaly. Transthoracic echocardiography showed left ventricular enlargement (end-diastolic diameter: 65 mm, end-systolic diameter: 45 mm), left ventricular ejection fraction was 50%. Also, transthoracic echocardiography showed a quadricuspid aortic valve in the short-axis view (Figure 1A). Transesophageal echocardiography showed a quadricuspid aortic valve with four equal cusps in the short-axis view (Figure 1B) and a central severe aortic regurgitation in the long axis view. Aortic valve replacement was recommended by reason of symptomatic severe aortic valve insufficiency. Severe aortic insufficiency due to quadricuspid aortic valve is a rare entity. It is responsible for regurgitation more often than stenosis. Transoesophageal echocardiography is helpful for the diagnosis and the precise description of the mechanism of the regurgitation.
Figure 1. (A) Transthoracic and (B) transesophageal echocardiograms showing a quadricuspid aortic valve in the short-axis view.
PP-052 A RARE CORONARY ANATOMY COMPRISING AN ANOMALOUS SEPTAL PERFORATOR ARTERY ORIGINATING FROM THE LEFT MAIN CORONARY ARTERY AND DUAL LEFT CIRCUMFLEX ARTERY M. Akkoyun1 , I˙ . Dırnak1 , A.B. Nacar1 , C. Zencir2 , G. Acar1 . 1 ˙ Department of Cardiology, Kahramanmaras¸ S¨ utc¨ u Imam University, Kahramanmaras,¸ Turkey; 2 Department of Cardiology, Necip Fazil State Hospital, Kahramanmaras,¸ Turkey Septal perforator artery originating from left main coronary artery is an extremely rare congenital coronary artery anomaly. A 55 year-old man presented our cardiology department with chest pain during exercise for 3 months. He underwent coronary angiography for detection of hypokinesia in the antero-apical wall of the left ventricle in transthoracic echocardiography. Left coronary angiography showed a significant stenotic lesion in the mid segment of left anterior descending artery. Also, there was a focal stenosis in the distal segment of left main coronary artery. There was non-significant plaque in the left circumflex artery. Additionally, in left coronary angiography, a septal perforator artery originating from left main coronary artery was showed (Figure 1A).
coronary artery stenosis. The patient was symptomless in the sixth month of treatment. We presented a patient with two separate vessels having different origins supplying the circumflex coronary artery distribution. Additionally, we demonstrated a septal perforator artery originating from left main coronary artery in the same patient. This coronary anomaly has not been previously described in large coronary anomaly series. PP-053 AN UNUSUAL CASE OF GIANT LEFT MAIN CORONARY ARTERY ANEURYSM: APICAL PSEUDOANEURYSM DETECTED BY CARDIAC MRI 2 C. Sekuri1 , M. Tum ¨ ukl ¨ u¨ 1 , A. Yuksel ¨ , A. Sa˘gcan1 , Z. Danao˘glu1 . 1 ˙ Department of Cardiology, Kent Hospital, Izmir, Turkey; 2 Department ˙ of Radiology, Kent Hospital, Izmir, Turkey Aneurysms of the left main coronary artery are very rare (0.1%) and the majority of cases related to atherosclerotic aethiologies. Morphologically, these aneurysms may be saccular or fusiform, single or multiple. Such lesions are generally defined as aneurysmal coronary dilation which exeed the diameter of normal segments by 1.5 to 2 times. The primary complication is myocardial ischemia and infarction due to thrombus formation and distal embolisation. A 71-year-old woman was admitted to our cardiology department with a medical history notable for type II diabetes mellitus, hypertension and combined hyperlipidemia. She had a 3 weeks history of a progressive exertional dyspnea and stable angina. On physical examination, there was a grade 1/6 systolic murmer on the apex. The electorcardiogram showed sinus rhythm with QS formation and inverted T wave in the anterior derivations. Diagnostic coronary angiography revealed that 18×21 mm saccular aneurysm originating from the distal left main coronary extended into the left anterior descending with slow flow and diffuse circumflex and right coronary artery plaque and ectasia with no significant stenosis (video 3). Left ventriculography revealed an ejection fraction of 0.54 and apical diverticular aneurysm (video 4). Cardiac morphologic and viability MRI assessment showed akinetic anteroseptal, apical and inferior wall motion abnormalities and transmural scar in LAD territory. Also, tubular narrowing of apical segment supported an apical pseudoaneurysm (Figures 1–3). Therapeutic options are controversial. Our patient was discharged in anticouagulation therapy added to aggresive medical treatments with close follow-up periods.
Figures: LMC aneurysm.
Figure 1. (A) Left coronary angiogram showing the septal perforator artery originating from left main coronary artery (arrow). (B) Coronary angiogram of the right coronary injection showing the right coronary artery and left circumflex coronary artery (arrow).
Right coronary artery had diffusely ectasic. Also, in right coronary angiography, another circumflex artery was detected originating from the proximal right coronary artery (Figure 1B). Coronary artery bypass grefting was recommended due to significant left main
PP-054 AN UNUSUAL CAUSE OF CHEST PAIN S. Koro˘ ¨ glu1 , B. Sen2 , N. Havan3 , A. Suner4 , E. Aksu5 , N. Aydın6 . 1 Department of Cardiology, Afsin State Hospital, Kahramanmaras, Turkey; 2 Department of Chest Disease, Afsin State Hospital, Kahramanmaras, Turkey; 3 Department of Radiology, Afsin State Hospital, Kahramanmaras, Turkey; 4 Department of Cardiology, Adiyaman University, Adiyaman, Turkey; 5 Department of Cardiology, Necip Fazil City Hospital, Kahramanmaras, Turkey; 6 Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey A seventy-seven years old man with a history of CABG six years ago admitted to cardiology clinic with penetrating chest