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PP-079 Multiple Left Ventricular Crypts in a Patient with Obstructive Hypertrophic Cardiomyopathy
MARCH 26e29, 2015
- PP-078 Pericardial Effusion in Childhood: Experience from Tertiary Care Center in Ankara. Tamer Yoldas¸1, Özkan Kaya1, S¸eyma Kayalı1, Ilker Ertugrul1, Vehbi Dogan1, Senem Özgür1, Utku Arman Örün1, Selmin Karademir1, Murat Koç2. 1Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children Research and Training Hospital; 2Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Maternity and Children Research and Training Hospital.
P O S T E R A B S T R A C T S
Pericardial effusion in children is caused by bacterial and viral infections, connective tissue disease, metabolic disorders and malignancies. Pericardial effusion have a broad range of clinical manifestations. Acute tamponade is the most serious form of presentation, for which treatment clearly needs to be rapid and effective. Pericardial drainage can be achieved either by percutaneous catheter drainage or by surgery. When tamponade is not present, time is available to perform appropriate investigations and arrange definitive treatment. Echocardiography is an accurate and sensitive, bedside, non-invasive diagnostic tool. We report our experience of pericardial effusions in childhood. We were retrospectively analyzed records of children admitted in pediatric cardiology unit with pericardial effusion from January 2005 to December 2013. The medical records of all patients with effusions were reviewed to determine etiology, management, and outcomes. Eighty-three children (47 male and 36 female) were diagnosed to have pericardial effusion during study period. The age range was 1 week to 19 years (median 9 years). The measured size of the pericardial effusion in right ventricle anterior wall ranged from 2 to 40 mm (median 14.4), in left ventricle posterior wall ranged from 3 to 66 mm (median 15.2), in apex nged from 2 to 40 mm (median 10). Eighteen patients (21.7%) had postsurgical pericardial effusion, 16 patients (19.3%) had an underlying neoplastic disorder; 9 patients (10.8%) had associated collagen vascular disease; and 4 patients (4.8%) had an underlying diagnosis of renal disease. Three patients (3.6%) were premature infants and had percutaneous long lines. One patients (1.2%) was infected with tuberculosis and three patients (3.6%) had other diagnoses (one each with hypothyroidism, acute rheumatic fever, and dilate cardiomyopathy). Twenty-nine patients (34.9%) had no identified etiology and were designated as having idiopathic disease. Echocardiography and/or fluoroscopy guided pericardiocentesis was done in 25 patients. Open surgical drainage in 8 (9.6%); 6 patients (7.2%) underwent initial percutaneous followed by surgical drainage. A wide variety of conditions may result in pericardial effusion. All types of acute pericarditis (inflammatory, infectious, immunologic or of physical origin) can be associated with pericardial effusion. When cardiac tamponade is suspected echocardiography-guided pericardiocentesis has a well-established therapeutic role.
- PP-079 Multiple Left Ventricular Crypts in a Patient with Obstructive Hypertrophic Cardiomyopathy. Duhan Fatih Bayrak, Ali Buturak. Department of Cardiology, Acıbadem University, Istanbul, Turkey. A 67 years-old male with subacute inferior myocardial infarction was referred to our hospital for coronary angiograhy which revealed critical proximal stenosis and distal chronic total occlusion of the right coronary artery (stent implantation performed for proximal lesion and medical follow up for distal occlusion planned). At predischarge echocardiogram, a myocardial defect was observed at mid-inferior segment and later multislice computed tomography (MSCT) for morphological and coronary evaluation is performed. Echocardiogram and MSCT images are demonstrated in Figure 1.
Figure. Apical 4 chamber transthoracic echocardiographic (TTE) images demonstrating obstructive hypertrophic cardiomyopathy (A,B), arrows demonstrating basal inferoseptal cleft and inferior myocardial defect on modified 2 chamber (C,D), subcostal TTE images (E,F), and post processed 3 dimensional volume rendered MSCT images (J,K,L), short axis MCST image demonstrating inferior mycoardial defect in the middle of first pass hypoperfused inferior segment (I). Hypertrophic cardiomyopathy (HCM) is characterized by diverse patterns of left ventricular (LV) hypertrophy. Presence of congenital clefts or diverticulum of LV is a rare cardiac malformation described in HCM. Recently, unusual deep crypts of the LV basal septum have been reported in HCM patients, with unknown clinical significance. Co-existance of basal septal crypt, mid-inferior defect and obstructive hypertrohic cardiomyopathy is demonstrated in the present patient. If inferior large myocardial defect (localized at the middle of hypoperfused segment) is a necrotic lesion or combination of a congenital defect and necrosis togethter is to be discussed.
- PP-080 Global Longitudinal and Circumferential Strain and also Epicardial and Endocardial Torsion Properties of Left Ventricle is Deteriorated in Patients with Behçet’s Disease. Zafer Isılak1, Mustafa Aparcı2, Ercan Karabacak4, Ersin Aydın3, Ömer Uz1, Ugur Küçük1, Mehmet Uzun1. 1 Gulhane Military Medical Academy, Haydarpasa Hospital, Department of Cardiology, Istanbul, Turkey; 2Air Force Hospital, Department of Cardiology, Istanbul, Turkey; 3 Kasımpasa Military Hospital, Department of Dermatology, _ Istanbul, Turkey; 4Gulhane Military Medical Academy, Haydarpasa Hospital, Department of Dermatology, Istanbul, Turkey. Aim: Behçet’s disease is chronic inflammatory disease which is associated with ulceration or inflammatory infiltration of various types of mucosal or visceral tissues. Since it is a multi-system disorder involvement additional organs is highly probable. It could be consequence with either subclinical or clinical pericarditis, myocarditis, and endocarditis, and etc. We aimed to evaluate LV strain patterns by speckle tracking imaging in order to document the involvement of myocardium. Material-Method: Totally, 34 patients with Behçet’s disease and 20 healthy control subjects with normal LV systolic function were enrolled to the study. We performed strain analysis of LV by speckle tracking imaging and calculated the global longitudinal and circumferential strain, endocardial and epicardial twist, and endocardial and epicardial torsion properties of LV. Results: We found that LV global longitudinal strain (-23,001,86 vs -18,911,50, p<0.001) and LV global circumferential strain
S132 The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
- PP-078 Pericardial Effusion in Childhood: Experience from Tertiary Care Center in Ankara. Tamer Yoldas¸1, Özkan Kaya1, S¸eyma Kayalı1, Ilker Ertugrul1, Vehbi Dogan1, Senem Özgür1, Utku Arman Örün1, Selmin Karademir1, Murat Koç2. 1Department of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children Research and Training Hospital; 2Department of Pediatric Cardiovascular Surgery, Dr. Sami Ulus Maternity and Children Research and Training Hospital.
P O S T E R A B S T R A C T S
Pericardial effusion in children is caused by bacterial and viral infections, connective tissue disease, metabolic disorders and malignancies. Pericardial effusion have a broad range of clinical manifestations. Acute tamponade is the most serious form of presentation, for which treatment clearly needs to be rapid and effective. Pericardial drainage can be achieved either by percutaneous catheter drainage or by surgery. When tamponade is not present, time is available to perform appropriate investigations and arrange definitive treatment. Echocardiography is an accurate and sensitive, bedside, non-invasive diagnostic tool. We report our experience of pericardial effusions in childhood. We were retrospectively analyzed records of children admitted in pediatric cardiology unit with pericardial effusion from January 2005 to December 2013. The medical records of all patients with effusions were reviewed to determine etiology, management, and outcomes. Eighty-three children (47 male and 36 female) were diagnosed to have pericardial effusion during study period. The age range was 1 week to 19 years (median 9 years). The measured size of the pericardial effusion in right ventricle anterior wall ranged from 2 to 40 mm (median 14.4), in left ventricle posterior wall ranged from 3 to 66 mm (median 15.2), in apex nged from 2 to 40 mm (median 10). Eighteen patients (21.7%) had postsurgical pericardial effusion, 16 patients (19.3%) had an underlying neoplastic disorder; 9 patients (10.8%) had associated collagen vascular disease; and 4 patients (4.8%) had an underlying diagnosis of renal disease. Three patients (3.6%) were premature infants and had percutaneous long lines. One patients (1.2%) was infected with tuberculosis and three patients (3.6%) had other diagnoses (one each with hypothyroidism, acute rheumatic fever, and dilate cardiomyopathy). Twenty-nine patients (34.9%) had no identified etiology and were designated as having idiopathic disease. Echocardiography and/or fluoroscopy guided pericardiocentesis was done in 25 patients. Open surgical drainage in 8 (9.6%); 6 patients (7.2%) underwent initial percutaneous followed by surgical drainage. A wide variety of conditions may result in pericardial effusion. All types of acute pericarditis (inflammatory, infectious, immunologic or of physical origin) can be associated with pericardial effusion. When cardiac tamponade is suspected echocardiography-guided pericardiocentesis has a well-established therapeutic role.
- PP-079 Multiple Left Ventricular Crypts in a Patient with Obstructive Hypertrophic Cardiomyopathy. Duhan Fatih Bayrak, Ali Buturak. Department of Cardiology, Acıbadem University, Istanbul, Turkey. A 67 years-old male with subacute inferior myocardial infarction was referred to our hospital for coronary angiograhy which revealed critical proximal stenosis and distal chronic total occlusion of the right coronary artery (stent implantation performed for proximal lesion and medical follow up for distal occlusion planned). At predischarge echocardiogram, a myocardial defect was observed at mid-inferior segment and later multislice computed tomography (MSCT) for morphological and coronary evaluation is performed. Echocardiogram and MSCT images are demonstrated in Figure 1.
Figure. Apical 4 chamber transthoracic echocardiographic (TTE) images demonstrating obstructive hypertrophic cardiomyopathy (A,B), arrows demonstrating basal inferoseptal cleft and inferior myocardial defect on modified 2 chamber (C,D), subcostal TTE images (E,F), and post processed 3 dimensional volume rendered MSCT images (J,K,L), short axis MCST image demonstrating inferior mycoardial defect in the middle of first pass hypoperfused inferior segment (I). Hypertrophic cardiomyopathy (HCM) is characterized by diverse patterns of left ventricular (LV) hypertrophy. Presence of congenital clefts or diverticulum of LV is a rare cardiac malformation described in HCM. Recently, unusual deep crypts of the LV basal septum have been reported in HCM patients, with unknown clinical significance. Co-existance of basal septal crypt, mid-inferior defect and obstructive hypertrohic cardiomyopathy is demonstrated in the present patient. If inferior large myocardial defect (localized at the middle of hypoperfused segment) is a necrotic lesion or combination of a congenital defect and necrosis togethter is to be discussed.
- PP-080 Global Longitudinal and Circumferential Strain and also Epicardial and Endocardial Torsion Properties of Left Ventricle is Deteriorated in Patients with Behçet’s Disease. Zafer Isılak1, Mustafa Aparcı2, Ercan Karabacak4, Ersin Aydın3, Ömer Uz1, Ugur Küçük1, Mehmet Uzun1. 1 Gulhane Military Medical Academy, Haydarpasa Hospital, Department of Cardiology, Istanbul, Turkey; 2Air Force Hospital, Department of Cardiology, Istanbul, Turkey; 3 Kasımpasa Military Hospital, Department of Dermatology, _ Istanbul, Turkey; 4Gulhane Military Medical Academy, Haydarpasa Hospital, Department of Dermatology, Istanbul, Turkey. Aim: Behçet’s disease is chronic inflammatory disease which is associated with ulceration or inflammatory infiltration of various types of mucosal or visceral tissues. Since it is a multi-system disorder involvement additional organs is highly probable. It could be consequence with either subclinical or clinical pericarditis, myocarditis, and endocarditis, and etc. We aimed to evaluate LV strain patterns by speckle tracking imaging in order to document the involvement of myocardium. Material-Method: Totally, 34 patients with Behçet’s disease and 20 healthy control subjects with normal LV systolic function were enrolled to the study. We performed strain analysis of LV by speckle tracking imaging and calculated the global longitudinal and circumferential strain, endocardial and epicardial twist, and endocardial and epicardial torsion properties of LV. Results: We found that LV global longitudinal strain (-23,001,86 vs -18,911,50, p<0.001) and LV global circumferential strain
S132 The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster