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PP-108 Endovascular Treatment Via Surgical Exploration at a Patient with Critical Limb Ischemia Who Has Already Had Repeated Femoropopliteal Bypass Surgeries
MARCH 10e13, 2016
- PP-105 Acute Anterior Myocardial Infarction after Synthetic Cannabinoid Usage in a Young Patient. Anil Sahin1, Murat Sunbul1, Zekeriya Dogan1, Esra Aydin Sunbul2, Osman Yesildag1. 1Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; 2Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Department, Istanbul, Turkey. Introduction: Use of synthetic cannabinoid (SC) is gradually increasing in the whole world due to intense psychoactive effects, easy accessibility, inexpensiveness and inability to detect of usage by routine toxicological screening methods. The consumption of products containing SC may lead to serious adverse effects including dizziness, vomiting, dyspnea, rhythm abnormalities, hypertension, chest pain, myocardial infarction, severe psychosis and acute renal failure. Cardiovascular effect of SC may lead to death in those patients. We report a young patient presenting with acute anterior myocardial infarction after SC usage. Case Presentation: A 26-year-old male patient is admitted to our emergency department with a chest pain which was rapidly deteriorating. He had no known disease or no drug usage but he had a history of five years of smoking and his mother had coronary artery by-pass graft surgery. On physical examination, blood pressure was 127/89 and heart rate was 94 beats/minute. His electrocardiogram revealed ST segment elevation in the anterior derivations. The interesting part of the electrocardiogram was after serial recordings, there were dynamic changes of ST segment elevation in the anterior derivations which made us think of possible thrombus formation or recanalization (Figure 1A-B). Because of his young age, detailed history was taken and it revealed that he had been smoking SC just before the chest pain began. This was the first time of usage of the patient and just after 15
Figure 1. Surface electrocardiography shows that ST segment elevation in the anterior derivations (A), dynamic changes of ST segment elevation in the anterior derivations (B), Coronary angiography shows that thrombus formation in the proximal part of left anterior descending artery (C), Percutaneous coronary stenting is performed to proximal left anterior descending artery with a drug-eluting stent (3.0 x 20mm, 18 atm pressure) (D).
minutes later, his chest pain began. Because of ongoing chest pain together with ST segment elevation, coronary angiography was performed. Before coronary angiography, transthoracic echocardiogram showed mild left ventricular systolic dysfunction due to apical hypokinesia but there were no any other valvular dysfunction or regurgitation. On coronary angiography, first right coronary artery was visualized and there were no significant lesion but when left coronary system is visualized, there was thrombus formation in the proximal part of left anterior descending artery (Figure 1C). And percutaneous coronary stenting is performed to proximal left anterior descending artery with a drug-eluting stent (Figure 1D). After successful percutaneous coronary intervention, the patient is transferred to coronary intensive care unit and glycoprotein 2b/3a inhibitor infusion was given in the appropriate dosage for 24 hours. His electrocardiogram revealed minimal Q wave in the anterior derivation and no ST segment elevation after the glycoprotein 2b/3a infusion therapy for 24 hours. The patient was discharged after five days later with medical therapy.
Interventions for Aorta and Peripheral Arterial Diseases (Abstract nos. PP-107 w PP-120) - PP-108 Endovascular Treatment Via Surgical Exploration at a Patient with Critical Limb Ischemia Who Has Already Had Repeated Femoropopliteal Bypass Surgeries. Alper Ucak1, Veysel Temizkan1, Arif Selçuk1, Murat Fatih Can1, Ejder Kardesoglu2. 1Department of Cardiovascular Surgery, Gata Haydarpas¸a Teaching _ Hospital, Istanbul, Turkey; 2Department of Cardiology, Gata _ Haydarpas¸a Teaching Hospital, Istanbul, Turkey. Objective: Critical limb ischemia can be seen as different clinics from amputation to life threatening problems. Endovascular and surgical techniques are performed for treatment. In femoral region anatomy changes and subcutaneous adherent tissue comes in sight due to recurrent surgical interventions and because of this reason endovascular technique may be difficult. A patient who has critical limb ischemia and endovascular treatment is hard for whom was aimed at treating by endovascular therapy via surgical exploration under local anesthesia. Methods: In his past history he has had three times ipsilateral and once contralateral peripheral artery bypass surgeries. A 60-year old male patient that has critical limb ischemia was admitted to our clinic with his ischemic limb which bypass grafts are occluded and with its ischemic ulcer. Beside the recurrent peripheral bypass surgeries he has COPD, DM and coronary artery disease. And with these diseases he has been accepted as a high-risk patient. Firstly the percutaneous intervention was tried through the ipsilateral femoral region but because of the occluded grafts, changing in anatomy and subcutaneous adhesions the percutaneous intervention were not been able to achieve. Contralateral percutaneous intervention was not tried due to not to cause harmfulness to the patent contralateral femoropopliteal bypass graft. So the region of ipsilateral femoral
The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
S77
P O S T E R A B S T R A C T S
MARCH 10e13, 2016 artery was exposured by local anesthesia and started the procedure by putting the sheath into the common femoral artery via open Seldinger technique. Results: Angioplasty and stent implant procedures were performed on arterial segments of above and below the knee by using drug-eluting balloon. Control angiography that is done after the procedure has demonstrated that there was a full patency through the plantar arch arterioles. In the 2nd month of postoperative time the ischemic wound on his left foot was seen as healed. Conclusion: Beside most of its advantages the percutaneous techniques might have difficulties about reaching lesions and maintaining a vascular access side. In such cases instead of majoropen surgery, as a minimally invasive approach the percutaneous technique that is used with local anesthesia and surgical exposure may be prefered. When the additional complications that can be seen while trying a different vascular access side and the financial expenses are considered, the assistance with a local surgery is more favorable.
- PP-110 Reduction Aortoplasty for Ascending Aortic Aneurysm: Midterm Results. Adnan Yalçınkaya1, _ Adem Ilkay Diken1, Ömer Faruk Çiçek2, Gökhan Lafçı3, Kerim Ça glı1. 1Department of Cardiovascular Surgery, Hitit University Çorum Research and Training Hospital, Çorum, Turkey; 2Department of Cardiovascular Surgery, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey; 3Department of Cardiovascular Surgery, Turkiye Yüksek ihtisas Research and Training Hospital, Ankara, Turkey.
P O S T E R A B S T R A C T S
Background: Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta aneurysm without aortic root involvement. This study was designed to evaluate the midterm follow-up of aortoplasty. Methods: From November 12, 2006, to September 30, 2013, 38 patients (27 male, mean age 59.9 15.8 ys) with dilatation of the ascending aorta underwent reduction aortoplasty in combination with other cardiac procedures. All patients underwent associated surgical procedures (13 aortic valve replacement, 6 aort valve reconstruction, 6 mitral valve replacement, 12 mitral valve reconstruction, 17 coronary artery bypass grafting). Results: The mean preoperative diameter of the ascending aorta was 49.21 2.87 mm. The mean preoperative EF is 51.3 8.4. 5 different aortoplasty technique performed to the patients (15 open plication, 10 close plication, 9 external wrapping (4 of them are beating heart), 4 shawl aortoplasty). Postoperative bleeding is 634.2 272.4 ml. Early postoperative (1 month) ascending aorta diameter was 35.66 2.21mm. After a mean postoperative period 48.3 22.1 months, the ascending aortic diameter 36.71 2.76 mm was still significantly reduced. No postoperative aortic-related complications including aortic rupture, dissection and reoperation were observed. The ascending aorta had not re-dilated to the preoperative diameter. Conclusion: With or without external support reduction aortoplasty is a safe and effective technique with low mortality, low morbidity, and rare late complications for selected chronic aneurysm of the ascending aorta.
- PP-111 Hematological Biomarkers for Predicting Carotid _ Kocayigit1, Vasospasm. Yusuf Can1, Harun Kılıç1, Ibrahim Muhammet Murat Aksoy1, Mehmet Bülent Vatan1, Hüseyin Gündüz1, Ersan Tatlı1, Ramazan Akdemir1, Altug Ösken2, Nimet Uçaroglu Can3, Bilgehan Atılgan Acar3, Salih S¸ahinkus¸4, Selçuk Yaylacı5, Ercan Aydın6, Alper Karacan7. 1Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey; 2 Department of Cardiology, Siyami Ersek Thoracic And Cardivascular Surgery Training and Research Hospital, Istanbul, Turkey; 3Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey; 4 Department of Cardiology, Akyazı State Hospital, Sakarya, Turkey; 5Department of Internal Medicine, Fındıklı State Hospital, Rize, Turkey; 6Department of Cardiology, Vakfıkebir State Hospital, Trabzon, Turkey; 7Department of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey. Objective: Vasospasm of carotid arteries is important for progression of neurological sequels. Many mechanisms were found to be related with this clinical phenomenon. Predicting this event by hematological biomarkers may provide opportunities for taking preventive measures against unfavorable neurovascular complications. The aim of this study is to determine the hematological predictors of carotid vasospasm. Methods: A total of 120 patients, who have undergone endovascular carotid artery catheterization procedure were included. Neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distribution width (RDW), platelet distribution width (PDW), leucocyte count, and monocyte count were compared between 21 patients who developed vasospasm (17.5%) and 99 patients who have not (82.5%). Results: Study group included 36 females (30%) and 84 males (70%). Mean age of cases and controls were 668 years and 668
Table 1 Comparisons of demographical characteristics and hematological parameters Cases (MeanSD)
Controls (MeanSD)
p
Age (years) 668 708 0.063 Male n, (%) 14 (66.7) 70 (70.7) 0.714 Hypertension n, (%) 19 (90.5) 80 (80.8) 0.362 Diabetes Mellitus n, (%) 12 (57.1) 30 (30.3) 0.019 Coronary Artery Disease n, (%) 7 (33.3) 30 (30.3) 0.785 Smoking n, (%) 5 (23.8) 21 (21.2) 0.793 Hyperlipidemia n, (%) 9 (42.9) 32 (32.3) 0.355 Hemoglobin (g/dl) 13.41.3 13.11.3 0.281 Leukocytes (x1000mL) 8057.11360.7 7336.41480.4 0.042 278.991.6 240.558.8 0.097 Platelets (x1000mL) MPV (fl) 7.90.9 81.3 0.696 Neutrophil (x1000mL) 5.01.1 4.41.3 0.018 Lymphocyte (x1000mL) 2.26.0 2.27.6 0.764 Neutrophil-Lymphocyte ratio 2.40.9 2.20.9 0.179 Creatinine (mg/dl) 0.90.2 10.3 0.037
S78 The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
- PP-105 Acute Anterior Myocardial Infarction after Synthetic Cannabinoid Usage in a Young Patient. Anil Sahin1, Murat Sunbul1, Zekeriya Dogan1, Esra Aydin Sunbul2, Osman Yesildag1. 1Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; 2Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Department, Istanbul, Turkey. Introduction: Use of synthetic cannabinoid (SC) is gradually increasing in the whole world due to intense psychoactive effects, easy accessibility, inexpensiveness and inability to detect of usage by routine toxicological screening methods. The consumption of products containing SC may lead to serious adverse effects including dizziness, vomiting, dyspnea, rhythm abnormalities, hypertension, chest pain, myocardial infarction, severe psychosis and acute renal failure. Cardiovascular effect of SC may lead to death in those patients. We report a young patient presenting with acute anterior myocardial infarction after SC usage. Case Presentation: A 26-year-old male patient is admitted to our emergency department with a chest pain which was rapidly deteriorating. He had no known disease or no drug usage but he had a history of five years of smoking and his mother had coronary artery by-pass graft surgery. On physical examination, blood pressure was 127/89 and heart rate was 94 beats/minute. His electrocardiogram revealed ST segment elevation in the anterior derivations. The interesting part of the electrocardiogram was after serial recordings, there were dynamic changes of ST segment elevation in the anterior derivations which made us think of possible thrombus formation or recanalization (Figure 1A-B). Because of his young age, detailed history was taken and it revealed that he had been smoking SC just before the chest pain began. This was the first time of usage of the patient and just after 15
Figure 1. Surface electrocardiography shows that ST segment elevation in the anterior derivations (A), dynamic changes of ST segment elevation in the anterior derivations (B), Coronary angiography shows that thrombus formation in the proximal part of left anterior descending artery (C), Percutaneous coronary stenting is performed to proximal left anterior descending artery with a drug-eluting stent (3.0 x 20mm, 18 atm pressure) (D).
minutes later, his chest pain began. Because of ongoing chest pain together with ST segment elevation, coronary angiography was performed. Before coronary angiography, transthoracic echocardiogram showed mild left ventricular systolic dysfunction due to apical hypokinesia but there were no any other valvular dysfunction or regurgitation. On coronary angiography, first right coronary artery was visualized and there were no significant lesion but when left coronary system is visualized, there was thrombus formation in the proximal part of left anterior descending artery (Figure 1C). And percutaneous coronary stenting is performed to proximal left anterior descending artery with a drug-eluting stent (Figure 1D). After successful percutaneous coronary intervention, the patient is transferred to coronary intensive care unit and glycoprotein 2b/3a inhibitor infusion was given in the appropriate dosage for 24 hours. His electrocardiogram revealed minimal Q wave in the anterior derivation and no ST segment elevation after the glycoprotein 2b/3a infusion therapy for 24 hours. The patient was discharged after five days later with medical therapy.
Interventions for Aorta and Peripheral Arterial Diseases (Abstract nos. PP-107 w PP-120) - PP-108 Endovascular Treatment Via Surgical Exploration at a Patient with Critical Limb Ischemia Who Has Already Had Repeated Femoropopliteal Bypass Surgeries. Alper Ucak1, Veysel Temizkan1, Arif Selçuk1, Murat Fatih Can1, Ejder Kardesoglu2. 1Department of Cardiovascular Surgery, Gata Haydarpas¸a Teaching _ Hospital, Istanbul, Turkey; 2Department of Cardiology, Gata _ Haydarpas¸a Teaching Hospital, Istanbul, Turkey. Objective: Critical limb ischemia can be seen as different clinics from amputation to life threatening problems. Endovascular and surgical techniques are performed for treatment. In femoral region anatomy changes and subcutaneous adherent tissue comes in sight due to recurrent surgical interventions and because of this reason endovascular technique may be difficult. A patient who has critical limb ischemia and endovascular treatment is hard for whom was aimed at treating by endovascular therapy via surgical exploration under local anesthesia. Methods: In his past history he has had three times ipsilateral and once contralateral peripheral artery bypass surgeries. A 60-year old male patient that has critical limb ischemia was admitted to our clinic with his ischemic limb which bypass grafts are occluded and with its ischemic ulcer. Beside the recurrent peripheral bypass surgeries he has COPD, DM and coronary artery disease. And with these diseases he has been accepted as a high-risk patient. Firstly the percutaneous intervention was tried through the ipsilateral femoral region but because of the occluded grafts, changing in anatomy and subcutaneous adhesions the percutaneous intervention were not been able to achieve. Contralateral percutaneous intervention was not tried due to not to cause harmfulness to the patent contralateral femoropopliteal bypass graft. So the region of ipsilateral femoral
The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
S77
P O S T E R A B S T R A C T S
MARCH 10e13, 2016 artery was exposured by local anesthesia and started the procedure by putting the sheath into the common femoral artery via open Seldinger technique. Results: Angioplasty and stent implant procedures were performed on arterial segments of above and below the knee by using drug-eluting balloon. Control angiography that is done after the procedure has demonstrated that there was a full patency through the plantar arch arterioles. In the 2nd month of postoperative time the ischemic wound on his left foot was seen as healed. Conclusion: Beside most of its advantages the percutaneous techniques might have difficulties about reaching lesions and maintaining a vascular access side. In such cases instead of majoropen surgery, as a minimally invasive approach the percutaneous technique that is used with local anesthesia and surgical exposure may be prefered. When the additional complications that can be seen while trying a different vascular access side and the financial expenses are considered, the assistance with a local surgery is more favorable.
- PP-110 Reduction Aortoplasty for Ascending Aortic Aneurysm: Midterm Results. Adnan Yalçınkaya1, _ Adem Ilkay Diken1, Ömer Faruk Çiçek2, Gökhan Lafçı3, Kerim Ça glı1. 1Department of Cardiovascular Surgery, Hitit University Çorum Research and Training Hospital, Çorum, Turkey; 2Department of Cardiovascular Surgery, Dr. Sami Ulus Research and Training Hospital, Ankara, Turkey; 3Department of Cardiovascular Surgery, Turkiye Yüksek ihtisas Research and Training Hospital, Ankara, Turkey.
P O S T E R A B S T R A C T S
Background: Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta aneurysm without aortic root involvement. This study was designed to evaluate the midterm follow-up of aortoplasty. Methods: From November 12, 2006, to September 30, 2013, 38 patients (27 male, mean age 59.9 15.8 ys) with dilatation of the ascending aorta underwent reduction aortoplasty in combination with other cardiac procedures. All patients underwent associated surgical procedures (13 aortic valve replacement, 6 aort valve reconstruction, 6 mitral valve replacement, 12 mitral valve reconstruction, 17 coronary artery bypass grafting). Results: The mean preoperative diameter of the ascending aorta was 49.21 2.87 mm. The mean preoperative EF is 51.3 8.4. 5 different aortoplasty technique performed to the patients (15 open plication, 10 close plication, 9 external wrapping (4 of them are beating heart), 4 shawl aortoplasty). Postoperative bleeding is 634.2 272.4 ml. Early postoperative (1 month) ascending aorta diameter was 35.66 2.21mm. After a mean postoperative period 48.3 22.1 months, the ascending aortic diameter 36.71 2.76 mm was still significantly reduced. No postoperative aortic-related complications including aortic rupture, dissection and reoperation were observed. The ascending aorta had not re-dilated to the preoperative diameter. Conclusion: With or without external support reduction aortoplasty is a safe and effective technique with low mortality, low morbidity, and rare late complications for selected chronic aneurysm of the ascending aorta.
- PP-111 Hematological Biomarkers for Predicting Carotid _ Kocayigit1, Vasospasm. Yusuf Can1, Harun Kılıç1, Ibrahim Muhammet Murat Aksoy1, Mehmet Bülent Vatan1, Hüseyin Gündüz1, Ersan Tatlı1, Ramazan Akdemir1, Altug Ösken2, Nimet Uçaroglu Can3, Bilgehan Atılgan Acar3, Salih S¸ahinkus¸4, Selçuk Yaylacı5, Ercan Aydın6, Alper Karacan7. 1Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey; 2 Department of Cardiology, Siyami Ersek Thoracic And Cardivascular Surgery Training and Research Hospital, Istanbul, Turkey; 3Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey; 4 Department of Cardiology, Akyazı State Hospital, Sakarya, Turkey; 5Department of Internal Medicine, Fındıklı State Hospital, Rize, Turkey; 6Department of Cardiology, Vakfıkebir State Hospital, Trabzon, Turkey; 7Department of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey. Objective: Vasospasm of carotid arteries is important for progression of neurological sequels. Many mechanisms were found to be related with this clinical phenomenon. Predicting this event by hematological biomarkers may provide opportunities for taking preventive measures against unfavorable neurovascular complications. The aim of this study is to determine the hematological predictors of carotid vasospasm. Methods: A total of 120 patients, who have undergone endovascular carotid artery catheterization procedure were included. Neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distribution width (RDW), platelet distribution width (PDW), leucocyte count, and monocyte count were compared between 21 patients who developed vasospasm (17.5%) and 99 patients who have not (82.5%). Results: Study group included 36 females (30%) and 84 males (70%). Mean age of cases and controls were 668 years and 668
Table 1 Comparisons of demographical characteristics and hematological parameters Cases (MeanSD)
Controls (MeanSD)
p
Age (years) 668 708 0.063 Male n, (%) 14 (66.7) 70 (70.7) 0.714 Hypertension n, (%) 19 (90.5) 80 (80.8) 0.362 Diabetes Mellitus n, (%) 12 (57.1) 30 (30.3) 0.019 Coronary Artery Disease n, (%) 7 (33.3) 30 (30.3) 0.785 Smoking n, (%) 5 (23.8) 21 (21.2) 0.793 Hyperlipidemia n, (%) 9 (42.9) 32 (32.3) 0.355 Hemoglobin (g/dl) 13.41.3 13.11.3 0.281 Leukocytes (x1000mL) 8057.11360.7 7336.41480.4 0.042 278.991.6 240.558.8 0.097 Platelets (x1000mL) MPV (fl) 7.90.9 81.3 0.696 Neutrophil (x1000mL) 5.01.1 4.41.3 0.018 Lymphocyte (x1000mL) 2.26.0 2.27.6 0.764 Neutrophil-Lymphocyte ratio 2.40.9 2.20.9 0.179 Creatinine (mg/dl) 0.90.2 10.3 0.037
S78 The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster