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PP-145 PERCUTANEOUS TRANSCATHETER CLOSURE OF DOUBLE ATRIAL SEPTAL DEFECTS WITH DOUBLE AMPLATZER SEPTAL OCCLUDER DEVICES
Cardiology Posters / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
the long tubular segment coarctation at the descending thoracic aorta. The second patient was two years old boy. He had malnutrition, dilated cardiomyopathy and narrowing at renal artery and infrarenal abdominal aorta. There was left main iliac artery occlusion, and significant narrowing in the right main iliac artery. Both patients were hypertensive and treated with immunosuppressive therapy. Conclusions: In this report we discussed clinical course and treatment of Takayasu arteritis in children.
PP-142 THE ROLE OF MULTIDETECTOR COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN THE FOLLOW UP OF CORONARY ARTERY FISTULA AFTER CLOSURE BY PERCUTANEOUS INTERVENTION 1
2
2
Hikmet Yorgun , Tuncay Hazirolan , Musturay Karcaaltincaba , Barbaros Cil 2 , Ugur Canpolat 1 , Ergun Baris Kaya 1 , Ahmet Hakan Ates 1 , Edis Demiri 1 , Kudret Aytemir 1 , Lale Tokgozoglu 1 , Giray Kabakci 1 , Ali Oto 1 1 Hacettepe University Department of Cardiology, Ankara, Turkey 2 Hacettepe University Department of Radiology, Ankara, Turkey Objective: Multidetector computed tomography (MDCT) coronary angiography is an excelent tool in the diagnosis of origin, course and drainage sites of coronary artery fistula (CAF). We aimed to assess the role of MDCT in the follow-up of patients who underwent closure of CAF with percutaneous intervention. Methods: In this retrospective study, we analysed 4 patients who underwent percutaneous closure with various methods and evaluated with dual source 64 slice MDCT Somatom Definition, Siemens, Erlangen, Germany). Retrospective gating technique was used to synchronize data reconstruction with the electrocardiographic signal. Best systolic and diastolic reconstructions were made in all patients at a slice thickness of 0.75 mm and a reconstruction increment of 0.5 mm. Results: Among 4 patients, 1 of them was closed wiyh detachable balon and others with detachable coils. In a median follow up of 39 months (14 to 65 months), minimal recanalisation was omserved in one patient and others were totally occluded. Repeat intervention was not needed in those patients. Conclusions: In addition to the valuable role in the diagnosis of CAF, coronary MDCT can give important data in the follow up. Coronary MDCT is a useful tool in the follow up of patients who underwent percutaneous closure.
Interventions in Different Clinical Settings
PP-143 BILATERAL CAROTID ARTERY STENTING IN A HIGH RISK PATIENT Ibrahim Susam, Yalin Tolga Yaylali Pamukkale University Department of Cardiology, Denizli, Turkey Objective: Carotid stenting with the use of an emboli-protection device (EPD) is not inferior to carotid endarterectomy for patients who have serious comorbid medical conditions. Here we present a 68 year old female patient with severe bilateral carotid stenosis who underwent successful revascularization with carotid artery stenting (CAS) with distal embolic protection. Methods: Our patient’s comorbid conditions including advanced age, significant cardiac disease, severe contralateral carotid stenosis made her a good candidate for carotid stenting. A diagnostic catheter was used to engage the CCA. FilterWire was delivered in a collapsed form across the carotid lesion on the attached guide wire. The lesion was predilated. Flexible self-expanding stents were placed. Postdilatation of the stent was performed with the use of a noncompliant balloon. Results: Our patient had a history of coronary artery disease (status post coronary artery bypass), peripheral arterial disease, and diabetes. Her carotid angiography showed bilateral severe stenosis (movies 1,5). The emboli protection devices were successfully used (movies 2,6). She underwent successful stent deployment on both carotids (movies 3,7). Postdilatation contrast angiographic results were satisfactory (movies 4,8). She had no cardiac or neurologic complications afterwards. She was doing fine one month after the procedure.
S81
Conclusions: We showed that bilateral carotid stenting on the same occasion in a patient with serious comorbid medical conditions may be safe and an efficacious method for carotid revascularization.
PP-144 CORONARY EMBOLISM IN A PATIENT WITH DOUBLE PROSTHETIC VALVES WITHOUT VALVE THROMBOSIS Abdullah Sokmen, Gulizar Sokmen, Sedat Koroglu, Gurkan Acar, Hakan Kaya, Cemal Tuncer Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey Coronary embolisms have been most frequently reported in the left anterior descending artery, and right coronary artery is relatively rare site of involvement. Here, we present a 34 years old man who has experienced acute inferior myocardial infarction caused by coronary embolism to right coronary artery from mechanical prosthesis due to inadequate anticoagulation. Transthoracic echocardiography showed neither thrombus nor vegetation in both prosthetic valves. The patient was given t-PA, and chest pain was relieved totally. Coronary angiogram showed coronary embolus riding on the bifurcation of posterior descending artery and posterolateral branch of right coronary artery with TIMI-3 flow. The patient was discharged on treatment with aspirin and warfarin with INR of 3.0, and was uneventful at the end of 2-months follow-up. This case has demonstrated that aggressive anticoagulation in high-risk patients with warfarin and acetylsalicylate is extremely important and life-saving, and thrombolytic therapy is a reliable approach for managing coronary embolism when it causes ST elevation acute myocardial infarction.
PP-145 PERCUTANEOUS TRANSCATHETER CLOSURE OF DOUBLE ATRIAL SEPTAL DEFECTS WITH DOUBLE AMPLATZER SEPTAL OCCLUDER DEVICES Zeynettin Kaya 1 , Mehmet Siddik Ulgen 1 , Mehmet Kayrak 1 , Omer Goktekin 2 1 Department of Cardiology, Selcuk University, Konya, Turkey 2 Departmnet of Cardiology, Osmangazi University, Eskisehir, Turkey A 19-year-old female college student was admitted to hospital with effort dyspnea and palpitations. On physical examination her arterial blood pressure was normal. There was normal S1, fixed splitting S2 and no systolic ejection murmur on auscultation. The electrocardiogram showed sinus tachycardia at a rate of 87 bpm and incomplete right bundle branch block. Right atrial and ventricular enlargements were noted as well as suspected interatrial flow on transthoracic echocardiographic (TTE) evaluation. Transesophageal echocardiography (TEE) was performed and revealed a left to right interatrial shunt via 2 Atrial Septal Defects (ASD): the defects sizes were 12mm and 17mm respectively. The calculated Qp:Qs ratio was 2.2:1. We decided to perform percutaneous closure, based on the size of the defects, an appropriate Qp:Qs ratio, right heart chamber enlargement and the presence of symptoms. Because of the large distance between two defects, we decided to use two different ASO devices. The procedure was performed under general anesthesia with TEE guidance. Two sizing balloons were inflated by TEE and fluoroscopic guidance to measure the exact sizes of defects. The 12mm ASO device was placed on the small defect, and the 20mm ASO device was placed on the larger one. First the small device then the larger device released after the positions of the devices were checked. The patient was observed overnight, evaluated with TTE and discharged from hospital with 300mg of aspirin daily for 6 months. ASDs account for 5-10% of all congenitally heart diseases. Percutaneous closure of a single and multiple ASDs has become an accepted technique in many cardiac centers. Various techniques have been developed for closing multiple ASDs, including only one ASO device, using only one CardioSeal device, fusioning the defects with the balloon atrial septostomy technique, then using a larger ASO device, using new Cribriform Ampletzer device and using different ASO devices simultaneously. The early and midterm success rates of different ASO devices used to close multiple ASDs are higher: 97.5% at 24 h, 97.5% after the first month, 97.4% at the third month, and 90% at the end of 1 year. A decrease in success rate at the end of 1 year was related to quitting follow-up. As far as we know, this is the first case in our country in which two ASDs were closed with the double ASO devices simultaneously.
the long tubular segment coarctation at the descending thoracic aorta. The second patient was two years old boy. He had malnutrition, dilated cardiomyopathy and narrowing at renal artery and infrarenal abdominal aorta. There was left main iliac artery occlusion, and significant narrowing in the right main iliac artery. Both patients were hypertensive and treated with immunosuppressive therapy. Conclusions: In this report we discussed clinical course and treatment of Takayasu arteritis in children.
PP-142 THE ROLE OF MULTIDETECTOR COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN THE FOLLOW UP OF CORONARY ARTERY FISTULA AFTER CLOSURE BY PERCUTANEOUS INTERVENTION 1
2
2
Hikmet Yorgun , Tuncay Hazirolan , Musturay Karcaaltincaba , Barbaros Cil 2 , Ugur Canpolat 1 , Ergun Baris Kaya 1 , Ahmet Hakan Ates 1 , Edis Demiri 1 , Kudret Aytemir 1 , Lale Tokgozoglu 1 , Giray Kabakci 1 , Ali Oto 1 1 Hacettepe University Department of Cardiology, Ankara, Turkey 2 Hacettepe University Department of Radiology, Ankara, Turkey Objective: Multidetector computed tomography (MDCT) coronary angiography is an excelent tool in the diagnosis of origin, course and drainage sites of coronary artery fistula (CAF). We aimed to assess the role of MDCT in the follow-up of patients who underwent closure of CAF with percutaneous intervention. Methods: In this retrospective study, we analysed 4 patients who underwent percutaneous closure with various methods and evaluated with dual source 64 slice MDCT Somatom Definition, Siemens, Erlangen, Germany). Retrospective gating technique was used to synchronize data reconstruction with the electrocardiographic signal. Best systolic and diastolic reconstructions were made in all patients at a slice thickness of 0.75 mm and a reconstruction increment of 0.5 mm. Results: Among 4 patients, 1 of them was closed wiyh detachable balon and others with detachable coils. In a median follow up of 39 months (14 to 65 months), minimal recanalisation was omserved in one patient and others were totally occluded. Repeat intervention was not needed in those patients. Conclusions: In addition to the valuable role in the diagnosis of CAF, coronary MDCT can give important data in the follow up. Coronary MDCT is a useful tool in the follow up of patients who underwent percutaneous closure.
Interventions in Different Clinical Settings
PP-143 BILATERAL CAROTID ARTERY STENTING IN A HIGH RISK PATIENT Ibrahim Susam, Yalin Tolga Yaylali Pamukkale University Department of Cardiology, Denizli, Turkey Objective: Carotid stenting with the use of an emboli-protection device (EPD) is not inferior to carotid endarterectomy for patients who have serious comorbid medical conditions. Here we present a 68 year old female patient with severe bilateral carotid stenosis who underwent successful revascularization with carotid artery stenting (CAS) with distal embolic protection. Methods: Our patient’s comorbid conditions including advanced age, significant cardiac disease, severe contralateral carotid stenosis made her a good candidate for carotid stenting. A diagnostic catheter was used to engage the CCA. FilterWire was delivered in a collapsed form across the carotid lesion on the attached guide wire. The lesion was predilated. Flexible self-expanding stents were placed. Postdilatation of the stent was performed with the use of a noncompliant balloon. Results: Our patient had a history of coronary artery disease (status post coronary artery bypass), peripheral arterial disease, and diabetes. Her carotid angiography showed bilateral severe stenosis (movies 1,5). The emboli protection devices were successfully used (movies 2,6). She underwent successful stent deployment on both carotids (movies 3,7). Postdilatation contrast angiographic results were satisfactory (movies 4,8). She had no cardiac or neurologic complications afterwards. She was doing fine one month after the procedure.
S81
Conclusions: We showed that bilateral carotid stenting on the same occasion in a patient with serious comorbid medical conditions may be safe and an efficacious method for carotid revascularization.
PP-144 CORONARY EMBOLISM IN A PATIENT WITH DOUBLE PROSTHETIC VALVES WITHOUT VALVE THROMBOSIS Abdullah Sokmen, Gulizar Sokmen, Sedat Koroglu, Gurkan Acar, Hakan Kaya, Cemal Tuncer Department of Cardiology, Sutcu Imam University, Kahramanmaras, Turkey Coronary embolisms have been most frequently reported in the left anterior descending artery, and right coronary artery is relatively rare site of involvement. Here, we present a 34 years old man who has experienced acute inferior myocardial infarction caused by coronary embolism to right coronary artery from mechanical prosthesis due to inadequate anticoagulation. Transthoracic echocardiography showed neither thrombus nor vegetation in both prosthetic valves. The patient was given t-PA, and chest pain was relieved totally. Coronary angiogram showed coronary embolus riding on the bifurcation of posterior descending artery and posterolateral branch of right coronary artery with TIMI-3 flow. The patient was discharged on treatment with aspirin and warfarin with INR of 3.0, and was uneventful at the end of 2-months follow-up. This case has demonstrated that aggressive anticoagulation in high-risk patients with warfarin and acetylsalicylate is extremely important and life-saving, and thrombolytic therapy is a reliable approach for managing coronary embolism when it causes ST elevation acute myocardial infarction.
PP-145 PERCUTANEOUS TRANSCATHETER CLOSURE OF DOUBLE ATRIAL SEPTAL DEFECTS WITH DOUBLE AMPLATZER SEPTAL OCCLUDER DEVICES Zeynettin Kaya 1 , Mehmet Siddik Ulgen 1 , Mehmet Kayrak 1 , Omer Goktekin 2 1 Department of Cardiology, Selcuk University, Konya, Turkey 2 Departmnet of Cardiology, Osmangazi University, Eskisehir, Turkey A 19-year-old female college student was admitted to hospital with effort dyspnea and palpitations. On physical examination her arterial blood pressure was normal. There was normal S1, fixed splitting S2 and no systolic ejection murmur on auscultation. The electrocardiogram showed sinus tachycardia at a rate of 87 bpm and incomplete right bundle branch block. Right atrial and ventricular enlargements were noted as well as suspected interatrial flow on transthoracic echocardiographic (TTE) evaluation. Transesophageal echocardiography (TEE) was performed and revealed a left to right interatrial shunt via 2 Atrial Septal Defects (ASD): the defects sizes were 12mm and 17mm respectively. The calculated Qp:Qs ratio was 2.2:1. We decided to perform percutaneous closure, based on the size of the defects, an appropriate Qp:Qs ratio, right heart chamber enlargement and the presence of symptoms. Because of the large distance between two defects, we decided to use two different ASO devices. The procedure was performed under general anesthesia with TEE guidance. Two sizing balloons were inflated by TEE and fluoroscopic guidance to measure the exact sizes of defects. The 12mm ASO device was placed on the small defect, and the 20mm ASO device was placed on the larger one. First the small device then the larger device released after the positions of the devices were checked. The patient was observed overnight, evaluated with TTE and discharged from hospital with 300mg of aspirin daily for 6 months. ASDs account for 5-10% of all congenitally heart diseases. Percutaneous closure of a single and multiple ASDs has become an accepted technique in many cardiac centers. Various techniques have been developed for closing multiple ASDs, including only one ASO device, using only one CardioSeal device, fusioning the defects with the balloon atrial septostomy technique, then using a larger ASO device, using new Cribriform Ampletzer device and using different ASO devices simultaneously. The early and midterm success rates of different ASO devices used to close multiple ASDs are higher: 97.5% at 24 h, 97.5% after the first month, 97.4% at the third month, and 90% at the end of 1 year. A decrease in success rate at the end of 1 year was related to quitting follow-up. As far as we know, this is the first case in our country in which two ASDs were closed with the double ASO devices simultaneously.