- Email: [email protected]
PP-146 EMBOLIZATION OF ATRIAL SEPTAL OCCLUDER DEVICE INTO THE PULMONARY ARTERY
S82
Cardiology Posters / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
PP-146 EMBOLIZATION OF ATRIAL SEPTAL OCCLUDER DEVICE INTO THE PULMONARY ARTERY Umuttan Dogan 1 , Kurtulus Ozdemir 1 , Cuneyt Narin 2 , Hakan Akilli 1 , Hakan Gulec 1 , Hasan Gok 1 1 Department of Cardiology, Selcuk University, Meram School of Medicine, Konya, Turkey 2 Department of Cardiovascular Surgery, Selcuk University, Meram School of Medicine, Konya, Turkey Objective: Percutaneous device closure of atrial septal defects (ASD) has been established as a safe and attractive alternative to surgical management. Besides advantages such as lower morbidity and hospital stay when compared to surgical closure, the number of the complications increase day by day as the number of percutaneous procedures increase. We present a case with embolization of a septal occluder device (SOD) to the main pulmonary artery. Methods: A 20–year old woman was referred to our cardiology department for percutaneous device closure. TTE findings were consistent with secundum type ASD occupying the entire fossa ovalis and percutaneous closure was scheduled as the left to right shunt ratio was >1.5. The length of superior, inferior and aortic rims were measured as 14, 9 and 4 mm respectively. It was noted that the aortic rim was thin and had a membranous appearance. Following general anesthesia, balloon stretched diameter was measured as 31 mm by using stop-flow method. A 34-mm Amplatzer SOD was employed after properly positioning the SOD on the atrial septum under the guidance of transesophageal echocardiography. The release of the device was performed after Minnesota Maneuver to ensure the stability. The views obtained by TEE were satisfactory with absence of a flow across the interatrial septum and the procedure was finalized. The patient did not have any symptoms. Results: Routine TTE which was performed in the subsequent day showed that the device was not in the defect area and left to right shunt across ASD persisted. The parasternal short axis view revealed that the device lodged at the main pulmonary artery. Fortunately, the oblique alignment of the device prevented the obstruction of the blood flow. Because of the oblique position and the relative large diameter of the device, the patient was referred to urgent surgery instead of any attempt to retrieve the device with snare. The device was retrieved under cardiopulmonary bypass and the defect was primarily sutured. The patient was discharged on the 6th day of the surgery. Conclusions: This case reemphasize the importance of echocardiography in percutaneous ASD closure in two aspects. First, the thickness of the rims are important as well as the lenght and they must be evaluated by using many echocardiographic views to warrant their supportive competence. Second, routine echocardiographic evaluation before discharge may be effective and simple way of monitorization of early complications of percutaneous ASD closure, even in the absence of any symptoms.
PP-147 TWO GIANT CORONARY ARTERY ANEURYSMS IN A PATIENT WITH MULTIPLE AORTIC ANEURYSMS AND HYBRID APPROACH TO THERAPY Bekir S. Cebeci 1 , Omer Yiginer 1 , Ejder Kardesoglu 1 , Namik Ozmen 1 , Huseyin O. Sildiroglu 2 , Omer Uz 1 , Zafer Isilak 1 , Bekir Y. Cingozbay 1 1 Department of Cardiology, GMMA Haydarpasa Hospital, Istanbul, Turkey 2 Department of Radiology, GMMA Haydarpasa Hospital, Istanbul, Turkey Objective: A 72-year-old woman was admitted to our instituition with the complaints of back pain, weigth loss and fatigue. Ten years earlier, she had undergone open surgery for repair of an abdominal aortic aneurysm using Dacron tubular aortic graft. Cardiac catheterization at that time had demonstrated mild aneurysmal dilation of LAD and RCA. Methods: At her examination, thoracoabdominal CT demonstrated one huge aneurysm at the descending thoracic aorta and fusiform aneurysmal dilation of the abdominal aorta beginning from infrarenal segment through the both common illiac arteries. Furthermore, her CT images revealed two giant coronary artery aneurysms (CAA) at the proximal segments of LAD and RCA with maximum diameters of 6.9 and 6.6 cm, subsequently. Conventional coronary angiography confirmed both of the giant CAA’s. (Video) Since the anatomic location of the aortic aneurysms were favorable for percutaneous intervention, firstly, we implanted endovascular stent-grafts for the aortic aneurysms. After the recovery period, the patient underwent
successful aneurysm resection and CABG operation including end to end anastomosis of the two edges of the LAD and aorta-saphenous vein graft implantation at the distal portion of the RCA and proximal ligation. Results: CAA is defined as a dilation greater than 1.5 times an adjacent normal coronary artery. It is found in about 0.15% to 4.9% of patients who undergo coronary angiography. Its etiology may be atherosclerosis as in our patient, Kawasaki disease, complications of percutaneous coronary intervention, chest trauma and cocaine abuse. In the literature, CAA’s with a diameter exceeding 5 cm are entitled giant aneurysms. Although giant CAA previously described, our case is unique in that there were two giant coronary aneurysms accompanied by multiple aortic aneurysms. Furthermore, we are reporting for the first time in the literature a hybrid therapy for multiple aortic aneurysms combined with giant CAA’s. Conclusions: Our case supports the opinion that aneurysmal disease is a systemic illness affecting multiple arteriel segments including coronary arteries. As in this case, some mild atherosclerotic CAA’s may reach to giant levels with time. Hybrid approach for the coronary and aortic aneurysms can be performed safely.
PP-148 TRANSCATHETER BALLOON DILATATION OF AORTIC COARCTATION AND CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH COIL DURING A SINGLE SESSION OF CATHETERIZATION IN A 34 DAYS OLD BABY Ali Baykan, Sadettin Sezer, Sertac Hanedan Onan, Kazim Uzum, Nazmi Narin Paediatric Cardiology, University of Erciyes School of Medicine Paediatric Department, Kayseri, Turkiye Introduction: Here we present a 34 days old 3070 g baby who had balloon angioplasty for CoA and coil occlusion of PDA in the same session. Case: Seven days old term baby girl from the first pregnancy of a 40 years old mother referred to child emergency department due to jaundice and cardiac murmur. In physical examination: weight was 2800g; tachycardia and 3/6 degree continuous murmur on left upper sternal border were noted. Femoral pulses were weak and no difference between the arterial tensions of upper and lower extremities were detected. Echocardiography revealed enlarged right atrium and ventricle, subaortic ventricular septal defect (VSD) and 9 mm sized secundum atrial septal defect (ASD). Suprasternal examination revealed PDA and juxtaductal coarctation with 25 mmHg pressure difference. Catheter angiography was performed and balloon angioplasty was applied to the coarctation. After the procedure the pressure difference at the site of coarctation decreased from 21mmHg to 4 mmHg. Than PDA was closed with a 3×3 mm Cook coil. Discussion: Combination of CoA and PDA is common. For treatment strategy of PDA with CoA age of patient, anatomy and size of the coarctation and the type of ductus arteriosus should be taken into account. In children <6 months of age because recoarctation frequency is very high after balloon dilatation, surgery is the treatment of choice. Transcatheter techniques are effective in the treatment of these defects and there are approaches that make catheterizations separately for each defect or single catheterization for all defects. Conclusion: Percutaneous techniques can be successfully applied in appropriate conditions even in the newborn period. In selected cases coarctation can be dilated and PDA can be occluded in a single session by transcatheter techniques. Less morbidity and decreased length of hospitalization makes it preferable to surgery.
PP-149 PERCUTANEOUS DEVICE CLOSURE OF A LEFT VENTRICULAR PSEUDOANEURYSM VIA TRANS-SEPTAL APPROACH Ibrahim Susam, Yalin Tolga Yaylali, Isik Tekin Pamukkale University Faculty of Medicine Department of Cardiology, Denizli, Turkey Objective: Cardiac pseudoaneurysm can form when cardiac rupture is contained by adherent pericardium or scar tissue after myocardial infarction, cardiac surgery, infectious endocarditis, and trauma to the chest. Therapeutic percutaneous device closure of defects in the heart is very widely used and is both safe and effective. A percutaneous approach for treating LV pseudoaneurysm has been reported. To our knowledge, this is the first report of such a percutaneous closure of a pseudoaneurysm by a femoral vein approach with trans-septal puncture.
Cardiology Posters / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
PP-146 EMBOLIZATION OF ATRIAL SEPTAL OCCLUDER DEVICE INTO THE PULMONARY ARTERY Umuttan Dogan 1 , Kurtulus Ozdemir 1 , Cuneyt Narin 2 , Hakan Akilli 1 , Hakan Gulec 1 , Hasan Gok 1 1 Department of Cardiology, Selcuk University, Meram School of Medicine, Konya, Turkey 2 Department of Cardiovascular Surgery, Selcuk University, Meram School of Medicine, Konya, Turkey Objective: Percutaneous device closure of atrial septal defects (ASD) has been established as a safe and attractive alternative to surgical management. Besides advantages such as lower morbidity and hospital stay when compared to surgical closure, the number of the complications increase day by day as the number of percutaneous procedures increase. We present a case with embolization of a septal occluder device (SOD) to the main pulmonary artery. Methods: A 20–year old woman was referred to our cardiology department for percutaneous device closure. TTE findings were consistent with secundum type ASD occupying the entire fossa ovalis and percutaneous closure was scheduled as the left to right shunt ratio was >1.5. The length of superior, inferior and aortic rims were measured as 14, 9 and 4 mm respectively. It was noted that the aortic rim was thin and had a membranous appearance. Following general anesthesia, balloon stretched diameter was measured as 31 mm by using stop-flow method. A 34-mm Amplatzer SOD was employed after properly positioning the SOD on the atrial septum under the guidance of transesophageal echocardiography. The release of the device was performed after Minnesota Maneuver to ensure the stability. The views obtained by TEE were satisfactory with absence of a flow across the interatrial septum and the procedure was finalized. The patient did not have any symptoms. Results: Routine TTE which was performed in the subsequent day showed that the device was not in the defect area and left to right shunt across ASD persisted. The parasternal short axis view revealed that the device lodged at the main pulmonary artery. Fortunately, the oblique alignment of the device prevented the obstruction of the blood flow. Because of the oblique position and the relative large diameter of the device, the patient was referred to urgent surgery instead of any attempt to retrieve the device with snare. The device was retrieved under cardiopulmonary bypass and the defect was primarily sutured. The patient was discharged on the 6th day of the surgery. Conclusions: This case reemphasize the importance of echocardiography in percutaneous ASD closure in two aspects. First, the thickness of the rims are important as well as the lenght and they must be evaluated by using many echocardiographic views to warrant their supportive competence. Second, routine echocardiographic evaluation before discharge may be effective and simple way of monitorization of early complications of percutaneous ASD closure, even in the absence of any symptoms.
PP-147 TWO GIANT CORONARY ARTERY ANEURYSMS IN A PATIENT WITH MULTIPLE AORTIC ANEURYSMS AND HYBRID APPROACH TO THERAPY Bekir S. Cebeci 1 , Omer Yiginer 1 , Ejder Kardesoglu 1 , Namik Ozmen 1 , Huseyin O. Sildiroglu 2 , Omer Uz 1 , Zafer Isilak 1 , Bekir Y. Cingozbay 1 1 Department of Cardiology, GMMA Haydarpasa Hospital, Istanbul, Turkey 2 Department of Radiology, GMMA Haydarpasa Hospital, Istanbul, Turkey Objective: A 72-year-old woman was admitted to our instituition with the complaints of back pain, weigth loss and fatigue. Ten years earlier, she had undergone open surgery for repair of an abdominal aortic aneurysm using Dacron tubular aortic graft. Cardiac catheterization at that time had demonstrated mild aneurysmal dilation of LAD and RCA. Methods: At her examination, thoracoabdominal CT demonstrated one huge aneurysm at the descending thoracic aorta and fusiform aneurysmal dilation of the abdominal aorta beginning from infrarenal segment through the both common illiac arteries. Furthermore, her CT images revealed two giant coronary artery aneurysms (CAA) at the proximal segments of LAD and RCA with maximum diameters of 6.9 and 6.6 cm, subsequently. Conventional coronary angiography confirmed both of the giant CAA’s. (Video) Since the anatomic location of the aortic aneurysms were favorable for percutaneous intervention, firstly, we implanted endovascular stent-grafts for the aortic aneurysms. After the recovery period, the patient underwent
successful aneurysm resection and CABG operation including end to end anastomosis of the two edges of the LAD and aorta-saphenous vein graft implantation at the distal portion of the RCA and proximal ligation. Results: CAA is defined as a dilation greater than 1.5 times an adjacent normal coronary artery. It is found in about 0.15% to 4.9% of patients who undergo coronary angiography. Its etiology may be atherosclerosis as in our patient, Kawasaki disease, complications of percutaneous coronary intervention, chest trauma and cocaine abuse. In the literature, CAA’s with a diameter exceeding 5 cm are entitled giant aneurysms. Although giant CAA previously described, our case is unique in that there were two giant coronary aneurysms accompanied by multiple aortic aneurysms. Furthermore, we are reporting for the first time in the literature a hybrid therapy for multiple aortic aneurysms combined with giant CAA’s. Conclusions: Our case supports the opinion that aneurysmal disease is a systemic illness affecting multiple arteriel segments including coronary arteries. As in this case, some mild atherosclerotic CAA’s may reach to giant levels with time. Hybrid approach for the coronary and aortic aneurysms can be performed safely.
PP-148 TRANSCATHETER BALLOON DILATATION OF AORTIC COARCTATION AND CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH COIL DURING A SINGLE SESSION OF CATHETERIZATION IN A 34 DAYS OLD BABY Ali Baykan, Sadettin Sezer, Sertac Hanedan Onan, Kazim Uzum, Nazmi Narin Paediatric Cardiology, University of Erciyes School of Medicine Paediatric Department, Kayseri, Turkiye Introduction: Here we present a 34 days old 3070 g baby who had balloon angioplasty for CoA and coil occlusion of PDA in the same session. Case: Seven days old term baby girl from the first pregnancy of a 40 years old mother referred to child emergency department due to jaundice and cardiac murmur. In physical examination: weight was 2800g; tachycardia and 3/6 degree continuous murmur on left upper sternal border were noted. Femoral pulses were weak and no difference between the arterial tensions of upper and lower extremities were detected. Echocardiography revealed enlarged right atrium and ventricle, subaortic ventricular septal defect (VSD) and 9 mm sized secundum atrial septal defect (ASD). Suprasternal examination revealed PDA and juxtaductal coarctation with 25 mmHg pressure difference. Catheter angiography was performed and balloon angioplasty was applied to the coarctation. After the procedure the pressure difference at the site of coarctation decreased from 21mmHg to 4 mmHg. Than PDA was closed with a 3×3 mm Cook coil. Discussion: Combination of CoA and PDA is common. For treatment strategy of PDA with CoA age of patient, anatomy and size of the coarctation and the type of ductus arteriosus should be taken into account. In children <6 months of age because recoarctation frequency is very high after balloon dilatation, surgery is the treatment of choice. Transcatheter techniques are effective in the treatment of these defects and there are approaches that make catheterizations separately for each defect or single catheterization for all defects. Conclusion: Percutaneous techniques can be successfully applied in appropriate conditions even in the newborn period. In selected cases coarctation can be dilated and PDA can be occluded in a single session by transcatheter techniques. Less morbidity and decreased length of hospitalization makes it preferable to surgery.
PP-149 PERCUTANEOUS DEVICE CLOSURE OF A LEFT VENTRICULAR PSEUDOANEURYSM VIA TRANS-SEPTAL APPROACH Ibrahim Susam, Yalin Tolga Yaylali, Isik Tekin Pamukkale University Faculty of Medicine Department of Cardiology, Denizli, Turkey Objective: Cardiac pseudoaneurysm can form when cardiac rupture is contained by adherent pericardium or scar tissue after myocardial infarction, cardiac surgery, infectious endocarditis, and trauma to the chest. Therapeutic percutaneous device closure of defects in the heart is very widely used and is both safe and effective. A percutaneous approach for treating LV pseudoaneurysm has been reported. To our knowledge, this is the first report of such a percutaneous closure of a pseudoaneurysm by a femoral vein approach with trans-septal puncture.