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PP-150 PERCUTANEOUS EXTRACTION OF CARDIAC PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS WITH A NEW TOOL; A SINGLE CENTER EXPERIENCE
Cardiology Posters / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
S83
Methods: A 70 year old man who presented with a history of class II heart failure was found to have a left ventricular pseudoaneurysm. Cardiac magnetic resonance angiography and echocardiography showed a large pseudoaneurysm with a neck of approximately 24 mm, and a high velocity bi-directional jet between the posterolateral wall of the left ventricle (LV) and a vast sump. Hand contrast angiography together with conventional angiography confirmed a communication between the LV cavity and a large false cavity. A trans-septal catheterization was deemed suitable as the delivery catheter length would preclude a femoral arterial approach. Results: A 24 mm Amplatzer sizing balloon was advanced into the pseudoaneurysm cavity which sized the orifice at 22 mm. A 10 French Amplatzer sheath was passed through the defect and a 26 mm Amplatzer septal occluder was deployed across the defect (1F). We noticed a collapse in the center of the discus deployed on the ventricular site suggesting that the design of the device may not be strong enough to withstand the pressure difference. Upon release of the delivery system, the device was dislocated. We attempted to retrieve the device with a snare catheter but we were unsuccessful. Afterwards the patient was given to surgery for device removal, and pseudoaneurysm resection. Unfortunately he died during early post-operative period. Conclusions: The novel and important aspects of our intervention is that a femoral vein approach with trans-septal puncture is safe and effective for percutaneous closure of a left ventricular pseudoaneurysm. We recommend a gentile Minnesota maneuver to be employed just to make sure releasing the delivery system is safe. A different Amplatzer device with a more robust design on one discus, which would be deployed on the ventricular site could be more appropriate for closure of a larger left ventricular pseudoaneurysm.
device used to close arterial access sites in patients who had undergone diagnostic and interventional coronary angiography procedures. Methods: A total of 551 Angio-Seal devices were placed in 551 patients in Angiography Laboratory of the Cardiology Department between January 2008 and January 2009. Of these, 527 were diagnostic and 24 were interventional coronary angiographic procedures. In all the patients unilateral puncture of the femoral arteries (mostly right femoral artery-97.8%) was performed for procedures. In 54 patients repeat diagnostic and interventional procedures were performed and followed by re-closure with an Angio-Seal device at the time of repeat puncture. Results: The procedural success rate for antegrade closures was 99.4% for all procedures. The device failed in 5 of 527 diagnostic procedures (0.94%). Major complication occurred in 2 patient only (0.37%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 4.1% (1 of 24 closures) and the minor complication rate was 6.6% (2 of 24 closures). However, in patients who received heparin in combination with antiplatelet agents after the coronary intervention, the major complication rate was 13.3%, but in other patients it was too low. Conclusions: According to preliminary results of this study cohort, the Angio-Seal STS vascular closure device is safe and effective in patients undergoing coronary diagnostic angiography and coronary intervention with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and antiplatelet medication.
PP-150 PERCUTANEOUS EXTRACTION OF CARDIAC PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS WITH A NEW TOOL; A SINGLE CENTER EXPERIENCE
Fuat Gundogdu 1 , Eftal Murat Bakirci 1 , Husnu Degirmenci 1 , Necip Becit 2 1 Department of Cardiology, Ataturk University, Erzurum, Turkey 2 Department of Cardiovascular Surgery, Ataturk University, Erzurum, Turkey
Ali Oto, Kudret Aytemir, Giray Kabakci, Hikmet Yorgun, Ugur Canpolat, Ergun Baris Kaya, Ahmet Hakan Ates, Muhammet Dural, Hamza Sunman, Banu Evranos, Aysegul Ulgen, Hilmi Ozkutlu Hacettepe University Department of Cardiology, Ankara, Turkey Objective: The growing problem with endocardial lead infections and lead malfunction has made percutaneous lead removal technology widespread. Hereby, we present our experience in percutaneous lead removal with a nonpowered sheath, EvolutionTM in a single center in Turkey. Methods: During 11 months, 13 leads in 8 patients were removed. All of the extracted leads present in the analysis were >12 months and indications for extraction were based on the recommendations of Heart Rhythm Society. The leads were removed using the EvolutionTM Lead Extraction System (Cook) with the rotational cutting force only, not laser or RF energy. Results: Indications for lead removal were: local (pocket) infection (50%) and lead malfunction (50%). In 63% of the cases, the extracted device was a pacemaker (PM), in 37% an iplantable cardioverter defibrillator (ICD). The median time from the preceding procedure was 48 months. Complete success was achieved in 11 leads and complete success with use of femoral snare was achieved in 2 leads. In 2 of the ventricular leads, the lead tip could not be removed with mechanical sheath and right femoral access was used for snare system. Remaining parts of ventricular electrode tips were removed successfully and all of the patients discharged uneventfully. Conclusions: Our experience confirms that the mechanical technique with nonpowered sheath known as the EvolutionTM is an effective and safe method for chronically implanted PM/ICD leads. Continued investigation is required to evaluate success and complication rates with other techniques.
PP-151 THE SAFETY AND EFFICACY OF THE ANGIO-SEAL CLOSURE DEVICE IN DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY SETTING: PRELIMINARY RESULTS OF SINGLE-CENTER EXPERIENCE WITH 551 CLOSURES Ugur Canpolat, Hikmet Yorgun, Ahmet Hakan Ates, Hamza Sunman, Ergun Baris Kaya, Giray Kabakci, Kudret Aytemir, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: We underlined the safety and efficacy of the Angio-Seal closure
PP-152 SINUS OF VALSALVA THROMBOSIS CAUSING PERIPHERAL EMBOLISM
Objective: Thrombus formation in the sinus of Valsalva without aneurysm is a rare condition. The patient must be treated immediately to prevent embolic events. However the optimal treatment of sinus of Valsalva thrombosis remains unclear. We report a case of peripheral embolism caused by a thrombus in the non-coronary sinus of Valsalva. Case: A 44-year-old female patient presented with acute onset of the left leg pain. There were no medical history of oral contraceptive use and coronary angiography. Her left posterior tibial, anterior tibial and dorsalis pedis pulses were not palpable by physical examination. The electrocardiogram showed sinus rhythm. A chest x-ray was normal. The hemogram and biochemical parameters were all found normal. Laboratory data for platelet count and antithrombin III and protein C and S concentrations were normal. Anticardiolipin antibodies were negative. Peripheral angiography demonstrated total occlusion of the popliteal artery. Femoral artery embolectomy was performed. The obstruction was successfully removed. The transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) clearly showed a mobile, round mass in the non-coronary sinus of Valsalva, without aneurysm of the sinus, aortic intimal flap, or aortic valve abnormality. It was considered that there might be a tumor, vegetation and artifacts other than the thrombus in the differential diagnosis of the mass. However, considering the patient’s clinical characteristics, the echocardiographic characteristics of the mass, and the gross appearance of the received specimen with Fogarty catheter, the mass was interpreted as being a thrombus. To prevent recurrent thromboembolism, surgical removal of the thrombus was considered, but since the patient did not accept undergo surgery, anticoagulation with coumadin was initiated. The patient was discharged ten days later. One month after coumadin treatment, TEE control was considered but the patient refused. TTE demonstrated disappearance of the thrombus in the coronary sinus of Valsalva. The patient has not experienced recurrent episodes of systemic embolization after the initiation of anticoagulation. Results: We diagnosed it as a thrombus because it disappeared after anticoagulation therapy. In this case, pathological examination could not underwent but in such cases it is essential for the definitive diagnosis of the mass. Conclusions: Sinus of Valsalva thrombosis should be considered in the differential diagnosis of the causes of peripheral arterial embolism. TTE and TEE in the detection of thrombus in sinus of Valsalva is an useful method. Furthermore, oral anticoagulation may be effective in the treatment of sinus of Valsalva thrombosis.
S83
Methods: A 70 year old man who presented with a history of class II heart failure was found to have a left ventricular pseudoaneurysm. Cardiac magnetic resonance angiography and echocardiography showed a large pseudoaneurysm with a neck of approximately 24 mm, and a high velocity bi-directional jet between the posterolateral wall of the left ventricle (LV) and a vast sump. Hand contrast angiography together with conventional angiography confirmed a communication between the LV cavity and a large false cavity. A trans-septal catheterization was deemed suitable as the delivery catheter length would preclude a femoral arterial approach. Results: A 24 mm Amplatzer sizing balloon was advanced into the pseudoaneurysm cavity which sized the orifice at 22 mm. A 10 French Amplatzer sheath was passed through the defect and a 26 mm Amplatzer septal occluder was deployed across the defect (1F). We noticed a collapse in the center of the discus deployed on the ventricular site suggesting that the design of the device may not be strong enough to withstand the pressure difference. Upon release of the delivery system, the device was dislocated. We attempted to retrieve the device with a snare catheter but we were unsuccessful. Afterwards the patient was given to surgery for device removal, and pseudoaneurysm resection. Unfortunately he died during early post-operative period. Conclusions: The novel and important aspects of our intervention is that a femoral vein approach with trans-septal puncture is safe and effective for percutaneous closure of a left ventricular pseudoaneurysm. We recommend a gentile Minnesota maneuver to be employed just to make sure releasing the delivery system is safe. A different Amplatzer device with a more robust design on one discus, which would be deployed on the ventricular site could be more appropriate for closure of a larger left ventricular pseudoaneurysm.
device used to close arterial access sites in patients who had undergone diagnostic and interventional coronary angiography procedures. Methods: A total of 551 Angio-Seal devices were placed in 551 patients in Angiography Laboratory of the Cardiology Department between January 2008 and January 2009. Of these, 527 were diagnostic and 24 were interventional coronary angiographic procedures. In all the patients unilateral puncture of the femoral arteries (mostly right femoral artery-97.8%) was performed for procedures. In 54 patients repeat diagnostic and interventional procedures were performed and followed by re-closure with an Angio-Seal device at the time of repeat puncture. Results: The procedural success rate for antegrade closures was 99.4% for all procedures. The device failed in 5 of 527 diagnostic procedures (0.94%). Major complication occurred in 2 patient only (0.37%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 4.1% (1 of 24 closures) and the minor complication rate was 6.6% (2 of 24 closures). However, in patients who received heparin in combination with antiplatelet agents after the coronary intervention, the major complication rate was 13.3%, but in other patients it was too low. Conclusions: According to preliminary results of this study cohort, the Angio-Seal STS vascular closure device is safe and effective in patients undergoing coronary diagnostic angiography and coronary intervention with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and antiplatelet medication.
PP-150 PERCUTANEOUS EXTRACTION OF CARDIAC PACEMAKER AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LEADS WITH A NEW TOOL; A SINGLE CENTER EXPERIENCE
Fuat Gundogdu 1 , Eftal Murat Bakirci 1 , Husnu Degirmenci 1 , Necip Becit 2 1 Department of Cardiology, Ataturk University, Erzurum, Turkey 2 Department of Cardiovascular Surgery, Ataturk University, Erzurum, Turkey
Ali Oto, Kudret Aytemir, Giray Kabakci, Hikmet Yorgun, Ugur Canpolat, Ergun Baris Kaya, Ahmet Hakan Ates, Muhammet Dural, Hamza Sunman, Banu Evranos, Aysegul Ulgen, Hilmi Ozkutlu Hacettepe University Department of Cardiology, Ankara, Turkey Objective: The growing problem with endocardial lead infections and lead malfunction has made percutaneous lead removal technology widespread. Hereby, we present our experience in percutaneous lead removal with a nonpowered sheath, EvolutionTM in a single center in Turkey. Methods: During 11 months, 13 leads in 8 patients were removed. All of the extracted leads present in the analysis were >12 months and indications for extraction were based on the recommendations of Heart Rhythm Society. The leads were removed using the EvolutionTM Lead Extraction System (Cook) with the rotational cutting force only, not laser or RF energy. Results: Indications for lead removal were: local (pocket) infection (50%) and lead malfunction (50%). In 63% of the cases, the extracted device was a pacemaker (PM), in 37% an iplantable cardioverter defibrillator (ICD). The median time from the preceding procedure was 48 months. Complete success was achieved in 11 leads and complete success with use of femoral snare was achieved in 2 leads. In 2 of the ventricular leads, the lead tip could not be removed with mechanical sheath and right femoral access was used for snare system. Remaining parts of ventricular electrode tips were removed successfully and all of the patients discharged uneventfully. Conclusions: Our experience confirms that the mechanical technique with nonpowered sheath known as the EvolutionTM is an effective and safe method for chronically implanted PM/ICD leads. Continued investigation is required to evaluate success and complication rates with other techniques.
PP-151 THE SAFETY AND EFFICACY OF THE ANGIO-SEAL CLOSURE DEVICE IN DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY SETTING: PRELIMINARY RESULTS OF SINGLE-CENTER EXPERIENCE WITH 551 CLOSURES Ugur Canpolat, Hikmet Yorgun, Ahmet Hakan Ates, Hamza Sunman, Ergun Baris Kaya, Giray Kabakci, Kudret Aytemir, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: We underlined the safety and efficacy of the Angio-Seal closure
PP-152 SINUS OF VALSALVA THROMBOSIS CAUSING PERIPHERAL EMBOLISM
Objective: Thrombus formation in the sinus of Valsalva without aneurysm is a rare condition. The patient must be treated immediately to prevent embolic events. However the optimal treatment of sinus of Valsalva thrombosis remains unclear. We report a case of peripheral embolism caused by a thrombus in the non-coronary sinus of Valsalva. Case: A 44-year-old female patient presented with acute onset of the left leg pain. There were no medical history of oral contraceptive use and coronary angiography. Her left posterior tibial, anterior tibial and dorsalis pedis pulses were not palpable by physical examination. The electrocardiogram showed sinus rhythm. A chest x-ray was normal. The hemogram and biochemical parameters were all found normal. Laboratory data for platelet count and antithrombin III and protein C and S concentrations were normal. Anticardiolipin antibodies were negative. Peripheral angiography demonstrated total occlusion of the popliteal artery. Femoral artery embolectomy was performed. The obstruction was successfully removed. The transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) clearly showed a mobile, round mass in the non-coronary sinus of Valsalva, without aneurysm of the sinus, aortic intimal flap, or aortic valve abnormality. It was considered that there might be a tumor, vegetation and artifacts other than the thrombus in the differential diagnosis of the mass. However, considering the patient’s clinical characteristics, the echocardiographic characteristics of the mass, and the gross appearance of the received specimen with Fogarty catheter, the mass was interpreted as being a thrombus. To prevent recurrent thromboembolism, surgical removal of the thrombus was considered, but since the patient did not accept undergo surgery, anticoagulation with coumadin was initiated. The patient was discharged ten days later. One month after coumadin treatment, TEE control was considered but the patient refused. TTE demonstrated disappearance of the thrombus in the coronary sinus of Valsalva. The patient has not experienced recurrent episodes of systemic embolization after the initiation of anticoagulation. Results: We diagnosed it as a thrombus because it disappeared after anticoagulation therapy. In this case, pathological examination could not underwent but in such cases it is essential for the definitive diagnosis of the mass. Conclusions: Sinus of Valsalva thrombosis should be considered in the differential diagnosis of the causes of peripheral arterial embolism. TTE and TEE in the detection of thrombus in sinus of Valsalva is an useful method. Furthermore, oral anticoagulation may be effective in the treatment of sinus of Valsalva thrombosis.