- Email: [email protected]
PP-215 Unusual Cases with Multiple Complex Branching False Tendons
MARCH 13e16, 2014 increased in patients with atrial fibrillation (AF). This study aims to investigate the relationship between pre- and postprocedural MPV levels and recurrence following cryoballon-based AF ablation. Methods-Results: 71 patients with paroxysmal AF and preserved left ventricular systolic function were prospectively enrolled and subjected to cryoballoon-based ablation following the detection of MPV levels in the complete blood count test. Post-procedural MPV levels were obtained after one-year follow-up. During one-year follow-up after ablation, the recurrence of AF was observed in 17(23.94%) patients. MPV levels significantly decreased following AF ablation, regardless of recurrence status following AF ablation (9.160.99 vs. 8.460.91; p<0.001 and 8.680.95 vs. 8.281.16; p<0.05, in patients with and without AF recurrence respectively). The decrease in MPV levels was significantly higher in patient group without AF recurrence (p<0.05). Conclusion: MPV levels are decreased in patients with atrial fibrillation following cryoballoon-based ablation, regardless of their recurrence status. These data points out a decrease in systemic platelet activation following cryoballoon-based atrial fibrillation ablation, which may be related to the decrease in atrial fibrillation burden.
Cardiac Imaging: Rare Observations (Abstract nos. PP-214 w PP-233) - PP-214
P O S T E R A B S T R A C T S
Bovine Aortic Arch And Pulmonary Artery Aneurysm Associated With Tracheal Compression. M.C. Sumerkan1, A. Gurdal1, T. Hamit1, S. Cetin1, F. Helvaci1, E. Uysal2, M. Basak2, I. Koramaz3. 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; 2Department of Radiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; 3 Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. Objective: Common trunk for the brachiocephalic (innominate) artery and left carotid arteries called bovine aortic arch. The name stems from the similarity of this variant with that of a normal bovine arch. Bovine aorta is a very rare abnormality of the cardiovascular system and usually has no clinical significance. However, it may associate with other cardiovascular anomalies, aortic dissection, pulsatile tinnitus, arterial embolic events. Despite publications showed the bovine aorta, very few of them associated with tracheal compression. Herein, we present a case with bovine aorta arch and pulmonary artery aneurysm associated with tracheal compression, which is incidentally detected by X-ray film. Case Details: A 56-year-old Caucasian female admitted to the cardiology clinic with complaint of chest pain. Her past medical history displays diabetes, and hypertension, and she is on medical therapy. She did not report any other prior medical history. She had smoked approximately one pack of cigarettes daily for 20 years. Physical examination was unremarkable. Blood biochemistry values and cardiac markers were in normal range. The twelve-lead electrocardiogram revealed 64 beats/ minute sinus rhythm with normal axis. Chest roentgenogram projection showed a widened mediastinum and no active pulmonary disease (Figure 1A). A subsequent transthoracic echocardiography showed; dilatation of the pulmonary artery (parasternal short-axis view diameter: 33mm), normal pulmonary artery pressure and normal systolic function. And, also suprasternal echocardiographic view revealed one major branch
Figure 1. (A) Posteroanterior chest radiography view demonstrated massive enlargement of the left pulmonary artery (arrow) and clear lung fields. (B) Lateral image of computed tomography showed severe dilation of the pulmonary artery trunk (diameter: 53mm). Note the diameter of the pulmonary artery exceeds the aorta (diameter: 41mm). No proximal filling defects are seen. Left subclavian artery arose from the dilated segment of the proximal brachiocephalic artery (diameter: 18mm). An ostial stenosis was defined as an isolated angiographic narrowing of 30% located within two mm of the right subclavian artery origin (arrow). (C) Suprasternal long axis view of echocardiography depicting one major branch from the aortic arch. The brachiocephalic (innominate) artery (triple dagger) shares a common origin with the left common carotid artery (vertical four white dots). (D) Aortic arch leans on the trachea wall, and the trachea was displaced slightly lateral and appeared flattened in its transverse diameter (arrow). (E) Axial contrast-enhanced computed tomography imaging revealed dilation of the main right (diameter: 33mm) and left branches (diameter: 45mm). Trachea and left main bronchus compressed by aortic arch and main right pulmonary artery. (F) 3 Dimensional computed tomography left oblique view of bovine aortic arch and pulmonary artery aneurysm. As ¼ Ascending aorta; Ds ¼ Descending aorta; RPA ¼ Right pulmonary artery.
originated from the aortic arch (Figure 1C). Computed tomography was performed for further evaluation. Computed tomography showed bovine aortic arch associated with pulmonary artery aneurysm. First aortic branch is the brachiocephalic artery, followed by the left subclavian artery. Left common carotid artery originated from brachiocephalic artery. The left subclavian artery originated individually from the aortic arch (Figure 1B, D, E, F). Therapeutic strategy balanced between risks of the cardiovascular abnormally and risks due to the surgical procedure. The repair surgery was not performed due to; patient refused the operation, vascular ring is not associated with serious complications and good general condition and prognosis of the patient. Hereby conservative approach adopted. Antiplatelet therapy started. The patient is asymptomatic and still under our supervision. Conclusion: Aortic vascular anomalies should be considered in patients with chest pain. Identification with imaging modalities is important for prevention of chronic and irreversible complications. And the unusual configuration aortic arch has led to some reported difficulties with aortic treatments, such as carotid artery stenting.
- PP-215 Unusual Cases with Multiple Complex Branching False Tendons. M.C. Sumerkan, T. Hamit, S. Cetin, F. Helvaci, A. Gurdal. Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
S88 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
MARCH 13e16, 2014 Objective: False tendons are fibromuscular thin, bandelike, echogenic structures that stretch across the left ventricle cavity from the septum to the free wall. They have no clinical importance except for their possible role in the genesis of innocent murmurs and arrhythmias. The Chiari’s network presents as a highly mobile and echogenic structure these can be seen in several locations in the right atrium. And, usually has no clinical significance. However, they may associate with intraatrial thrombus, patent foramen ovale, paradoxical arterial embolic events or cardiac arrhythmias. Despite publications showed the Chiari’s network, none of them associated by more than five false tendons. Also, it is extremely rare to find multiple complex branching false tendons. Herein, we present two cases with multiple false tendons. Case 1: A 45-year-old Caucasian male admitted to the cardiology clinic with complaint of chest pain. He had no known medical history. He had smoked approximately one pack of cigarettes daily for 20 years. Physical examination and blood biochemistry values were in normal range. His blood pressure on admission was 130/85 mmHg. The electrocardiogram showed normal findings. Echocardiography was performed for further evaluation. Transthoracic echocardiography showed; normal systolic function, left ventricular concentric hypertrophy, prominent Chiari’s network and multiple false tendons (Video 1, Figure 1A). Case 2: A 29-year-old Caucasian male admitted to the cardiology clinic with complaint of chest pain. He did not have any prior cardiovascular disease. Electrocardiogram and laboratory tests were normal along with a normal physical examination. Two-dimensional echocardiography was performed which revealed trace mitral, tricuspid and pulmonary regurgitation and multiple complex branching false tendons between papillary muscles and ventricular walls (Figure 1B, C). Because of the absence of other cardiovascular anomalies and the patients remained asymptomatic, we decided to follow up patients for future symptoms. The patients remain stable on follow-up. Conclusion: False tendon and Chiari’s network are rare anatomic variants of the normal human heart. Determination of them is important for identification of associated other congenital cardiovascular malformations, arrhythmias and murmurs. And, also they should not be misinterpreted as pathologic structures such as flail mitral chordae tendineae or mural thrombi. With the increasing use of echocardiography and advancement of new echocardiography devices and the development of new imaging methods like 3Dimensional quantification, anatomy of the false tendon and Chiari’s network and their relationship to other cardiac structures will be increasingly recognized.
- PP-216 Ring Shaped Mass in Right Atrium. Kamil Güls¸en, Cenk Conkbayır, Barıs¸ Ökçün. Near East University School of Medicine. Introduction: Eustachian valve is one of the congenital remnant structure that some times emerge with infective endocarditis, trombus or obstruction. We introduce an interesting presentation of eustachian valve. Case: We present a 35 year old man that consult us for check his heart status without any cardiac complain. In his echocardiographic images we detected a large eustachian valve with patent foramen ovale in apical window (Figure 1A,1B ), in subcostal widow images seems like a mobile ring (Figure 1C,1D Video 1). Conclusion: There are some case reports in literature about various shapes and clinics for eustachian valve. Sometimes differentiating to this anatomical structure from intracardiac tumor or vegetation could be difficult.
Figure 1. Large eustachian valve and patent foramen ovale A, B Ring shaped seen C, D
- PP-217 Hypertrophic Cardiomyopaty with Mid-Ventricular Obstruction: One Obstruction, Three Dictinct Jet in One Chamber. L. Dinc Asarcikli1, M. Cebeci2, Y. Guray2, O. Tufekcioglu2. 1Diskapi Y. Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey; 2Yuksek Ihtisas Education and Research Hospital, Department of Cardiology, Ankara, Turkey. Figure 1. (A) Apical four chamber 3-dimensional transthoracic echocardiographic view with the appearance of multiple false tendons (arrows) in the left ventricle. (B) Modified 4 chamber long axis view depicting two false tendons (arrows) from anterolateral mitral papillary muscle to bazal segment of anterior septal wall. False tendons is restricting the movement of the papillary muscle by pulling towards to interventricular septal wall. Fortunately mitral valve dysfunction did not occur secondary to these lesions. (C) Modified apical 2 chamber view revealed complex branching false tendons (arrow) between base of anterolateral and posteromedial mitral papillary muscles and chordae tendinea.
A 65-year-old male admitted to outpatient clinic with shortness of breath. He had no known cardiac disease. The electrocardiography showed left ventricular (LV) hypertrophy and strain pattern(A).Echocardiography demonstrated concentric hypertrophy of LV with an apical aneurysm and mid-ventricular obstruction(MVO).ColorDoppler displayed a turbulence of blood flow at midventricular(MV) level and pulsed wave Doppler mapping ofLV demonstrated systolic intra-ventricular gradient at MV.Continuouswave Doppler envelope consisted of3distinct high velocity jet peaks(B).There was nomitral regurgitation flow detected with colorM-mode(C).Myocardial perfusion imaging revealed focal reversible
The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
S89
P O S T E R A B S T R A C T S
Cardiac Imaging: Rare Observations (Abstract nos. PP-214 w PP-233) - PP-214
P O S T E R A B S T R A C T S
Bovine Aortic Arch And Pulmonary Artery Aneurysm Associated With Tracheal Compression. M.C. Sumerkan1, A. Gurdal1, T. Hamit1, S. Cetin1, F. Helvaci1, E. Uysal2, M. Basak2, I. Koramaz3. 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; 2Department of Radiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; 3 Department of Cardiovascular Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. Objective: Common trunk for the brachiocephalic (innominate) artery and left carotid arteries called bovine aortic arch. The name stems from the similarity of this variant with that of a normal bovine arch. Bovine aorta is a very rare abnormality of the cardiovascular system and usually has no clinical significance. However, it may associate with other cardiovascular anomalies, aortic dissection, pulsatile tinnitus, arterial embolic events. Despite publications showed the bovine aorta, very few of them associated with tracheal compression. Herein, we present a case with bovine aorta arch and pulmonary artery aneurysm associated with tracheal compression, which is incidentally detected by X-ray film. Case Details: A 56-year-old Caucasian female admitted to the cardiology clinic with complaint of chest pain. Her past medical history displays diabetes, and hypertension, and she is on medical therapy. She did not report any other prior medical history. She had smoked approximately one pack of cigarettes daily for 20 years. Physical examination was unremarkable. Blood biochemistry values and cardiac markers were in normal range. The twelve-lead electrocardiogram revealed 64 beats/ minute sinus rhythm with normal axis. Chest roentgenogram projection showed a widened mediastinum and no active pulmonary disease (Figure 1A). A subsequent transthoracic echocardiography showed; dilatation of the pulmonary artery (parasternal short-axis view diameter: 33mm), normal pulmonary artery pressure and normal systolic function. And, also suprasternal echocardiographic view revealed one major branch
Figure 1. (A) Posteroanterior chest radiography view demonstrated massive enlargement of the left pulmonary artery (arrow) and clear lung fields. (B) Lateral image of computed tomography showed severe dilation of the pulmonary artery trunk (diameter: 53mm). Note the diameter of the pulmonary artery exceeds the aorta (diameter: 41mm). No proximal filling defects are seen. Left subclavian artery arose from the dilated segment of the proximal brachiocephalic artery (diameter: 18mm). An ostial stenosis was defined as an isolated angiographic narrowing of 30% located within two mm of the right subclavian artery origin (arrow). (C) Suprasternal long axis view of echocardiography depicting one major branch from the aortic arch. The brachiocephalic (innominate) artery (triple dagger) shares a common origin with the left common carotid artery (vertical four white dots). (D) Aortic arch leans on the trachea wall, and the trachea was displaced slightly lateral and appeared flattened in its transverse diameter (arrow). (E) Axial contrast-enhanced computed tomography imaging revealed dilation of the main right (diameter: 33mm) and left branches (diameter: 45mm). Trachea and left main bronchus compressed by aortic arch and main right pulmonary artery. (F) 3 Dimensional computed tomography left oblique view of bovine aortic arch and pulmonary artery aneurysm. As ¼ Ascending aorta; Ds ¼ Descending aorta; RPA ¼ Right pulmonary artery.
originated from the aortic arch (Figure 1C). Computed tomography was performed for further evaluation. Computed tomography showed bovine aortic arch associated with pulmonary artery aneurysm. First aortic branch is the brachiocephalic artery, followed by the left subclavian artery. Left common carotid artery originated from brachiocephalic artery. The left subclavian artery originated individually from the aortic arch (Figure 1B, D, E, F). Therapeutic strategy balanced between risks of the cardiovascular abnormally and risks due to the surgical procedure. The repair surgery was not performed due to; patient refused the operation, vascular ring is not associated with serious complications and good general condition and prognosis of the patient. Hereby conservative approach adopted. Antiplatelet therapy started. The patient is asymptomatic and still under our supervision. Conclusion: Aortic vascular anomalies should be considered in patients with chest pain. Identification with imaging modalities is important for prevention of chronic and irreversible complications. And the unusual configuration aortic arch has led to some reported difficulties with aortic treatments, such as carotid artery stenting.
- PP-215 Unusual Cases with Multiple Complex Branching False Tendons. M.C. Sumerkan, T. Hamit, S. Cetin, F. Helvaci, A. Gurdal. Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
S88 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
MARCH 13e16, 2014 Objective: False tendons are fibromuscular thin, bandelike, echogenic structures that stretch across the left ventricle cavity from the septum to the free wall. They have no clinical importance except for their possible role in the genesis of innocent murmurs and arrhythmias. The Chiari’s network presents as a highly mobile and echogenic structure these can be seen in several locations in the right atrium. And, usually has no clinical significance. However, they may associate with intraatrial thrombus, patent foramen ovale, paradoxical arterial embolic events or cardiac arrhythmias. Despite publications showed the Chiari’s network, none of them associated by more than five false tendons. Also, it is extremely rare to find multiple complex branching false tendons. Herein, we present two cases with multiple false tendons. Case 1: A 45-year-old Caucasian male admitted to the cardiology clinic with complaint of chest pain. He had no known medical history. He had smoked approximately one pack of cigarettes daily for 20 years. Physical examination and blood biochemistry values were in normal range. His blood pressure on admission was 130/85 mmHg. The electrocardiogram showed normal findings. Echocardiography was performed for further evaluation. Transthoracic echocardiography showed; normal systolic function, left ventricular concentric hypertrophy, prominent Chiari’s network and multiple false tendons (Video 1, Figure 1A). Case 2: A 29-year-old Caucasian male admitted to the cardiology clinic with complaint of chest pain. He did not have any prior cardiovascular disease. Electrocardiogram and laboratory tests were normal along with a normal physical examination. Two-dimensional echocardiography was performed which revealed trace mitral, tricuspid and pulmonary regurgitation and multiple complex branching false tendons between papillary muscles and ventricular walls (Figure 1B, C). Because of the absence of other cardiovascular anomalies and the patients remained asymptomatic, we decided to follow up patients for future symptoms. The patients remain stable on follow-up. Conclusion: False tendon and Chiari’s network are rare anatomic variants of the normal human heart. Determination of them is important for identification of associated other congenital cardiovascular malformations, arrhythmias and murmurs. And, also they should not be misinterpreted as pathologic structures such as flail mitral chordae tendineae or mural thrombi. With the increasing use of echocardiography and advancement of new echocardiography devices and the development of new imaging methods like 3Dimensional quantification, anatomy of the false tendon and Chiari’s network and their relationship to other cardiac structures will be increasingly recognized.
- PP-216 Ring Shaped Mass in Right Atrium. Kamil Güls¸en, Cenk Conkbayır, Barıs¸ Ökçün. Near East University School of Medicine. Introduction: Eustachian valve is one of the congenital remnant structure that some times emerge with infective endocarditis, trombus or obstruction. We introduce an interesting presentation of eustachian valve. Case: We present a 35 year old man that consult us for check his heart status without any cardiac complain. In his echocardiographic images we detected a large eustachian valve with patent foramen ovale in apical window (Figure 1A,1B ), in subcostal widow images seems like a mobile ring (Figure 1C,1D Video 1). Conclusion: There are some case reports in literature about various shapes and clinics for eustachian valve. Sometimes differentiating to this anatomical structure from intracardiac tumor or vegetation could be difficult.
Figure 1. Large eustachian valve and patent foramen ovale A, B Ring shaped seen C, D
- PP-217 Hypertrophic Cardiomyopaty with Mid-Ventricular Obstruction: One Obstruction, Three Dictinct Jet in One Chamber. L. Dinc Asarcikli1, M. Cebeci2, Y. Guray2, O. Tufekcioglu2. 1Diskapi Y. Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey; 2Yuksek Ihtisas Education and Research Hospital, Department of Cardiology, Ankara, Turkey. Figure 1. (A) Apical four chamber 3-dimensional transthoracic echocardiographic view with the appearance of multiple false tendons (arrows) in the left ventricle. (B) Modified 4 chamber long axis view depicting two false tendons (arrows) from anterolateral mitral papillary muscle to bazal segment of anterior septal wall. False tendons is restricting the movement of the papillary muscle by pulling towards to interventricular septal wall. Fortunately mitral valve dysfunction did not occur secondary to these lesions. (C) Modified apical 2 chamber view revealed complex branching false tendons (arrow) between base of anterolateral and posteromedial mitral papillary muscles and chordae tendinea.
A 65-year-old male admitted to outpatient clinic with shortness of breath. He had no known cardiac disease. The electrocardiography showed left ventricular (LV) hypertrophy and strain pattern(A).Echocardiography demonstrated concentric hypertrophy of LV with an apical aneurysm and mid-ventricular obstruction(MVO).ColorDoppler displayed a turbulence of blood flow at midventricular(MV) level and pulsed wave Doppler mapping ofLV demonstrated systolic intra-ventricular gradient at MV.Continuouswave Doppler envelope consisted of3distinct high velocity jet peaks(B).There was nomitral regurgitation flow detected with colorM-mode(C).Myocardial perfusion imaging revealed focal reversible
The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
S89
P O S T E R A B S T R A C T S