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PP-272 A FREE-FLOATING LEFT ATRIAL THROMBUS IN A CASE WITH RHEUMATIC MITRAL STENOSIS
S190
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-272 A FREE-FLOATING LEFT ATRIAL THROMBUS IN A CASE WITH RHEUMATIC MITRAL STENOSIS A. Ulucay ¸ 1 , M.A. Celkan2 , M.F. Aksoy1 , S.K. Bayatlı2 . 1 Department of Cardiology, Defne Hospital, Antakya, Hatay, Turkey; 2 Department of Cardiovascular Surgery, Defne Hospital, Antakya, Hatay, Turkey Objective: A free-floating thrombus in the left atrium without attachment to any cardiac structure is a rare clinical entity. Clinical consequences may be fatal in such a case. The thrombus may obstruct the mitral orifice or cause cerebral-peripheral embolic events. Methods: A 72-year-old woman presented with complain of shortness of breath. At the time of admission, she was not on any medication and in New York Heart Association functional class III. On physical examination, she was dysrhythmic, tachycardic (110 beats/min) and normotensive (blood pressure 110/75 mm Hg). Cardiac auscultation findings were typical for mitral and aortic stenosis. An electrocardiogram showed atrial fibrillation with nonspecific T wave changes in the anterolateral leads. A transthoracic echocardiography (TTE) revealed a rheumatic mitral stenosis with a planimetric valvular area of 1.0 cm2 , and an echogenic left-atrial mass diagnosed as a free-floating left-atrial thrombus (Figure 1). In addition, she had moderate aortic stenosis and mild to moderate aortic valve regurgitation with preserved left ventricular systolic functions. Coronary angiography showed a normal left coronary artery tree, and a high take off right coronary artery with wall irregularities. The patient underwent an emergency cardiac surgery to remove the left atrial mass and replace the mitral and aortic valves. At the time of the surgery, left atrial thrombectomy, mitral valve replacement (29 mm St Jude Medical (SJM) valve, St. Jude Medical Inc., St. Paul, MN), aortic valve replacement (21 mm SJM valve) and surgical ablation of atrial fibrillation were performed successfully. Results: Histological examination of the mass confirmed that it was a thrombus. Post-operative course was uneventful, and she was discharged after 6 days in the hospital. Conclusions: In a case with a free-floating left atrial thrombus, prompt surgical intervention may be life saving.
Collaboration of Endocarditis-Prospective Cohort, CNS constitute %7.8 of all native valve endocarditis (NKE). According to this cohort, there were major differences between patients with community based native valve endocarditis and those with hospital based endocarditis. Most of the patients who had hospital based endocarditis had predisposing factors such as previous history of hemodialysis, invasive procedure, pacemaker or presence of a central catheter for a long time. In our case, there were no history of hospitalization or history of any invasive procedure. Methods: Our patient admitted to emergency department with the chief complaint of chest pain. She was taken to the catheter laboratory with a diagnosis of inferior MI and the coronary angiogram revealed normal coronary arteries (Figure 1). In the clinical course, the patient had a worsening situation, high degree fever (up to 40C) and acute pulmonary edema. The physical exam revealed high degree fever (up to 40C), 3/6 murmur in the aortic position, diffuse rales in the bazal and mid portions of both lungs. In the laboratory results, Troponin I was 8.2 ng/dL, sedimentation was 106 mm/h abd C Reactive Protein was 4.02 mg/dL.ST elevation was detected in II, III and aVF leads (Figure 2). During transthoracic echocardiography examination, there was detected a heterogenous irregular mass on the noncoronary cuspis of the aortic valve which was thought to be a vegetation (Figure 3). TEE was performed thereafter and there a mass with a diameter of 0.23×0.91 cm on the noncoronary cuspis of aortic valve which was consistent with vegetation (Figure 4). Besides, moderate to severe aortic insufficiency and moderate mitral insufficiency were present. After taking blood cultures, antibiotics were started empirically with the diagnosis of infective endocarditis. There were no clinical response to empirical antibiotherapy during the hospital course. Methicilline resistant coagulase negative Staphylococci was cultured and vankomycine was started upon the sensitivity of the cultured bacteria. There was a dramatical improvement in the clinical situaiton of the paitent and the therapy was went on for 6 weeks under the suggestions of the Department of Infectious Diseases. Results: Coagulase negative Staphylococci seem to be an increasing cause of native valve endocarditis. It is located mostly in the right side of heart the patients who had with prolonged hospitalization and history of invasive procedure.
Figure 1. Apical four chamber view showed a thickened-calcified mitral valve and mobile mass (3.5×2.7 mm) in the left atrium. PP-274 LEFT SIDED ENDOCARDITIS CAUSED BY COAGULASE NEGATIVE STAPHYLOCOCCI 1 2 M.F. Karakas¸ 1 , E. Buy ¨ ukkaya ¨ , A.B. Akcay ¸ 1 , V.M. Koksaldı ¨ , 3 2 ¨ H. Sozen ¨ , P. Bilen1 , M. Kurt1 , Y. Onlen , N. Sen ¸ 1 . 1 Department of Cardiolog, Mustafa Kemal University, Hatay, Turkey; 2 Department of Infectious Diseases, Mustafa Kemal University, Hatay, Turkey; 3 Department of Infectious Diseases, Mugla University, Mugla, Turkey Objective: Coagulase negative Staphylococci (CNS) is an increasing cause of native valve endocarditis. According to International
Figures 1–4: Coronary angiogram revealed normal coronary arteries, ST elevation was detected in II, III and aVF leads, TTE and TEE examination;vegetation on the noncoronary cuspis of aortic valve.
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-272 A FREE-FLOATING LEFT ATRIAL THROMBUS IN A CASE WITH RHEUMATIC MITRAL STENOSIS A. Ulucay ¸ 1 , M.A. Celkan2 , M.F. Aksoy1 , S.K. Bayatlı2 . 1 Department of Cardiology, Defne Hospital, Antakya, Hatay, Turkey; 2 Department of Cardiovascular Surgery, Defne Hospital, Antakya, Hatay, Turkey Objective: A free-floating thrombus in the left atrium without attachment to any cardiac structure is a rare clinical entity. Clinical consequences may be fatal in such a case. The thrombus may obstruct the mitral orifice or cause cerebral-peripheral embolic events. Methods: A 72-year-old woman presented with complain of shortness of breath. At the time of admission, she was not on any medication and in New York Heart Association functional class III. On physical examination, she was dysrhythmic, tachycardic (110 beats/min) and normotensive (blood pressure 110/75 mm Hg). Cardiac auscultation findings were typical for mitral and aortic stenosis. An electrocardiogram showed atrial fibrillation with nonspecific T wave changes in the anterolateral leads. A transthoracic echocardiography (TTE) revealed a rheumatic mitral stenosis with a planimetric valvular area of 1.0 cm2 , and an echogenic left-atrial mass diagnosed as a free-floating left-atrial thrombus (Figure 1). In addition, she had moderate aortic stenosis and mild to moderate aortic valve regurgitation with preserved left ventricular systolic functions. Coronary angiography showed a normal left coronary artery tree, and a high take off right coronary artery with wall irregularities. The patient underwent an emergency cardiac surgery to remove the left atrial mass and replace the mitral and aortic valves. At the time of the surgery, left atrial thrombectomy, mitral valve replacement (29 mm St Jude Medical (SJM) valve, St. Jude Medical Inc., St. Paul, MN), aortic valve replacement (21 mm SJM valve) and surgical ablation of atrial fibrillation were performed successfully. Results: Histological examination of the mass confirmed that it was a thrombus. Post-operative course was uneventful, and she was discharged after 6 days in the hospital. Conclusions: In a case with a free-floating left atrial thrombus, prompt surgical intervention may be life saving.
Collaboration of Endocarditis-Prospective Cohort, CNS constitute %7.8 of all native valve endocarditis (NKE). According to this cohort, there were major differences between patients with community based native valve endocarditis and those with hospital based endocarditis. Most of the patients who had hospital based endocarditis had predisposing factors such as previous history of hemodialysis, invasive procedure, pacemaker or presence of a central catheter for a long time. In our case, there were no history of hospitalization or history of any invasive procedure. Methods: Our patient admitted to emergency department with the chief complaint of chest pain. She was taken to the catheter laboratory with a diagnosis of inferior MI and the coronary angiogram revealed normal coronary arteries (Figure 1). In the clinical course, the patient had a worsening situation, high degree fever (up to 40C) and acute pulmonary edema. The physical exam revealed high degree fever (up to 40C), 3/6 murmur in the aortic position, diffuse rales in the bazal and mid portions of both lungs. In the laboratory results, Troponin I was 8.2 ng/dL, sedimentation was 106 mm/h abd C Reactive Protein was 4.02 mg/dL.ST elevation was detected in II, III and aVF leads (Figure 2). During transthoracic echocardiography examination, there was detected a heterogenous irregular mass on the noncoronary cuspis of the aortic valve which was thought to be a vegetation (Figure 3). TEE was performed thereafter and there a mass with a diameter of 0.23×0.91 cm on the noncoronary cuspis of aortic valve which was consistent with vegetation (Figure 4). Besides, moderate to severe aortic insufficiency and moderate mitral insufficiency were present. After taking blood cultures, antibiotics were started empirically with the diagnosis of infective endocarditis. There were no clinical response to empirical antibiotherapy during the hospital course. Methicilline resistant coagulase negative Staphylococci was cultured and vankomycine was started upon the sensitivity of the cultured bacteria. There was a dramatical improvement in the clinical situaiton of the paitent and the therapy was went on for 6 weeks under the suggestions of the Department of Infectious Diseases. Results: Coagulase negative Staphylococci seem to be an increasing cause of native valve endocarditis. It is located mostly in the right side of heart the patients who had with prolonged hospitalization and history of invasive procedure.
Figure 1. Apical four chamber view showed a thickened-calcified mitral valve and mobile mass (3.5×2.7 mm) in the left atrium. PP-274 LEFT SIDED ENDOCARDITIS CAUSED BY COAGULASE NEGATIVE STAPHYLOCOCCI 1 2 M.F. Karakas¸ 1 , E. Buy ¨ ukkaya ¨ , A.B. Akcay ¸ 1 , V.M. Koksaldı ¨ , 3 2 ¨ H. Sozen ¨ , P. Bilen1 , M. Kurt1 , Y. Onlen , N. Sen ¸ 1 . 1 Department of Cardiolog, Mustafa Kemal University, Hatay, Turkey; 2 Department of Infectious Diseases, Mustafa Kemal University, Hatay, Turkey; 3 Department of Infectious Diseases, Mugla University, Mugla, Turkey Objective: Coagulase negative Staphylococci (CNS) is an increasing cause of native valve endocarditis. According to International
Figures 1–4: Coronary angiogram revealed normal coronary arteries, ST elevation was detected in II, III and aVF leads, TTE and TEE examination;vegetation on the noncoronary cuspis of aortic valve.