named after Dr. Nicholas Kounis in 1991 coining it âallergic anginaâ. Since then this condition has evolved to include a number of mast cell activation disorders ...
MARCH 13e16, 2014
- PP-301 Behçet Disease Presented with Acut Cerebral and Coronary Infarct Caused by Left Main Coronary Artery Aneurysm. A. Do gan, M. Oylumlu, C. Kilit, B. Amasyalı. Department of Cardiology, Dumlupınar University, Kütahya, Turkey.
P O S T E R A B S T R A C T S
A 17 years old male was admitted to the emergency department with paraplejia and suddenly loss of consciousness tree months ego. At that time, acute cerebral infarct have been identified. He was hospitalized to the neurology clinic with a diagnosis of stroke., After treatment, when opened of consciousness and the general state improved of the patient was discharged with neurological sequelae. Tree months after the stroke, the patient was admitted to our clinic with complaints of shortness of breath. There were signs of prior MI in the anterior leads of ECG(QS pattern in V1-4) (Figure 1A). Echocardiography showed an ejection fraction of 0.45, with hypokinesia of the left ventricular apex and septum. Myocardial perfusion scintigraphy was performed for the ischemia analysis. Because of transmural infarction and ischemia was detected in apex and septum, we performed coronary angiography. Coronary angiogram showed a giant, saccular aneurysm of the left main coronary artery, which measured 24 mm 16 mm(Figure 1B). Other coronary arteries were normal. The patient had no history of diabetes mellitus, hypertension, hyperlipidemia and smoking and body mean index was normal. Biochemical and hematological parameters were normal. As a result of rheumatologic examination, Behçet’s disease was diagnosed. At the whole body computed tomography, other vascular pathology was not detected. Because of another thromboembolic focus could not be found, coronary aneurysm was considered as a cause of cerebral and coronary infarction. The patient was referred for coronary artery bypass surgery. Coronary aneurysm is rarely seen in Behcet’s disease. As in our case, coronary aneurysm may present with thromboembolic events and this events can cause serious morbidity and mortality. For this reason we suggest that Behcet’s disease should be kept in mind in the etiology of coronary aneurysms and every Behcet’s disease should be evaluated for coronary aneurysms.
Kounis syndrome is characterized by a group of symptoms that manifest as unstable vasospastic or non-vasospastic angina secondary to a hypersensitivity reaction. This syndrome was first described and therefore named after Dr. Nicholas Kounis in 1991 coining it “allergic angina” Since then this condition has evolved to include a number of mast cell activation disorders which are associated with acute coronary syndrome. Examples include reactions to multiple medications (NSAIDs, antibiotics, and antineoplastic agents), contrast exposure, poison ivy, bee stings and reaction to shellfish. The following case report describes a patient who experienced anaphylactic shock an associated with coronary artery ischaemia (inferior ST-segment elevation myocardial infarction) A 37-year-old male patient was admitted to a hospital because of and urticaria.and he was given feniramine. A few minutes thereafter, the patient developed chest pain and his electrocardiography (ECG) showed ST-segment elevation in leads II, III and avF. The patient was immediately shifted to our hospital because of acute myocardial infarction. Cardiac catheterization demonstrated diffuse coronary spasm of right coronary artery (RCA). After intracoronary nitroglycerin injection there was no lesion of his RCA. After catheterization. He had not complain any symptoms of angina pectoris and his ECG had no specific changes.Cardiac enzymes and troponin-I were elevated. He had no history of diabetes mellitus, hypertension, smoking orother risk factors for cardiovascular events. The patient was discharged to home with oral nitrogliserin Myocardial Infarction with elevated ST-Segment is a rare complication of anaphylactic reactions, but can occur even in patients with angiographically normal coronary arteries, and similar cases have been reported before. We recommend that ECG be done in all patients developing hypersensitivity reactions. In case a previously normal patient develops acute coronary spasm, all possible causes of allergy should be looked for.
Functional and Hemodynamic Evaluation in Valvular Disease (Abstract nos. PP-303 w PP-308) - PP-303 Aortic Elastic Properties in Patients with Mitral Valve Prolapse. _ Ö. Uçar Elalmıs¸, H.T. Gürsoy, D. S¸ahin, H. Çiçekçioglu, M. Ileri. Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Figure 1. A) Electrocardiogram shows QS pattern in V1-4. B) Coronary angiogram shows a giant aneurysm in the left main coronary artery (25 16 mm).
- PP-302 Kounis Syndrome: Inferior ST-Segment Elevation Myocardial Infarction Following Anaphylactıc Shock. A. Balun, E. Kızıltunç, M. Çetin, H. Çiçekçioglu, Z. Çetin, M. S¸ahin, E. Örnek, F.V. Ulusoy. Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Introduction: Mitral valve prolapse (MVP) is the most common valvular heart disease and characterized by displacement of mitral valve leaflet >2 mm into the left atrium during systole. Other echocardiographic findings associated with MVP are, leaflet thickening (in classic form), redundancy, annular dilatation and chordal elongation. Therefore MVP may be with increased elastic properties of the aorta. There are conflicting results in previous studies. In one study, aortic elastic properties were decreased. In another study, classic (with leaflet thickeninig) and non-classic (without leaflet thickening) forms of MVP were compared and aortic elasticity was found to be increased in classic MVP group. We also aimed to investigate elastic properties of the aorta in patients with MVP. Methods: In present study, 16 patients with MVP and 19 healthy controls were included. Inclusion criteria: Echocardiographic evidence of >2 mm systolic displacement of mitral valve leaflets into the left
S128 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
MARCH 13e16, 2014 atrium, no history of hypertension, diabetes, hyperlipidemia, coronary artery disease or end-stage renal disease. Aortic strain, stiffness index and distensibility were calculated by using aortic diameters obtained by echocardiography and blood pressures measured by sphygomanometer. Diameter of the aorta was measured from M-mode tracing at a level of 3 cm above the aortic wall. The aortic systolic diameter (AoS) was measured at the maximal anterior motion of the aorta, whereas diastolic diameter (AoD) was measured at the peak of QRS complex. Following formulas were used: Aortic strain¼AoS-AoD/AoD, stiffness index¼ln(systolic blood pressure/diastolic blood pressure)/aortic strain, aortic distensibility¼2xaortic strain/pulse pressure. All subjects had normal left atrial and ventricular diameters and normal left ventricular ejection fraction. Results: Baseline characteristics and aortic elasticity parameters are given in table 1. There was no significant difference between MVP and control group by means of age, gender, systolic blood pressure, diastolic blood pressure, systolic aortic diameter and diastolic aortic diameter. When the aortic elastic parameters were compared (aortic strain, stiffness index and distensibility), no difference were found between MVP and control group (Table 1). Conclusion: We found similar aortic elastic properties between MVP and control patients. Studies give inconsistent results on this subject and further larger scale studies are needed.
Table 1
Methods: Peripheral venous plasma value of mean platelet volume was measured in 84 consecutive patients (16 men, 68 women; mean ageSD¼ 4413 years) with RMS who had no left atrial thrombus by transesophageal echocardiography. The control group consisted of 32 healthy subjects (9 men, 23 women; mean age SD¼ 387 years). Results: The patients had significantly higher MPV values ( mean SD ¼ 10.32 1.14 fl) compared with the healthy subjects ( mean SD ¼ 8.21 0.84 fl) (p˂0.001). Among many clinical and echocardiographic variables, severe mitral regurgitation (odds ratio¼ 7.4, P˂0.001) and left atrial spontaneous echo contrast positivity (odds ratio¼ 18.5, P˂ 0.001) appeared as significant predictors of increased platelet activity in multivariate logistic regression analysis. Conclusion: Patients with RMS have increased platelet activity reflected as elevated MPV; and coexistence of severe mitral regurgitation and presence of left atrial spontaneous echo contrast are determinants of this increment.
- PP-305 Functional and Hemodynamic Outcome of Mitral Valve Repair and Echo Dobutamine Assessment in Barlow’s Disease. E. Prifti1, M. Bonacchi2, G. Giunti2, A. Baboci1, A. Veshti1, A. Ibrahimi1, M. Zeka1. 1Division of Cardiac Surgery, University Hospital Center of Tirana, Albania; 2Division of Cardiac Surgery, Policlinico Careggi, Florence, Italy. Objectives: The aim of this report was to evaluate the stability of repair and haemodynamic response to stress using Dobutamine infusion in patients undergoing anatomic correction of mitral valve regurgitation in Barlow’s disease. Materials-Methods: Between January 2002 and January 2012, a total of 35 patients with Barlow’s disease underwent mitral valve repair. Five patients were in NYHA class I, 17 patients in class II and 13 in class III. All patients had a flail posterior leaflet and were treated by quadrangular resection and the “ sliding technique”. Those with a flail anterior leaflet (6 patient) were treated with insertion of gore-tex chordae. Posterior annuloplasty was performed in 20 patients by a 3 mm ⌀ gore-tex tube. At 1 year, all patients underwent baseline and dobutamine stress echocardiography to assess the stability of repair and the haemodynamic response to stress. Results: Cardiopulmonary by-pass and aortic cross-clamp time were, respectively, 6625 min and 5019 min. No hospital death occurred. The mean post-operative stay was 8,52,5 days. The pre-discharge echo showed: absence of mitral regurgitation in 20 patients, mild regurgitation in 15 patients and normal trans-mitral flow in all patient. Dobutamine stress echocardiography showed normal annular excursions, mitral valve area, mean transvalvular gradient and pulmonary artery pressure at rest and stress. LVESD under stress improved significantly from 427.3mm at rest to 386.2 mm under stress (p¼0.002), mitral valve area at rest 2.90.9 cm2 to 4.5 1.7 cm2 at stress (p¼0.001). Conclusions: Anatomic correction of mitral valve regurgitation is feasible in Barlow’s disease with optimal results. Dobutamine stress echocardiography is helpful to evaluate the haemodynamic response to stress after mitral valve reconstruction.
- PP-304 Increased Mean Platelet Volume in Rheumatic Mitral Stenosis: Assessment of Clinical and Echocardiographic Determinents. _ M. Ileri, S. Kanat, H.T. Gürsoy, D. S¸ahin, P.T. Bayır, G. Çiçek, F. Bas¸yi git, Ö.U. Elalmıs¸, Ü. Güray. Kardiyoloji Klinigi, Ankara Numune E gitim ve Aras¸tırma Hastanesi, Ankara, Türkiye. Objective: The aim of this study was to investigate mean platelet volume (MPV) in patients with rheumatic mitral stenosis (RMS) and to define the determinants of a possible platelet activation reflected as platelet volume enlargement.
- PP-306 Caseous Calcification of Mitral Annulus: A Rare Variant of Mitral Annular Calcification. M. Dogan1, Z. Is¸ılak1, M. Atalay2, Ö. Uz1. 1 Department of Cardiology, GATA Haydarpasa Military Hospital, Istanbul, Turkey; 2Department of Cardiology, Merzifon Military Hospital, Amasya, Turkey. Introduction: Mitral annular calcification (MAC) is a common echocardiographic image mostly seen in elderly women, that is found in
The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster S129
P O S T E R A B S T R A C T S
