P1734 Surprising image in the aortic root, is it zebra ?

Abstract CASE 80 year old-man patient was admitted our emergency department with dyspnea and chest pain. Transthoracic echocardiography (TTE) was performed.Ejection fraction was %60.Severe tricuspid regurtation was observed and pulmonary artery pressure was 55 mmHg.TTE showed mobile, hyperdense, flap-like appearance (Figure 1-A) Thorax computerized tomography (CT) angiography scan was performed with the suspicion of aortic dissection.CT angiography showed that there is no aortic dissection.(Figure 1-B) Transesophageal echocardiography (TEE) was planned. TEE showed an appearance consistent with the prosthetic material extending from the ascending aorta to the left main coronary artery.(Figure 1-C,D) When the patient"s history was investigated in detail, it was learned that the patient underwent coronary angiography six months ago.The patient was recommended bypass surgery, but he refused bypass surgery. Due to his rejection of bypass surgery, percutaneous intervention was attempted to the left anterior descending artery. Percutaneous coronary intervention was unsuccessful due to the severely calcified lesions. After learning this information, it was decided to perform imaging with fluoroscopy and chest CT without contrast.Because the image mimicking aortic dissection was thought to be the material related to previous unsuccesfull percutaneous coronary intervention. CT showed linear, hyperdense metallic densities that mimicked aortic dissection,extending form the left main coronary artery orifice to the ascending aorta. (Figure 1-E) The patient underwent imaging under fluoroscopy. In the imaging of the patient under fluoroscopy, it was observed that the image was consistent with the stent extending from the aorta to the left main coronary. (Figure 1-F) The mystery was solved and it was understood that during the unsuccessfull percutaneous coronary intervention the stent was removed from the balloon in the ascending aorta. CONCLUSİON In patients presenting with shortness of breath and chest pain, differantial diagnoses should always be life-threatening conditions such as aortic dissection, myocardial infarction and pulmonary embolism. When you hear hoofbeats, think of horses not zebras as taught in the early years of medical schools. Everything is never as it seems.Sometimes the sound of hoofbeats may also belong to the zebras.It is very important to evaluate the patient and medical history together with different perspectives. Abstract P1734 Figure.</jats:p

P699 Atrial septum tearing due to balloon sizing in percutaneous closure of ASD

Abstract INTRODUCTION Percutanous closure of atrial septal defect (ASD) has become an accepted ,reliable procedure and alternative to surgical treatment.Various complications associated with this procedure have been identified but tear of atrial septal rim is a very rare complication.We report a case of atrial septal rim tear due to balloon sizing and diagnosed at the same time by transesophageal echocardiography (TEE). CASE A 64-year-old female patient was admitted to our clinic with dyspnea.Transthoracic echocardiography (TTE) was performed.Ejection fraction was %60 .Moderate tricuspit regurgitation was observed and pulmonary artery pressure was 45 mmHg. TTE revealed a left to right shunt and TEE was planned.2D and 3D-TEE was performed.Two separate secundum type ASD were observed and diameters of defects were measured as 15 mm and 14 mm.Measurement of rim between two defects was 7 mm.(Figure 1 A-B-C) It was observed that the aortic rim was absent but the other rims were sufficient for percutaneous closure.Percutaneous closure was planned .Balloon sizing with a 34-mm AGA balloon resulted in a stretched defect diameter of 26 mm using the stop-flow technique.After the measurement of ASD with sizing balloon flail structure was observed in atrial septal rim.We evaluate this image from various echocardiographic window and we diagnosed the atrial septal rupture. (Figure 1-E ) The patient was hemodynamically stable during the intervention and the atrial septal rupture diameter did not increase. Therefore it was decided to continue the process.ASD diameter was measured again after the rupture of the atrial septum and it was measured 26 mm by TEE and sizing balloon. A 28-mm Amplatzer septal occluder (ASO) was selected.In the same session 28 mm ASO device was successfully placed in the defect.In the TEE examination, it was found that the device was in correct place, there was no shunt from left to right and the torn was between the two discs of the device.(Figure 1-F) The procedure was successfully completed without complications. DISCUSSION Rupture of the interatrial septum or rim during percutaneous ASD closure is a very rare complication. Possible causes of rupture in the interatrial septum when using sizing balloon may be the manipulation of the sizing balloon, passing the guide wire through a small atrial septum fenestration , and the over-stretching of the sizing balloon.There are very rare case reports in the literature about this subject. The rupture of the atrial septum can be enlarged, and therefore surgical treatment has to be performed in these cases in the literature. CONCLUSION In this case, we tried to present the rupture of the interatrial septum, which is a rare complication that may develop when using sizing balloon, and successful percutaneous closure of ASD in the same session. Abstract P699 Figure. </jats:sec

Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries

WOS: 000468732700018PubMed ID: 31054483Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.ESC - EORP; AmgenAmgen; Eli LillyEli Lilly; PfizerPfizer; SanofiSanofi-Aventis; Ferrer; Novo NordiskNovo NordiskThe EUROASPIRE V survey was carried out under the auspices of the ESC - EORP. Since the start of EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript

Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries

Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8\% of the patients and had been started or increased in intensity in 11.7\%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8\% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient