299: Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

ObjectivesThe purpose of this study is to assess cardiac remodeling and to determine factors predicting the occurrence of atrial arrhythmia after surgical closure of atrial septal defect (ASD) in adults.MethodsRetrospective study including 33 adult patients (>20 years old, mean age: 34±11 years, 26 women) who underwent surgical closure of secundum or sinus venosus ASD. Before operation, all patients had dyspnea and 15% were in NYHA III-IV. Sinus rythm was present in 85% of patients. The ratio of pulmonary to systemic blood flow was calculated, yielding a mean of 2,8±1 and pulmonary artery hypertension (PAH) was observed in 80% of patients with a mean value of 41,3±10mmHg. The ASD were closed by pericardial or Dacron patch in 97% of cases.ResultsOperative death was observed in 2 cases. In survival patient, with a follow-up of 97+/−57 months, regression of right ventricular dilatation and PAH occurred in the first post-operative month and was maintained at late follow-up. Atrial arrhythmia occurred in 4 patients and were determined by older operative age (p=0.003) and the absence of cardiac remodeling after surgery.ConclusionSurgical correction of ASD in adults is safe and efficacious. Cardiac remodeling after ASD closure in the adult is a common and an early event and prevents late morbidity which is in most cases due to arrhythmias. The mode of closure does not seem to significantly impact remodeling

161: Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

IntroductionPercutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC.Methods322 patients (66% women), average age: 35 ±13 years (9-75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC >1,5cm2 and gain in MA >25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA <1,5cm2 and/or loss >50% of initial gain in MA.ResultsThe rate of primary success of PMC was 86% and mean MA post PMC was 1,82±0,33cm2 compared to MA pre-PMC of 1±0,18cm2 (p <0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62±32 months, only 12% of patients had a dyspnea stage IIIIV of NYHA, MA was 1,64±0.3cm2 (p<0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60,48±27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score >8, MA after PMC <1,8cm2 and absence of bicommissural opening post PMC.ConclusionA favorable anatomy of mitral apparatus and the optimisation of immediate result of PMC are the guaranty for the maintain of good result in the long term

323: Pulmonary embolism: the value of transthoracic echocardiography

IntroductionAcute pulmonary embolism (PE) remains a life-threatening disease and one of three major disease entities with chest discomfort seen in the emergency room. Despite progress in imaging techniques and knowledge of this disease, its medical diagnosis is one of the most difficult to achieve. The clinical assessment of PE probability remains central to the diagnosis and evaluation. Presently, accepted diagnostic modalities for the confirmation of PE include V/Q scanning, chest CT, and standard angiography. All approaches have limitations. Because echocardiography is noninvasive, provides rapid bedside results. It is an attractive imaging modality to diagnose PE.PurposeThe purpose of this study is to assess the contribution of transthoracic echocardiography (TTE) in the clinical setting of PE.ResultsEighteen patients were included. There were 7 men and 11 women. The mean age was 57 years [28; 80]. TTE was performed in all patients within the first 24 to 72 hours of admission. The diagnosis of PE was confirmed by standard angiography in all cases. Tricuspid regurgitation was the most common TTE finding (16 of 18), followed by dilated right ventricle (15 of 18), pulmonary hypertension (11 of 18), paradoxical interventricular septal motion (7 of 18) and right ventricular hypokinesis (2 of 18). TTE revealed thrombi inside the right-sided heart cavities in 3 patients. The thrombus was detected at the apex of the right ventricle in the first case, at the right atria in the second case and many thrombi were objectified even at the right atria and ventricle, at the inferior vena cava and at the left pulmonary artery in the third case.ConclusionTransthoracic echocardiography may reveal findings that strongly support hemodynamically significant PE. In the majority of cases TTE provides only indirect signs of PE. It could, though, far less frequently visualise thromboembolic material inside the right-sided heart cavities. Direct visualisation of the thrombus, although confirming PE, remains an exceptional finding. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy