S. Fırtına

A giant pericardial cyst in an unusual localization

Pericardial cysts are rareand benign lesions of the heart. They are usually asymptomatic and incidentally diagnosed on chest X-ray. Most are located at the right cardiophrenic angle. Life-threatening complications may be infrequently encountered. We report the case of a 54 year-old male with acute coronary syndrome and a pericardial cyst in an unusual localization.

Percutaneous effective closure of severe aortic prosthetic paravalvular leak using Amplatzer duct occluder device with the guidance of 3D TEE.

Aortic paravalvular leaks are well-known complications of prosthetic valve replacement. They are asymptomatic and small, but sometimes may cause symptoms due to severe regurgitation or hemolysis. Medical therapy is limited, while operation causes significant mortality. Percutaneous transcatheter closure techniques, potentially offer symptomatic relief. We describe the use of an Amplatzer duct occluder device with the guidance of 3dimensional transesophageal echocardiography (3DTEE) in a patient with severe aortic prosthetic paravalvular leak resulting in effective closure.

The Value of Frontal Planar QRS-T Angle in Patients without Angiographically Apparent Atherosclerosis

Objective: The present study was undertaken to investigate the prognostic value of the frontal planar QRS-T angle in patients without angiographically apparent coronary atherosclerosis. Subjects and Methods: Three hundred and seven patients with normal coronary arteries on coronary angiography were included. The absolute difference between the frontal QRS- and T-wave axes was defined as the frontal planar QRS-T angle, and patients were divided into 3 subgroups based on the frontal planar QRS-T angle (<45, 45-90, and >90°). Demographic, clinical, laboratory, and angiographic data were compared between groups. Based on the regression analysis results, patients were recategorized into 4 groups according to their luminal calibers of left main coronary artery (LMCA) and history of hypertension (HT) (nonhypertensive LMCA ≤4.13 mm, nonhypertensive LMCA >4.13 mm, hypertensive LMCA ≤4.13 mm, and hypertensive LMCA >4.13 mm). Results: The median value of the frontal planar QRS-T angle of all participants was 38°. Subjects with the widest frontal planar QRS-T angle were older (p = 0.027), were hypertensive (p = 0.001), and had higher corrected QT values (p = 0.001). Patients with the widest frontal planar QRS-T angle had larger LMCA and left anterior descending coronary artery diameters compared to subjects with a normal and borderline frontal QRS-T angle (p = 0.004 and p = 0.028, respectively). Corrected QT, HT, and LMCA diameter were found as independent predictors of the frontal planar QRS-T angle. Subjects with HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle. Conclusion: Patients with a history of HT and a larger luminal caliber of LMCA had the widest frontal planar QRS-T angle. Since HT-induced electrophysiological changes are still not well established and we observed that changes in the luminal caliber of coronary arteries are associated with an abnormal frontal QRS-T angle, the frontal QRS-T angle could serve as a marker of ventricular repolarization heterogeneity in hypertensive patients in addition to keeping track of arrhythmic events, even before overt disease.

Utility of γ-Glutamyl Transferase in Predicting Troponin Elevation in Emergency Departments

Serum γ-glutamyl transferase (GGT) activity is a risk predictor for the development of coronary artery disease and is related to cardiovascular morbidity and mortality. We evaluated the clinical utility of GGT activity in predicting high troponin levels in patients with acute coronary syndrome (ACS) admitted to the emergency department with chest pain. A total of 200 troponin-positive and 203 troponin-negative patients were classified into groups 1 and 2, respectively. γ-Glutamyl transferase activity was significantly higher in group 1 (44 ± 34 U/L) compared with group 2 (31 ± 26 U/L, P = .001). A GGT activity cutoff >25.5 showed 62% sensitivity and 61% specificity in predicting troponin positivity. Logistic regression analysis demonstrated a significant predictive value of GGT for troponin positivity. Spearman rank correlation analysis showed a moderately strong relationship between GGT activity and troponin positivity. Considering the predictive value of high GGT activity for troponin positivity, GGT activity may complement other diagnostic biomarkers for predicting troponin positivity in patients having ACS admitted with chest pain.

The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography

To evaluate the myocardial dysfunction in the early stage of nonhemorrhagic stroke and its association with the National Institutes of Health Stroke Scale (NIHSS) score, by two‐dimensional speckle tracking echocardiography.

Torsade de Pointes Triggered by Early Ventricular Escape Beats in a Patient with Complete Atrioventricular Block.

Torsade de pointes is an uncommon and malignant form of polymorphic ventricular tachycardia and associated with a prolonged QT interval, which may be congenital or acquired. Complete atrioventricular block may cause QT interval prolongation and torsade de pointes. In this paper, we present a case with complete atrioventricular block complicated with frequent episodes of torsade de pointes triggered by early premature ventricular contractions despite normal QT intervals.

PP-068 CARDIAC AMYLOIDOSIS DIAGNOSED WITH ALTERED GADOLINIUM KINETICS ON CARDIAC MR

younger twin, increased trabeculations in left ventricular lateral and apical segments with the ratio of non-compacted to compacted layers of 1.6 were observed. CMR also revealed mid-myocardial and subepicardial late linear gadolinium enhancement indicating nonischemic myocardial injury. Conclusion: Genetic predisposition to the development of cardiomyopathy must be evaluated before management. As in our cases, in the absence of hereditary factors, it is believed that a possible viral intervention during fetal life can produce cardiomyopathy in twins. The CMR findings may prove to have value in diagnosis with high sensitivity and specifity.

PP-197 LARGE THROMBUS BURDEN IN ACUTE MYOCARDIAL INFARCTION: ROLE OF CONSERVATIVE STRATEGY

uneventfully. Discussion: Younger patients presenting with ACS generally have a larger thrombus burden in the absence of a significant coronary stenosis. Thrombus-rich coronary lesions are at higher risk for distal embolization and no-reflow. In this report we describe a relatively rare finding in the setting of acute myocardial infarction: the presence of large intraluminal thrombus without critical impairment of the anterograde flow (TIMI 2–3) in a coronary artery without detectable atherosclerosis. In this setting the optimal strategy is controversial. In patients who have a large-thrombus burden and no significant coronary stenosis thrombolysis without stenting may provide an optimal solution.

PP-071 RIGHT ATRIAL MASS AFTER SURGICAL REPAIR OF ATRIAL SEPTAL DEFECT: THROMBUS MASQUERADING AS A MYXOMA

PP-070 LEFT COMMON PULMONARY VENOUS OSTIUM MIMICKING LEFT ATRIAL APPENDAGE ANEURYSM: ECHOCARDIOGRAPHIC MISDIAGNOSIS U.C. Yuksel, E. Yalcinkaya, E. Yildirim, T. Celik, U. Bozlar, M. Celik, Y. Gokoglan, B. Bugan, S. Firtina, A. Iyisoy, H.K. Kabul. Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Cardiology, Malatya Army Hospital, Malatya, Turkey; Department of Cardiology, Erzincan Army Hospital, Erzincan, Turkey Objective: The two most common pulmonary venous (PV) anomalies are the presence of aright middle PV and common left trunk. Herein, we report a patient with left common pulmonary venous ostium misdiagnosed as left atrial appendage aneurysm on echocardiography. Methods: A 67-year-old female with a medical history of hypertension admitted to our outpatient department for palpitation and dyspnea on exercise. She was advised to undergo routine echocardiography, which showed dilated left ventricle, decreased left ventricular ejection fraction (25%), moderate mitral regurgitation and left atrial appendage aneurysm. She was referred to cardiac computed tomographic angiography (CTA) for delineating anatomy. Results: CTA revealed an unusual pulmonary venous anomaly consisting of a left-sided common and unusually large ostium of left pulmonary veins draining to left atrium and normal coronaries. Conclusion: Cardiac anatomic variants has become increasingly important as the number of radiofrequency ablations has increased. The definite differentiation of pulmonary common ostium from an atrial appendage aneurysm could be made with transesophageal echocardiography, computed tomography and magnetic resonance imaging.

PP-072 PERSISTENT LEFT SUPERIOR VENA CAVA WITH AGENESIS OF RIGHT SUPERIOR VENA CAVA: DIAGNOSIS OF RARE CONGENITAL CONCOMITANCE WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

PP-070 LEFT COMMON PULMONARY VENOUS OSTIUM MIMICKING LEFT ATRIAL APPENDAGE ANEURYSM: ECHOCARDIOGRAPHIC MISDIAGNOSIS U.C. Yuksel, E. Yalcinkaya, E. Yildirim, T. Celik, U. Bozlar, M. Celik, Y. Gokoglan, B. Bugan, S. Firtina, A. Iyisoy, H.K. Kabul. Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey; Department of Cardiology, Malatya Army Hospital, Malatya, Turkey; Department of Cardiology, Erzincan Army Hospital, Erzincan, Turkey Objective: The two most common pulmonary venous (PV) anomalies are the presence of aright middle PV and common left trunk. Herein, we report a patient with left common pulmonary venous ostium misdiagnosed as left atrial appendage aneurysm on echocardiography. Methods: A 67-year-old female with a medical history of hypertension admitted to our outpatient department for palpitation and dyspnea on exercise. She was advised to undergo routine echocardiography, which showed dilated left ventricle, decreased left ventricular ejection fraction (25%), moderate mitral regurgitation and left atrial appendage aneurysm. She was referred to cardiac computed tomographic angiography (CTA) for delineating anatomy. Results: CTA revealed an unusual pulmonary venous anomaly consisting of a left-sided common and unusually large ostium of left pulmonary veins draining to left atrium and normal coronaries. Conclusion: Cardiac anatomic variants has become increasingly important as the number of radiofrequency ablations has increased. The definite differentiation of pulmonary common ostium from an atrial appendage aneurysm could be made with transesophageal echocardiography, computed tomography and magnetic resonance imaging.