The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 299
Poster Session
PS 1203 Cardiology
Predictive Factors of Reversibility in Patients with Se- vere Tricuspid Regurgitation
Jae Yeong Cho1, Kye Hun Kim1, Kyung Jin Lee1, Yi Rang Yim1, Sung Soo Kim1, Hae Chang Jeong1, Ki Hong Lee1, Keun Ho Park1, Doo Sun Sim1, Hyun Ju Yoon1, Nam Sik Yun1, Young Joon Hong1, Hyung Wook Park1, Ju Han Kim1, Youngkeun Ahn1, Myung Ho Jeong1, Jeong Gwan Cho1, Jong Chun Park1
Chonnam National University Hospital, Korea1
Background:Since severe tricuspid regurgitation (TR) is an uncommon fi nding which develops in various conditions, the present study aimed to investigate etiology, clinical characteristics, and predictors of reversibility in patients with severe TR.
Methods:A total of 232 patients (67.4±14.1 years, 80 males) who were diagnosed with severe TR by echocardiography were enrolled. Severe TR was defi ned as vena contracta width greater than 0.7 cm and systolic fl ow reversal in hepatic veins according to the current guideline of American Society of Echocardiography (ASE). Improvement of TR to moderate or less degree on follow up echocardiography was considered as reversible TR in the present study. Primary end points were adverse events at long-term follow-up.
Adverse events were defi ned as all-cause death and operation due to severe TR.
Results: Reversible TR was observed in 35 out of 153 patients (23.0%). Sixty-one pa- tients showed clinical improvement, but the degree of TR was not changed. Forty-nine patients (32%) who did not show clinical improvement despite of medical therapy eventually underwent surgical correction of TR, and 7 patients died. In addition, 17 pa- tients died without operation, so 24 deaths (16%) were observed in total. Finally, total adverse events developed in 66 patients (41%) during 2 years of follow-up period.
Logistic regression analysis revealed prosthetic mitral valve was the only independent predictors of future adverse events (OR 2.47, 95%CI 1.05-5.77, p=0.038). Independ- ent predictors of improved TR turned out to be the use of RAAS blockade (HR 3.02, 95%CI 1.12-8.17, p=0.030) and the use of spironolactone (HR 3.39, 95%CI 1.05-10.90, p=0.041). Low ejection fraction (LVEF <50%) also had a trend toward the reversibility (HR 2.82, 95%CI 0.94-8.40).
Conclusions:Considering results above, reversible severe TR mainly associated with left heart failure and medical treatment should be given before considering surgery for severe TR.
PS 1204 Cardiology
Giant Left Atrial Free-Floating Ball Thrombus without Mitral Stenosis and Atrial Fibrillation
Young Soo Lee1, Dong Ju KIM1, Dong Keun KIM1, Yong Hoon CHOI1, Wook Hyun Cho1 Internal Medicine, Sahmyook Medical Center, Korea1
A giant left atrial free-fl oating ball thrombus is a rare condition. And to our best knowl- edge, one without mitral stenosis and atrial fi brillation has never before been reported.
Here we present a case of a large free fl oating ball thrombus which was in the left atrial cavity and was dissolved after anticoagulant theraphy. The patient had a history of diabetes mellitus and hypertension. Cerebral infaction was detected in the early days of admission, but the patient did not have mitral stenosis or atrial fi brillation except an episode of paroxysmal atrial fi brillation that occurred during the admission period. Even- tually, the patient died due to multiple embolism in cerebral and aortoiliac arteries and ongoing infections including bed sores and Clostridium diffi cille infection. The patient was not subjected to cardiac surgery - although prompt surgical removal is the preferred theraphy - because she was in poor physical and neurological condition.
PS 1205 Cardiology
Thrombolytic Therapy during Pregnancy in Patients with Prosthetic Mitral Valve Thrombosis: A Case Report
Jiyung Lee1, Jong Shin Woo1, Jin Bae Kim1, Soo Joong Kim1, Weon Kim1, Woo-Shik Kim1, Kwon Sam Kim1
Kyung Hee University Hospital, Korea1
Pregnancy is procoagluation state increasing risk of thrombosis in patients with me- chanical prosthetic heart valves. Even pregnant women have been treated with anti- coagulation, thromboembolic complications occur relatively high and lead to maternal or fetal death. Current guidelines suggest optimal anticoagulation or surgical therapy like thrombectomy or valve replacement for the treatment of prosthetic mechanical valve thrombus regarding patient’s condition and previous treatment effi cacy. Recent- ly, we experienced a pregnant 34-year-old women with prosthetic mechanical valve thrombus. She had a mitral valve replaced with a mechanical valve at 17 years of age.
After switching warfarin to low molecular weight heparin with medical consultation, she was pregnant. At 19 weeks of pregnancy, she hospitalized for pre-term labor and suddenly developed dyspnea. Echocardiography showed mitral valve thrombus (Figure A) with elevated pressure gradient (32 mmHg, Figure B). Low-dose, slow infusion of tissue-type plasminogen activator (tPA, 20mg alteplase for 6 hours infusion) without bolus was treated with continuous echocardiographic monitoring. After 3-day tPA therapy, her dyspnea was improved with decreased pressure gradient (from 32 to 16 mmHg, Figure C). We decided to stop lytic therapy because of hematuria. After war- farinization, a healthy baby was delivered by caesarian section without any anomaly at 37 weeks of gestation. After delivery, mechanical valve replacement was performed and revealed as organized thrombus with pannus at mechanical valve leafl et (Figure D). As shown our patient’s case, low-dose, slow infusion of tPA monitoring by echo- cardiography could be a safer and effective alternative treatment option in pregnant patients with prosthetic mechanical valve thrombus.
