S106 Poster Discussions/International Journal of Cardiology 147S2 (2011) S103–S130 blood pressure of 110/70mmHg, respiratory rate of 20/min, and a pulse rate of 106/min (irregular). On cardiac auscultation, heart sounds were soft and 2/6 systolic murmur was heard in the mezocardiac area. Electrocardiography revealed atrial fibrillation with a ventricular rate of 110/min.. The chest x-ray was normal. The transthoracic echocardiogram (TTE) showed measuring 5*8 mm mobile mass on posterior mitral leaflet. TEE revealed measuring 24 * 10 mm mobile thrombus in the left atrium originating from LAA. Results: We decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin (bolus of 80 U/kg, 18 U/kg per hour) for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. Follow-up echocardiography after 48 hours showed regression of the thrombus dimensions. Administration of heparin was then stopped and treatment was continued with warfarin. The patient was discharged from the hospital in good condition, receiving oral anticoagulation therapy. Conclusions: TEE has a much higher sensitivity than the transthoracic approach when diagnosing left atrial thrombus, in particular when located in the left atrial appendage. However, in this case, we showed that an obvious view of the thrombus can also be demonstrated with modified transthoracic echocardiographic windows when the left auricular appendage is enlarged. Therefore, cardiologists should be aware of this; an unusual echo-image may contribute to our clinical practice as a treatment option. PP-010 ACUTE THROMBUS FORMATION ON THE AMPLATZER DEVICE DURING TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT ASSOCIATED WITH HOMOZYGOUS FACTOR V LEIDEN MUTATION O. Karaca, M. Sahin, V. Yazicioglu, E. Guler, G.B. Guler, M. Turkmen. Kardiyoloji Anabilim Dali, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey Objective: A 32-year-old woman with previously unknown homozygous Factor V Leiden mutation, undergone transcatheter closure of a secundum-type atrial septal defect (ASD) with the Amplatzer device. During the procedure, a highly mobile thrombus attached to the left atrial disc of the device was detected by transesophageal echocardiography (TEE). The device and the associated thrombus were successfully withdrawn and the patient was started on a combination of heparin and tirofiban infusion. The procedure was completed without any recurrent thrombus formation or residual shunt. Searching for trombophillia revealed a homozygous Factor V Leiden mutation and the patient was started on a life-long warfarin therapy. Follow-up TEE revealed proper device position with no recurrent thrombus and the patient discharged home uneventfully. PP-011 TREATMENT OF GIGANTIC LEFT VENTRICULAR THROMBUS: CASE REPORT M. Sahin 1 , H. Simsek 2 , H.A. Gumrukcuoglu 3 , S. Akdag 3 , B. Ekici 1 . 1 Bitlis State Hospital, Cardiology Department, Bitlis, Turkey; 2 Osmaniye State Hospital, Cardiology Department, Osmaniye, Turkey; 3 Yuzunci Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey Objective: Inflammation of the endocardium resulting from myocardial necrosis in any location may produce layered, mural thrombus. However, thrombus most frequently develops in anterior infarcts with expansion or aneurysmal dilation that involves the apex, caused by the combination of endocardial inflammation and stasis. More extensive thrombi with a protruding appearance are at increased risk for systemic embolization. Case: 58-year-old man with a history of anteror myocardial infarction was evaluated for progressive effort intolerance. Blood pressure values were 110/60mmHg, the heart rate was 62 beats per minute, the oxygen saturation was 93% on room air. The electrocardiography was performed and it showed a sinusal rhythm and bad R progression in chest derivations. Transthoracic echocardiography revealed severe systolic dysfunction that an estimated ejection fraction of 25% and a gigant fragile thrombi was seen in the apical segment, which measured 3.5 cm. A treatment with an oral anticoagulant drug was added. A second TTE was repeated after fifteen days of warfarin therapy showed complete resolution of the thrombus. Conclusions: Proper management of left ventricular thrombi is still controversial. Depending on size, location, and mobility, left ventricular thrombi have the tendency to embolize, sometimes with direct consequences. Full-dose warfarin is recommended when LV thrombus is visualized, although there are no data for this subset from randomized trials. PP-012 THE ROLE OF INTRAVASCULAR ULTRASOUND IN THE MANAGEMENT OF RIGHT CORONARY ARTERY DISSECTION DUE TO CORONARY ANGIOGRAPHY M. Celik 1 , A. Iyisoy 2 , T. Celik 2 , B. Bugan 2 , S. Demirkol 3 , U.C. Yuksel 4 . 1 Department of Cardiology, Van Army District Hospital, Van, Turkey; 2 Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey; 3 Department of Cardiology, Malatya Army District Hospital, Malatya, Turkey; 4 Department of Cardiology, Sarikamis Army District Hospital, Kars, Turkey Objective: There is not an evidence-based guidelines about the management of catheter induced coronary artery dissection. Currently, the treatment made on a case-by-case basis. Intravascular ultrasound (IVUS) is a valuable adjunct to angiography, providing new insights in the diagnosis of and therapy for coronary disease. Methods: A 22 year-old male without any cardiovascular risk factors admitted to our hospital for his tightening and squeezing chest pain. Treadmill exercise test was doubtful. So, we decided to perform coronary angiography (CAG) for the evaluation of coronary artery disease. There was no definite angiographic findings related to coronary artery disease in his coronary arteries. However, we noticed a small, insignificant dissection in the proximal segment of RCA after CAG. There was not a chest pain or a ST segment changes on ECG monitoring and coronary blood flow was TIMI III distally. So, we decided to observe the patient without any intervention. When he was waiting for the removing of sheat, he had a severe tightening chest pain. Then, we performed a control CAG and noticed that the small, innocent dissection turned to a large, spiral dissection and the coronary blood flow was impaired with TIMI 0. Urgent PCI decision was made. The dissection was crossed with a 0.014 ′′ guidewire and 3.5 × 18 mm bare metal stent was implanted. But, no sufficient coronary blood flow was achieved after stent implantation and the patient’s complaint was continued. Then, an IVUS examination was performed and revealed that stent was placed through the false lumen partially and the extent of dissection was so longer than we expected. The dissection was crossed with an other 0.014 ′′ guidewire after position within the true lumen confirmed by IVUS. Subsequently, two stents were implanted in the true lumen distally, a 4.0 × 25 mm bare metal stent was implanted in the trure lumen proximally by the guidance of IVUS and previously misimplanted stent was crushed by this new stent. The optimal lumen area was achieved and the procedural result was excellent with TIMI-3 flow distally. Conclusions: The use of IVUS guidance minimizes the incorrect wire placement within false lumen in the era of coronary artery dissection. Also, IVUS provides guiding stent sizing, confirming optimal stent expansion and obliteration of the false lumen. By the findings of our case, we suggest that IVUS should be used in the treatment of every type of coronary artery dissections, even in small, innocent dissections.