S70 Oral Presentations/International Journal of Cardiology 147S2 (2011) S37–S98 Friday, 25 March 2011 13:30–15:00 Interventions for Structural Heart Diseases OP-148 TRANSCATHETER CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECTS USING AMPLATZER AND FIGULLA SEPTAL OCCLUDER IN ADULT PATIENTS: INTERMEDIATE AND LONG TERM FOLLOW-UP RESULTS A. Oto 1 , K. Aytemir 1 , A.H. Ates 1 , U. Canpolat 1 , H. Yorgun 1 , M. Dural 1 , L. Sahiner 1 , E.B. Kaya 1 , L. Tokgozoglu 1 , G. Kabakci 1 , S. Ozkutlu 2 , H. Ozkutlu 1 . 1 Department of Adult Cardiology, Hacettepe University, Ankara, Turkey; 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: The incidence of transcatheter closure of secundum atrial septal defects (ASD) which has become an established treatment option, is constantly increasing. The aim of our study is to evaluate the effectiveness and safety of the Amplatzer and Figulla Septal Occluder devices for secundum ASD closure. Methods: Study cohort constitutes 134 patients who underwent transcatheter secundum ASD closure with Amplatzer and Figulla septal occluder devices between January 2001 and November 2010. Indications for closure were a significant left-to-right shunt, pulmonary and systemic blood flow (Qp/Qs) ratio ≥1.5 measured invasively, volume overload of the right ventricle on transthoracic echocardiography, and/or clinical symptoms of dyspnea, reduced exercise capacity, or paradoxical embolism. Before the procedure, all patients had undergone transthoracic or transesophageal echocardiography (TEE) and electrocardiography. Angiography was not performed routinely. Ostium secundum ASDs with the size of <32 mm in the largest radius, and with enough rim length for device attachment were considered to be suitable for transcatheter occlusion. All procedures were conducted in the hemodynamic laboratory under general anesthesia with the guidance of TEE. Follow-up physical examinations were scheduled 1, 3, 6, and 12 months after the procedure and annually thereafter. Results: One hundred thirty four patients (n = 134) were enrolled in the study (53 males, 81 females; mean age±SD 37.5±13.4 years). Among implanted devices 105 (78.4%) were Amplatzer Septal Occluder, 29 (21.6%) were Figulla Septal Occluder. The mean device size was 20.2±5.6 mm (range 7–33 mm). All interventions were successfully completed without complications except device embolization from left atrium to the abdominal aorta which extracted by femoral snare system, and thereafter ASD was closed with a larger device in one patient and also periprocedural thrombus formation who successfully treated with unfractioned heparin in 2 patients. In one case, two septal occluder device were used for 2 separate ASDs. During the mean 30±23.3 (6–120) months follow-up period, no patient had a major complication (cardiac rupture, thromboembolism, thrombus, device embolism or infective endocarditis). Only in one case paroxismal atrial fibrillation was developed and converted to sinus rhythm with medical cardioversion. Conclusions: Transcatheter closure of secundum ASDs by Amplatzer and Figulla Septal Occluder may be feasible, safe, and effective alternative to surgery whenever the size and the location of ASD is suitable. Figure 1. (A) Amplatzer Septal Occluder (B) Figulla Septal Occluder. OP-149 EFFECTIVENESS OF OCCLUDER DEVICES FOR CLOSURE OF PATENT FORAMEN OVALE IN PATIENTS WITH CRYPTOGENIC STROKE A. Oto 1 , K. Aytemir 1 , A.H. Ates 1 , U. Canpolat 1 , H. Yorgun 1 , K.M. Gurses 1 , L. Sahiner 1 , E.B. Kaya 1 , L. Tokgozoglu 1 , G. Kabakci 1 , S. Ozkutlu 2 , H. Ozkutlu 1 . 1 Department of Adult Cardiology, Hacettepe University, Ankara, Turkey; 2 Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey Objective: Optimal management of patients with PFO and paradoxical embolic events is still debated. Patent foramen ovale (PFO) has been reported to be significantly more frequent in young stroke patients than in matched control subjects. The suggested mechanism of stroke is paradoxical embolism. The aim of our study is to evaluate the effectiveness and safety of the PFO occluder devices for transcatheter closure of PFO. Methods: Retrospective cohort study was conducted between May 2004 and November 2010 involving 141 transcatheter PFO closure procedures in our institution. The patients were less than 60 years old with at least two episodes of transient ischemic attack (TIA) or stroke, or with multiple ischemic gliotic lesions showed by cranial MRI. All other causes of TIA or stroke were excluded, and the patients were shown to have PFO by transesophageal echocardiography. Patients were evaluated clinically and echocardiographically at 1, 6 and 12 months after the procedure and yearly thereafter. Primary endpoints were death, recurrent stroke or TIA. Results: One hundred and forty one (n = 141) patients were enrolled in the study [74 males, 67 females; mean age±SD 40.3±10.2 years (18–60 years)]. During the study period, 74 (52.5%) Amplatzer, 61 (43.3%) Occlutech Figulla and 6 (4.3%) BioSTAR PFO occluder devices were used. The mean device diameter was 24.1±2.5 (18–28) mm. All interventions were successfully completed without any complications. The patients were followed both clinically and imaging techniques like echocardiography, transcranial doppler, cranial MRI. There was no recurrent cerebrovascular accident (CVA) or TIA in the study group during medium-term follow-up period. Only one patient had bilateral renal embolic event (0.7%). Also 1 (0.7%) patient revealed late thrombus formation on PFO occluder device after total abdominal histerectomy operation. Conclusions: Transcatheter closure of PFOs by PFO occluder devices may be feasible, safe, and effective treatment for the prevention of CVA recurrence in patients with crytogenic stroke. OP-150 CYANOACRYLATE FOR NONSURGICAL SEPTAL REDUCTION THERAPY IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY A. Oto, K. Aytemir, S. Okutucu, B. Cil, B. Peynircioglu, E.B. Kaya, A. Deniz, B. Evranos, L. Sahiner, G. Kabakci, L. Tokgozoglu, H. Ozkutlu. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Alcohol septal ablation (ASA) has been shown to be an effective treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are refractory to medical treatment. We describe an alternative approach for septal ablation with glue (cyanoacrylate), which is particularly useful in patients with the collateral formation to the right coronary artery in whom ASA is contraindicated. Methods: In our method left coronary ostium was cannulated with 6–8F guiding catheter. Septal branch was cannulated with a 4F catheter and a microcatheter then cyanoacrylate mixture was instilled into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery, and also into the right coronary artery (RCA) via septal collaterals. Results: Glue septal ablation (GSA) was performed in 20 patients (7 patients had collateral branches to RCA). Immediately after the procedure peak left ventricular outflow (LVOT) gradient reduced significantly both in cardiac catheterization (65.0±13.9