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Conclusion: Amongst apparently well long-term survivors of submassive PE, 55%demonstrated below than expected 6MWT, and 16% had 6MWT distance <350mimplying significantly impaired exercise capacity in this population.Disclosure of Interest: None Declared

PW077

Are higher levels of C reactive protein predictive of positive echocardiographicfindings of infective endocarditis ?

Abhishek Sengupta*1, Samuel Hillier1, Emma Ivens1, David Platts1, John Sedgwick11Cardiology, The Prince Charles Hospital, Brisbane, Australia

Introduction: Serum C-reactive protein (CRP) is an acute phase reactant protein present ininflammatory conditions and infections including endocarditis. Its relationship to type ofbacteraemia, and presence of positive echocardiographic findings is not well defined.Objectives: To determine how initial CRP levels correlate with blood cultures and echo-cardiographic findings.Methods: Patients from the last two years referred for echocardiography at our institution toexclude infective endocarditis were included, and imaging findings were reviewed. Weanalysed initial blood cultures, CRP at or near time of presentation and epidemiological data.Results: 139 patients were selected from our echocardiography database for referral ofpossible endocarditis over the last two years (males 68%), average age 58 years (range 22-94). The major echocardigraphic findings of infective endocarditis included: vegetation(53), abscess (16), and leaflet perforation (16). Mean CRP in these groups was 147, 119and 120 respectively. 39/139 (28%) patients had positive blood cultures and echocar-diographic findings suggestive of infective endocarditis; 38/139 (27%) had bacteraemia andno echocardiographic criteria of infective endocarditis; and 7/139 (5%) patients had pos-itive echocardigraphic findings despite negative blood cultures. Mean CRP in this groupwas 141, 134, 49 and 72 respectively (see table below). There were 40 cases of native valveendocarditis, 20 cases of prosthetic valve endocarditis, and 4 cases of pacing lead infection.In these sub- groups, mean CRP was 153, 142, and 125.

Echo

Positive Negative

Blood Culture Positive 141 134.4 p¼NS

Negative 72 49.5 p¼NS

p¼0.07 p¼0.002

Conclusion: The main predictor of serum CRP levels in this study was the presence ofbacteraemia, rather than the actual echocardigraphic changes. Although positive echocar-diographic findings were predictive of higher CRP values in all subgroups, the differencewas small. Hence, using CRP to monitor response to antimicrobial therapy is less likely tocorrelate with improvement in echocardigraphic changes.Disclosure of Interest: None Declared

PW078

Imaging for Complications of Infective Endocarditis: a 10 year review

Edward Buratto*1, Andrew Lin2, Myles Wright1, Andrew Newcomb1, Philip Davis1,Jonathan Darby3, Andrew Wilson4, Melbourne Endocarditis Study Group (MESG)1Department of Cardiac Surgery, 2Department of Cardiology, 3Department of Infectious Disease,4Cardiology, St Vincent’s Hospital, Melbourne, Australia

Introduction: Infective endocarditis (IE) is associated with a myriad of complications dueto septic, embolic and vascular phenomena. As a result, IE patients are subjected to a largenumber of investigations, yet the diagnostic yield of such investigations is unknown.

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Objectives: The present study was designed to review the investigations performed forIE complications over a 10 year period and determine their rate of positive findings.Methods: Imaging requests and reports recorded from January 2003 to January 2013 weresearched for the terms “mycotic aneurysm”, “septic embolus” and “endocarditis”. For eachinvestigation the report was reviewed to determine relevance and the presence and natureof IE related sequelae. For each patient discharge summaries and echocardiography reportswere reviewed to confirm the presence of endocarditis.Results: A total of 224 patients underwent 971 investigations for complications of IE duringthe study period. Staphylococcus aureus was the most common infective agent (81 cases),followed by viridans Streptococci (34 cases) and Enterococcus spp. (13 cases). Cerebral imagingwas most frequent (329 studies), followed by abdominal imaging (300 studies), thoracic (131studies), spinal (78 studies) and nuclear medicine imaging (70 studies). 415 of these in-vestigations (43%) identified at least 1 complication of IE. The complications identifiedincluded 166 infarcts, 63 septic emboli, 63 mycotic aneurysms, 61 bone and joint infections,54 abscesses and 40 haemorrhages. For cerebral imaging, MRI had a significantly higher pickup rate than CT (66.2% v 40.2%, p<0.001). Likewise for spinal imaging, MRI identifiedsignificantly more complications than CT (58.5% v 23.1%, p¼0.02) For abdominal imagingCT had a greater pick up rate than ultrasound (40.0% v 19.5%, p¼0.01). There was noincrease in imaging rates or complication pick-up rates over the study period.Conclusion: Imaging performed to investigate complications of IE over a 10-year period atthe study institution had a high rate of identifying complications. Many of the complica-tions are important causes of morbidity and mortality, and significantly impact on patientmanagement, risk stratification and prognostication. MRI has a superior rate of identifyingcerebral and spinal complications than CT. For abdominal imaging, CT identifies com-plications more frequently than CT. Further analyses will identify the cost effectiveness ofthe various imaging modalities studied.Disclosure of Interest: None Declared

PW079

Timing, Characteristics And Outcomes Of Surgery For Infective Endocarditis: Seven-Year Contemporary Study

Tom Kai Ming Wang*1, Timothy Oh1, Jamie Voss1, Nicholas Kang1, James Pemberton11Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

Introduction: Infective endocarditis remains a heterogeneous disease with high mortality,and surgery is required in approximately half for resultant heart failure, uncontrolledinfection or embolism prevention. Several recent studies advocate operating early to havesuperior outcomes.Objectives: We reviewed the characteristics, timing and outcomes of cardiac operationsperformed for infective endocarditis at Auckland City Hospital.Methods: All patients undergoing surgery for infective endocarditis during 2005-2012were analysed, focusing on outcomes and predictors, and comparing early (within 7 days ofdiagnosis) and late surgery.Results: 146 patients were studied with mean age 48.8+/-16.0 years and 70.5% (103) weremale. Pre-operatively, 47.3% (69) had congestive heart failure and 40.4% (59) had newembolic event. Structures involved were predominantly aortic valve 64.4% (94) and mitralvalve 42.5% (62), with 33.6% (49) having prosthetic valve involvement and 27.4% (40) hadintracardiac abscess. Blood culture grew Staphylococcus aureus in 29.5% (43). Early surgerywas performed in 42.5% (62). Operative mortality and composite morbidity were 6.8% (10)and 33.6% (49) respectively. One and five year survivals were 92.5% and 89.0%, freedomsfrom recurrent endocarditis 96.6% and 92.8%, and freedoms from re-operation 96.4% and86.8%. All outcomes were similar between early and late surgery (operative mortality 8.1%(5) vs 6.0% (5), P¼0.744 respectively). Critical pre-operative state, previous coronary surgeryand dialysis were independent predictors of operative and follow-up mortality.Conclusion: Our outcomes compare favourably to other studies internationally, andimportant predictors for adverse outcomes were identified. Delaying surgery for medicalstabilisation was not associated with survival benefit.Disclosure of Interest: None Declared

PW080

Ascending aorta aneurysm complicating bicuspid aortic valve stenosis

Majdi Gueldich1, Ellouze Tarak2, ahmed tounsi3, abid dorra3, faten triki3, leila abid*3,samir kammoun3, imed frikha41cardiovascular and thoracic surgery, Habib Bourguiba hospital, 2Habib Bourguiba hospital. Sfax.Tunisia, 3cardiology, hedi chaker hospital, 4cardiovascular and thoracic surgery, HabibBourguiba hospital. Sfax. Tunisia, sfax, Tunisia

Introduction: The bicuspid aortic valve (BAV) is the most common congenital abnormalityof the human heart. It is estimated that a bicuspid morphology will lead to structural aorticvalve problems (stenosis or regurgitation) in all patients who live long enough to manifestthem. The BAV disease accounts for more morbidity and mortality than all other congenitalheart diseases combined. The dimensions of the proximal aorta (especially the tubularascending aorta) are significantly larger than those in persons with tricuspid aortic valve,even in the absence of significant valvular hemodynamic disturbance.Objectives: We report a case of bicuspid aortic valve stenosis complicated by an aneurysmof the ascending aorta.Methods: 40 year old patient, admitted for chest pain with exertional dyspnea NYHA classIII. Chest radiograph showed a mediastinal enlargement. ECG and troponines levelsweren’t in favor of an acute coronary syndrome.Results: Echocardiography showed a bicuspid aortic valve stenosis. Left ventricle – aortagradient was 60 mmHg. Left ventricle parameters were normal: telesystolic diameter:

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28mm; telediastolic diameter: 45mm: inter ventricular septum: 11mm. Left ventricle vol-ume ejection was estimated to be 65%. Moreover, an aneurysm of the ascending aortameasuring 50 mm was detected. Aortic angiography confirmed the ultrasound data byobjectifying a significant ectasia of the ascending aorta measuring 52 * 63 mm. In addition,the aortic walls were thin and regular. Thus, patient was addressed to department ofsurgery for Bentall operation. Intra operative exploration found, addition to calcifiedbicuspid aortic valve, an important dilatation of the ascending aorta (tubular segment). Adouble replacement of the aortic valve and the ascending aorta was achieved withoutnecessity to coronary arteries’re implantation. Postoperative course was marked by onset ofthird degrees auriculo-ventricular bloc well evolved with a decline of 6 months.Conclusion: BAV is a common congenital anomaly which involves not only vavulardamages but also structural aortic wall abnormalities. Hemodynamic and genetic hy-pothesis have well explained the possible occurrence of aortic aneurysm or dissection.Currently, diagnosis is based on ultrasonographic data and results of computed tomog-raphy. Other risk factors such as hypertension and dyslipidemia must be researched andtreated. Genetic hypothesis should encourage familial screening.Disclosure of Interest: M. Gueldich Shareholder of: none, Grant/research support from:none, Consultancy for: none, Employee from: none, Honorarium from: NONE, Speakersbureau: NONE, E. Tarak: None Declared, A. tounsi: None Declared, A. dorra: NoneDeclared, F. triki: None Declared, L. abid: None Declared, S. kammoun: None Declared, I.frikha: None Declared

Emergency Bridge Palliative Total

In-hospital mortality 7 (41.2%) 3 (4.9%) 2 (2.4%) 12 (7.5%)

1 year mortality 59.7% 25.6% 37.1% 35.1%

Subsequent AVR 5 (29.4%) 33 (55.9%) 2 (2.8%) 40 (27.0%)

- SAVR 2 (11.8%) 6 (10.2%) 1 (1.4%) 9 (6.1%)

- TAVR 3 (17.6%) 27 (45.8%) 1 (1.4%) 31 (20.9%)

PW081

The Profile of Mitral Valve Prolapse in Hasan Sadikin General Hospital, Bandung,Indonesia

Robin H. Wibowo*1, Syarief Hidayat1, Erwan Martanto1, Wuri Setyaningrum1,Triwedya I. Dewi11Cardiology and Vascular Medicine, Padjadjaran University, Bandung, Indonesia

Introduction: Mitral valve prolapse (MVP) is a variable clinical syndrome that results fromdiverse pathogenic mechanism. Recent observational studies demonstrated that MVP has aprevalence of 2.4% in adults. with twice as frequent in females than in males. The majorityof patients with MVP are asymptomatic. Echocardiography plays an essential role in thediagnosis of MVP and has been delineation of this syndrome.Objectives: To establish the MVP profile data in Indonesian population.Methods: This descriptive study evaluated 14687 echocardiographic records from August2008 to June 2013. MVP was defined as superior displacement of the mitral leaflets of morethan 2 mm during systole. Echocardiographic examinations were performed using Vivid 7.The mitral valve apparatus and mitral regurgitation was examined with long axis images,short axis images and apical four chamber images.Results: There were 257 patients with 128(49,8%) males and 129(50,2%) females, themean age was 50,2 years old with the youngest is 7 years old and the oldest is 87 years old.The proportion of MVP was 1,75% in our population with age group younger than 35years and older than 36 years were 60(23,3%) and 197(76,7%) respectively. Prolapse ofanterior and posterior mitral leaflet was found in 181(70,4%), 66(25,7%), and both10(3,9%) respectively. Mitral regurgitation was found in 247(96,1%) patients and thegrading was trivial in 27(10,5%), mild in 86(33,5%), moderate in 73(28,4%) and severe in61(23,7%) patients. The ejection fraction below 50% was found in 35(13,6%) patients.Conclusion: Mitral valve prolapse is on low proportion in our population with similarfrequency in male and female. The findings was predominantly older patients and anteriormitral valve prolapse involvement. The presentation of MVP was more frequent withmoderate to severe mitral regurgitation.Disclosure of Interest: None Declared

PW082

Mitral Valve Replacement For Surgical Correction of Post Rheumatic Heart Disease InChildren In A Tertiary Sub-Saharan Centre

Tantchou Tchoumi Jacques Cabral*1, Gianfranco Butera21Cardiac centre, St. Elizabeth Catholic General Hospital, Shisong, Kumbo, Cameroon, 2PediatricCardiology, Cardiac Surgery and GUCH unit, Policlinico San Donato IRCC, San Donato, Milan,Italy

Introduction: Rheumatic heart disease is the most important sequelae of acute rheumaticfever, which is caused by group A streptococci and usually presents in childhood, affecting5 to 14 years old although it can strike people up to the age of 30.Objectives: To study the outcome and early follow-up in children with mitral valvereplacement for post rheumatic valvulopathy correction.Methods: This retrospective analysis included 29 patients who underwent mitral valvereplacement from April 2003 through June 2009. Data from patients’ records, operativeintervention, and preoperative and postoperative parameters were reviewed. The durationof the follow-up was from 6 months to 91 months.Results: 29 patients (14 males and 15 females) aged between 9,5 and 17 years with a meanage of 10,5 � 6,5 years old underwent mitral valve replacement with a mechanical pros-thesis. Mitral valve regurgitation was the commonest diagnosis present in 51,7% patients,35% had pure mitral stenosis. Patients were extubated from 5-10 hours after surgery, themean stay in intensive care unit was 1,5 � 0,5 days. The mean cardiopulmonary by-passtime was 104 � 20 min. The drains were removed at the 3rd � 1,5 post surgical day in theward. In the early post surgical period, the ejection fraction (EF) changed from 45,3 � 1,5% to 56,1 � 1,4% (p<0,005) in 3 months and stayed almost the same after sixmonths 57,2 � 2,7% (p>0,05); at nine months it was 55,1 � 1,8% (p>0,05), at

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12 months - 58,4 �1,7% (p>0,05), at the latest patient’s check up, the EF was 56,2 �1,3% (p>0,05); however the basal part of the interventricular septum was hypokinetic.Conclusion: The study showed very good early results in the post surgical follow-up ofpatients with valve replacement for the correction of post rheumatic valvulopathies. Due tofinancial limitation poverty and illiteracy of parents, the post surgical follow up of patientsis challenging.Disclosure of Interest: None Declared

PW083

Long term outcomes after percutaneous mitral commissurotomy in the real world

Carlos Uribe1,2, Carlos Tenorio1,2, Carlos Eusse1,2, Carlos Rubio1,2, Julian Ochoa3,Roland Njoh4, Bernardo Lombo*4, John Forrest41Cardiology, Clinica CardioVID, 2Universidad Pontificia Bolivariana, Medellin, 3Cardiology,Fundacion Valle de Lili, Cali, Colombia, 4Cardiology, Yale New Haven Hospital, Yale University,New Haven, United States

Introduction: In 1993, Colombia, South America began a National Mitral Balloon Val-vuloplasty Registry. This multicenter database was designed to establish the long termsafety and efficacy of percutaneous mitral commissurotomy, as well as rate of restenosis.Objectives: To evaluate the long term clinical results of percutaneous mitral balloon val-vuloplasty in patients with rheumatic mitral stenosis.Methods: Between January 1993 and December 2011, 182 patients >18 years old weretreated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers inColombia, South America. Clinical, echocardiographic and hemodynamic data were storedin an electronic database. The Inoue Balloon technique was used in 99% of patients. Thelongest follow up period was 15 years.Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia(1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%)were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients).Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site relatedcomplications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients werealive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severerestenosis of mitral valve was 4.8%; 19.2%; 15.2% at one, five and 10 years of follow up.Conclusion: Percutaneous mitral valvuloplasty using the Inoue balloon technique im-proves the hemodynamic profile of severe mitral stenosis. Long term follow up suggest thatit is a safe alternative to mitral valve surgery in well selected patients.Disclosure of Interest: None Declared

PW084

Contemporary indications and outcomes of balloon aortic valvuloplasty in the era oftranscatheter aortic valve replacement

James Marangou*1, Sandeep Chopra1, Jamie Rankin1, Robert Larbalestier1, Gerald Yong11Cardiology, Royal Perth Hospital, Perth, Australia

Introduction: Transcatheter aortic valve replacement (TAVR) has emerged as a viableoption to surgical aortic valve replacement (SAVR) for high risk patients with symptomaticsevere aortic stenosis (AS). This has led to an increased incidence of balloon aortic val-vuloplasty (BAV) as an important percutaneous treatment modality.Objectives: To describe the contemporary indications as well as immediate and mediumterm outcomes of patients who underwent BAV in a setting whereby TAVR is available.Methods: Retrospective analysis was undertaken on all BAV performed at a single stateTAVR centre since initiation of the program in 2009. The indications for BAV were clas-sified as 1. Emergency (patients with shock or admission with heart failure recalcitrant toaggressive therapy therefore preventing discharge from hospital); 2. Bridge (aimed atimproving certain cardiac physiology or clinical features with a view to definitive valvereplacement in the future); 3. Palliative (symptomatic relief in patients deemed unsuitablefor SAVR or TAVR). The in-patient and medium term outcomes were reported.Results: Since 2009, 160 BAV were performed on 148 patients (mean age 83 years). 11patients had repeat procedures, including one who underwent three valvuloplasties. In-dications included: Emergency (n¼17); Bridge (n¼61); Palliative (n¼82). Procedural deathoccurred in two cases (1.3%). In-hospital and one year mortality and subsequent definitivetreatment with AVR are described in the following table:

The patients who underwent AVR following BAV had a significantly lower 1 yearmortality compared to those who did not undergo subsequent AVR (12.6% vs 54.7%,p¼0.001).Conclusion: BAV in this contemporary era is a relatively safe procedure in high risk pa-tients with severe aortic stenosis not immediately suited for AVR and forms an importanttreatment option in TAVR programs. Except in patients with BAV performed for Palliative

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