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Article history: Received 20 November 2015 Accepted 22 November 2015 Available online 23 November 2015 artery dissection and rupture after successful TAVI procedure with axillary artery approach. The patient was admitted to our hospital because of severe and symptomatic aortic valve stenosis. The patient had hypertension, dyspnea and syncope on her history. On physical examination, the arterial blood pressure was 138/65 mmHg, the pulse was 86 bpm. There was a 4/6 systolic murmur on the right sternal border radiating to the right side of the neck. The peripheral arterial

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to close the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy with the computed tomography guidance. This case is the second from Turkey, so the first one was published recently in this journal [12]. In this second case, we used the CT guidance for optimal puncture of cardiac apex. A 44 year old female was admitted to our department with severe dyspnea (NHYA classes II–III). She had hemolytic anemia (hemoglobin level 8.0 g/dL, lactate dehydrogenase level was high). She had a history ofmitralmetallic prosthesis valve replacement in 1994. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and 9mm) of themitral valve prosthesis. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and

We have read with great interest the recently published letter by Hellman and coworkers in which they showed misplacement of the Angioseal device anchor in the right common artery by using CT angiography accompanied with 3-D reconsctruction [1]. A 56-year-old male patient underwent stent implantation in the left anterior descending coronary artery due to stable angina uncontrolled medical treatment. Following 24 hour heparin treatment sheath was removed and the puncture site in the right femoral arterywas closedwith AngioSeal vascular closure device (St.Jude Medical, Minnetonka, MN). In early post-inventional period the patient complained with pain in the right thigh. At physical examination distal pedal pulses were absent. There was extensive occlusion on the right superficial femoral artery with slight flow and vast filling defect in selective digital arterial angiography performed from theleft femoral artery (Fig. 1). Surgical intervention was performed to remove the material with vertical incision of the superficial femoral artery. In surgery the material with a diameter of 0.5×1.5 cmwas foundandexcised (Figs. 2–4).Anteriorwall of the superficial femoral artery was damaged because of collagenouse material and it was repaired with saphenous vein patch plasty. No complications were observed at post-operative period, and the patient was discharged on the 5th post-operative day. Vascular access site complications result in significant morbidity after vascular interventional procedures,with an incidence of 0.5–16.8% of cases. Although manual compression is effective in achieving hemostasis in most cases, it requires 10–20 min sustained compression

PP-181 CORONARY BYPASS GRAFTING IN A YOUNG PATIENT WITH CORONARY DISSECTION ASSOCIATED ACUTE CORONARY SYNDROME F.G. Yesil, M. Tavlasoglu, M. Kurkluoglu, Z. Arslan, A. Guler, M.A. Sahin, F. Cingoz. Department of Cardiovascular Surgery, Gulhane Military Medical Hospital, Etlik, Ankara, Turkey; Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Yenisehir, Diyarbakir, Turkey; Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington, DC, USA; Gelibolu Military Hospital, Department of Cardiology, Canakkale, Turkey Background: Primary spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) with an estimated prevalence of 0.1–1.1% in angiographic series and especially seen in younger females. Methods: A young patient aged 38 year applied the emergency service with a diagnosis of acute coronary syndrome. In angiographic screening, three vessels disease including LAD artery lesion was diagnosed. An urgent operation was decided.

Objective: Kommerell’s diverticulum is a rare condition, involving the left fourth aortic arch and the anomalous origin of the right subclavian artery (0.5%-2%). It is usually asymptomatic and is most often an incidental finding. In symptomatic patients symptoms usually arise from compressing of trachea and esophagus. Methods: A 38 year old male who was diagnosed chronic obstructive lung disease with his symptoms such as dyspnea and dysphagia presented to our department due to worsening of his symptoms. Three dimensional computerized tomography scans performed to him and kommerell’s diverticulum with aberrant right subclavian artery and patent ductus arteriosus has found. At the same CT, accidentally, there were left sided liver and right sided spleen in three pieces. As the scans showed, we confirmed that his symptoms occured due to that anomaly. Results: We report an unique case of Kommerell’s diverticula with patent ductus arteriosus, aberran right subclavian artery, persistant left superior vena cava, ascending aortic aneurysm, right sided liver and left sided three pieces spleen.