Funding Acknowledgements Type of funding sources: None. Background Prosthetic valve thrombosis (DVT) is a  very serious complication, with high morbidity and mortality, a high risk of stroke during hospital admission, and which occurs especially in patients with poorly anticoagulated mechanical prostheses. Therapeutic options available for DVT are surgery, with or without prosthetic replacement, and intravenous thrombolysis. However, there is no randomized study comparing these two interventions. Therefore optional treatment is controversial. This is also reflected in the current clinical practice guidelines of international scientific societies of the year 2017, where the American College of Cardiology / American Heart Association considers surgery and thrombolysis as comparable treatments (Class I), and On the other hand, the European Society of Cardiology (ESC) opts for surgery, leaving thrombolysis only for when surgery is not available, has a very high risk or for cases of right valve thrombosis. Purpose In our center we have used a thrombolysis regimen with low doses of t-PA and in slow infusion with adequates results, proposed by Özkan et al. with 25 mg of t-PA administered over 25 hours, repeating this dose up to DVT resolution or a maximum of 8 times. Methods We reviewed eleven patients, all with mechanical valve prostheses, six treated with surgery and five with systemic thrombolysis. Of the latter, two cases were treated with a high-dose and accelerated t-PA regimen (10 mg bolus and 90 mg in 2 hours) and the other three cases with low and ultra-slow doses (25 mg in 25 hours). We consider the normalization of the mean transvalvular gradients and the resolution of regurgitation in cases of prosthetic insufficiency a successful result. The mean age was 62.6 years and the mean time from surgery to DVT of 84.9 months. Most of the patients belonged to class III and IV of the NYHA. Anticoagulation was subtherapeutic in 80% of cases. The thrombolysis success rate was 100%.  Of the three cases of ultra-slow pattern, only one of them required a second dose. No side effects or complications were observed. In the surgery group, two patients died during hospital admission as a result of shock and a state of low postoperative cardiac output. In the thrombolysis group, there was only one deceased at 8 months, although not related to DVT related to metastatic melanoma. Results We observed a full success rate in the resolution of DVT, with no complications in cases of thrombolysis compared to surgery. Bolus ultra-slow infusion of t-PA is equally effective in resolving DVT, although logically with less bleeding risk due to the dose used and the time of administration, without embolic events having been observed due to slower lysis of the thrombus or new thrombosis during a year of follow-up. Conclusion According to our results treatment with low-dose and ultra-slow t-PA regimen will be the initial therapeutic option in clinical practice guidelines given the safety, low cost, and efficacy. Abstract Figure. valvular thrombosis. Evolution.

Background Echocardiographic assessment of the left ventricular systolic function is essential in diagnosis and during the follow up of cardiovascular diseases. Although subjective visual approach method is easily applied, quantitative systems give more objective information about systolic function analyses. The purpose of this study is to evaluate the different quantitative methods of estimating systolic function basal in non-invasive techniques Methods We used a group of 40 patients, prospectively collected, under chemotherapy treatment with preserved systolic function. Same echocardiography device (Philips EPIQ-7) has been used in all studies (acquiring apical 4 and 2 chambers and 3 D of apical volume by an experimented operator). We compare three standard methods with impact in the literature (Speckle tracking and 3D Heartmodel system) to the echocardiographic gold-standard (Simpson’s biplane method). The Bland-Altman method has been used for the graphic comparison of the values of the resulting measures while the statistical comparison was made by a T-student method. Results Three quantitative methods were used to compare left ventricular systolic function assessment (Heart Model 3D (60.4% ± 5.2%), Strain (60.50% ± 7.1%), global longitudinal strain (-19.7 ± 3.15%) to Simpson’s biplane (mean 62.10% ± 5.75%). Values of differential means (2.73 with Heart model 3D and 2.08 with Strain) compared to Simpson’s biplane were translated to a Bland-Altman plot and means were compared with a T-student method. A statistically significant difference was found in case of the Heartmodel method compared with Simpson’s biplane (p < 0.05), though it does not imply any clinical difference. Less time consuming and better segmentation of the cardiac cavities in just one beat with the 3D-Heart Model technique was a magnificent point compared to the Strain method that needed a postprocessing modification Conclusions Heartmodel method is probably the most time-saving and with a good accuracy of left ventricular systolic function assesment and it is not inferior compared to the echocardiographic gold-standard Simpson’s biplane method. Abstract P334 Figure 1. Bland-Altman analysis

Background Left atrial appendage (LAA) occlusion devices represent an important alternative to anticoagulation in patients with atrial fibrillation (AF) with high risk of bleeding and who have suffered any hemorrhagic event. At first, a transesophageal ultrasound is performed to examine cardiac cavities, take measures of LAA and discharge the presence of thrombi. We redo a new transesophageal ultrasound as a control three months later after having installed the device. The purpose of this article is to show our experience in ultrasound follow up of LAA occlusion. Methodology All measures of LAA were taken with the transoesophageal ultrasound device by the same operator. According to the size acquired from the appendage of each patient, they were divided into a first group with the implementation of the Watchman device (23 patients) and Amplatzer (6 patients). A transthoracic echocardiography control was performed on each patient to rule out the presence of complications after the intervention, before to be discharged from hospital. After three months, a new transoesophageal study was repeated to assess the correct position of the device and to rule out the presence of any disfunctions or clot formation. Results A total of 29 patients with AF (CHADSVASC 4.09 HASBLED 2.96) with a high risk of bleeding and after having suffered any complications (41% brain bleeding, 31% major gastrointestinal bleeding, 27% advanced chronic kidney disease) were presented for the implantation of a LAA closure device. Firstly, LAA size was confirm and the presence of a thrombi was rule out. No patient suffered complications during the procedure that was confirmed with transthoracic echocardiography (discharging the presence of perforation, pericardial effusion or tamponade). At three months later, we performed a new transoesophageal as a control for the assessment of the place and presence of GAPs, if any (80% correct-placed, 15% placed with a gap of 2-4 mm with passage of flow throughout). In a 10-month follow-up, it was found that practically 93% of patients were still without anticoagulation, except two patients, one of them (CHADSVASC 4 HASBLED 2) had to reintroduce oral anticoagulation due to the fact of the clot formation on the device. The second one (CHADSVASC 4 HASBLED 2) had to reintroduce temporarily fractionated heparin due to stent thrombosis in the femoral artery. None of them presented any ischemic complications or new haemorrhagic events. Conclusions LAA occlusion devices are an effective and safe alternative to anticoagulation in patients with atrial fibrillation with predisposition to bleeding where ultrasound techniques play an essential role in all stages of procedure (prior to implantation of the device, during and at the follow-up).