Day 3 :
Vice President , Brazilian Society of Cardiovascular Surgery, Brazil
Keynote: How can we change training for cardiovascular surgeons? A new way of looking at an old problem
Time : 09:00-09:50
Rui Manuel de Sousa Sequeira Antunes de Almeida is the Board Member of the Paraná’ Society of Cardiovascular Surgery, since 2002, and became its President (2006-08). He was elected as a President of the South Brazilian’ Society of Cardiovascular Surgery (2007-09), a Member of the Board of the Brazilian’ Society of Cardiovascular Surgery (2009-2010), President of the Board (2011-2013) and President of the Endovascular Department of the Brazilian’ Society of Cardiovascular Surgery (2011-2013), Scientific Director of the Brazilian’ Society of Cardiovascular Surgery (2014-15) and Vice-President for the period of 2016-17. He has published more than 100 papers in peer reviewed national and international medical journals and presented more than 250 papers in scientific meetings. He also served as the Editorial Board Member of 10 international journals and five Brazilian journals.
Cardiovascular surgery has always been a specialty that has a solid education, when we take training into account. In a country vast as Brazil, with a population growing, it is imperative to have the same strategies to teach in different subsets. Lately with the increasing number of new techniques and the diseases severity of most patients, it is becoming more difficult to train new surgeons, or for the matter, to retrain old surgeons, not only in new techniques, but also to intend to train to become expertise in some operations. It is know that to become an expert in a known technique a continuous training in a full time period will be needed for some years. It is also known that for a training program to be efficient, the trainers, tutors or teachers, should have skills different from what we were accustom to. In Brazil, through the national society of cardiovascular surgery, a program was started, to train new cardiovascular surgeons, after a four year residency in general cardiac surgery, or retrain established cardiac surgeons, into becoming experts in endovascular surgery. The program has a theoretical approach, followed by a part where the trainee is located to a “Hands On” lab or a biological simulator, under the supervision of specialists, and also to virtual simulators. After this, the trainee follows a strict program in a specialized center, where he has the opportunity not only to participate in all cases, being the theoretical discussion and the clinical and surgical part of the procedure. An integrated center for the theoretical and simulator part was created in the center of Brazil, in cooperation with the industry, and eight clinical centers, which receive the trainees, after a process of evaluation, so that they can actually perform the surgeries. These features are a way to solve the problems of training with good specialists in a vast country, with some logistic problems.
Chief Quality Officer, SKMC, Cleveland Clinic, UAE
Time : 09:50-10:40
Dr. Ellahham has served as Chief Quality Officer for SKMC since 2009. In his role, Dr. Ellahham has led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by a number of awards. As Chief Quality Officer and Global Leader, Dr. Ellahham has a focus on ensuring that that implementation of this best practices leads to breakthrough improvements in clinical quality and patient safety.
In most countries worldwide, the number of patients with chronic heart failure (HF) is growing, with 1–3% of the adult population suffering from this syndrome, rising to about 10% in the very elderly. In the near future a large part of the worldwide population will suffer from heart failure and society will be faced with the consequences. On average one in five patients is readmitted within 12 months, making heart failure one of the most common causes of hospitalization in people over 65 years of age. A multidisciplinary team approach involving several professionals with their own expertise is important in attaining an optimal effect. Physicians, nurses, and other health care professionals are key to ensuring the delivery of evidence based care. Markers of clinical (in) stability, psychosocial risk factors, and issues related to patient mobility might be important indicators to determine which inter-professional service might be most effective for which patient. Current HF guidelines recommend that HF patients are enrolled in a multidisciplinary-care management program to reduce the risk of HF hospitalization. A multidisciplinary approach to HF may reduce costs, decrease length of stay, curtail readmissions, improve compliance, and reduce mortality. An important limitation, however, is the substantial heterogeneity in both the terms of the models of care and the interventions offered, including: clinic or community-based systems of care, remote management, and enhanced patient self-care. Conventional trials that randomize individual patients may not be the best way to test the effect of a service; novel approaches, such as the cluster randomized controlled trial, may be superior. It is unlikely that any one approach is optimal. The best form of care might seek to compensate for the weaknesses of each approach by exploiting their strengths.
A strong HF cardiology lead, supported by primary care physicians, nurse specialists, and pharmacists in the hospital and community with the ability to offer patients remote support might offer the best service. Key to the success of multidisciplinary HF programs may be the coordination of care along the spectrum of severity of HF and throughout the chain-of-care delivered by the various services within the healthcare system. Further research is warranted to identify the most efficacious multidisciplinary approaches to HF.
- Heart Diagnosis | Cardiac and Cardiovascular Research
Atletico de Madrid Football Club, Spain
Title: Football elite players: Special exercise practise and cardiac repercussions. Sport cardiac evaluation consensus is needed to prevent abnormal cardiovascular events
Time : 10:55-11:20
Ramon Hernandez Molina is a Clinical Cardiologist with over 25 years of experience in Cardiovascular Risk Assessment including prevention of cardiovascular events, as well as the cardiological follow-up of people who practice sports. For more than 5 years, he is the Reference Cardiologist for the continuous evaluation of the players of the first soccer team of Atletico Madrid. Developing activity through an intensive electrocardiographic and echocardiographic clinical evaluation in each and every one of the players, he believes that it is very important to individualize the cardiological prevention needs of the elite player to minimize their possible cardiovascular events.
Among the events of greater participation and worldwide repercussion is the practice of professional football. This is a sport of great importance in most of the countries of the five continents, with football-related sporting events being one of the most followed events by the world population. Unfortunately, the occurrence of adverse events related to the practice of this sport of cardiovascular origin constitutes a very important obstacle both for the normal development of this activity at a competitive level and in the development of the sports activity of elite players. The age range of high competition players in football is between 16 and 35 years. Normally these players undergo pre-entry examinations at different soccer clubs but the development of their physical activity in relation to cardiovascular events, among them sudden death, has shown that this initial evaluation is insufficient for the correct follow-up and prevention of cardiovascular events in the extreme physical activity that this type of athletes develop. The development of norms of cardiological performance in these players will allow a very significant decrease in the appearance of negative cardiovascular events as well as the prevention of any alterations that may affect their normal physical activity. There is no doubt that this type of cardiological action on the football player will contribute to the best development of football matches of the training and any activity of this type of elite athletes.
University of Technology MARA (UiTM), Malaysia
Title: Procedural safety and one month outcome of patients treated with magnesium bioresorbable scaffold
Time : 11:20-11:45
Nicholas Chua is an Interventional Cardiology Fellow and Medical Lecturer at University of Technology MARA, Malaysia. His expertise is on Clinical Medicine, Undergraduate Teaching and Interventional Cardiology. His ongoing researches are on young acute coronary syndrome, statin therapy and dysfunctional HDL cholesterol.
Background: Magnesium Bioresorbable Scaffold (BRS) was launched last year. The advantage of using BRS include, reduced long-term complications such as stent fracture, late stent thrombosis and in-stent restenosis with return of normal vasomotor function and late lumen gain with plaque regression. However, procedural safety and long-term outcome data is scarce.
Objective: The objective of the study is to identify safety and outcome of patients undergoing Percutaneous Coronary Intervention (PCI) with magnesium BRS.
Materials & Methods: This was a prospective, observational single center study conducted in UiTM Sungai Buloh from 1st November 2016 to 14th February 2017.
Results: 7 patients who were enrolled had mean age of 46 (±9). All were male. Ethnicity breakdown showed 5 Malays, 1 Chinese and 1 Indian. Cardiovascular risk assessment revealed 85.7% diabetes mellitus, 42.9% smokers, 28.6% hypertension and 28.6% dyslipidemia. Target vessels treated were 6 left anterior descending (LAD) and 1 right coronary artery (RCA). Out of the 7 patients, 28.6% were type A lesions, 42.8% were type B1 and 28.5% were type C. Among those, 4 involved LAD-D1 bifurcations and 2 were Chronic Total Occlusions (CTO). The lesions were prepared with semi-compliant balloons in 5 cases and non-compliant balloons in 2 cases. The balloon-to-stent ratio were 1:1 (n=1), 0.92:1 (n=1), 0.85:1 (n=4) and 0.83:1 (n=1). The magnesium BRS diameters used were 3.5 mm (n=4) and 3.0 mm (n=3) with length of 15 mm (n=1), 20 mm (n=4) and 25 mm (n=2). Post-dilatation in one patient was carried out with non-compliant balloon of equal diameter to the stent, while the rest had upsizing with +0.5 mm larger balloons. Procedural outcome was 100% successful. At one-month follow-up, there were no symptoms, MACE or TLR.
Conclusions: We demonstrated safety and good short-term outcome in the use of magnesium BRS in our cohort. However, larger cohort and long-term outcome monitoring would better delineate the safety and efficacy of this BRS.
“Carol Davila” University of Medicine and Pharmacy, Bucharest
Title: Association between hypomagnesaemia and hyperuricemia accompany more severe forms of atherosclerosis and inflammatory syndrome in patients with cardiovascular disease from Romania
Time : 11:45-12:10
Ioan A Gutiu has expertise in the study of atherosclerosis risk factors in cardiovascular disease especially in inflammation contribution, pathogenic interventions of non-traditional risk factors such as dental state, magnesium, uric acid, etc., all with possible therapeutical consequences. All his scientific and medical activities are linked to educational work in “Carol Davila” University of Medicine from Bucuresti –Romania.
Statement of the Problem: In atherosclerosis, hypomagnesaemia (HMg) may increase oxidation of LDL, activation of macrophages and platelets aggregation, freeing of cytokines, etc. Hyperuricemia (HUA) may increase risk of cardiovascular disease by metabolic interventions: could promote oxidative stress, endothelial dysfunction and low level inflammatory syndrome. Effects of association between HUA and HMg on atherosclerosis in cardiovascular disease (CVD) are still unclear now. We hypothesize that association of HMg and HUA may be found in more severe forms of atherosclerosis and may influence and aggravate atherosclerosis consequences (cardiovascular disease-CVD).
Methodology: In a cross sectional study of 405 cardiovascular patients (old myocardial infarction, angina pectoris, stroke), mean age 52.5 years, men 127 (31%), we analyzed presence of main atherosclerosis risk factors (dyslipidemia, arterial hypertension, serum glucose, smoking, obesity, etc.) and some usual markers of inflammation (fibrinogen, CPR, serum leukocytes, dental state: missing tooth and carries as markers of chronic gum inflammation).
Findings: We compared the patients group with HMg (first tertile) and high uric acid level (last tertile) with the rest of patients. Some atherosclerosis risk factors differ significantly in these groups: triglycerides (228.5+/-175.8 versus 144.5+/-108.5 mg%, P<0.001); HDL-cholesterol (45.3+/-12.5 versus 50.3+/-11.8 mg%, P<0.013), serum glucose (128.9+/-52.7 versus 95.7+/-25.7 mg%, P<0.001), systolic arterial pressure: (160.5+/-22.1 versus 152.9+/-26 mmHg, P<0.04); concerning inflammation: fibrinogen (410.8+/-120.8 versus 376.5+/-110.4mg%, P<0.034), missing tooth (18.4+/-8.4 versus 15.6+/-8.4, P<0.034).
Conclusion & Significance: Association of HMg and HUA may delimit a group of CAD patients with more severe atherosclerosis and inflammation. These deleterious effects of association of HMg and HUA imply an early detection and suppose therapeutically consequences.
Individualized Heart Health Acupuncture Clinic, Australia
Title: Respiratory muscle training reduces significant stress level measured by the short term heart rate variability (HRV)
Time : 12:10-12:50
Jerzy Dyczynski MD is a Cardiologist, a Medical Doctor and a Scientist who has over 40 years of Medical Experience. Initially, he worked as a Medical Physician. He graduated in Traditional Chinese Medicine during the early 1990’s in Beijing, China. He received his Doctorate in Cardiology in 2002 and graduated in Medical MBA (2008) from the German University in Management of Outpatient and Integrative Medical Care. Since 1991, he has practiced Holistic Cardiology, Internal Medicine, Holistic Medicine and Acupuncture in the hospital settings and performed cardiovascular research in Europe, before immigrating to Perth in 2007. He has been working at the Edith Cowan University in Perth on heart/brain medicine. He has been engaged in numerous medical research projects and published 60 scientific works in cardiology, cardiac diagnostics and acupuncture. Since 2014, he is running his medical practice in Perth.
This scientific study takes more than 2000 years of the exercise of a breathing technique practice to a new level of a significant medical intervention. The study included consecutive 163 patients, 53 males, 100 females from 39 to 93 years; average age was 73. A small portable device creates a dynamic window into the essential cardiovascular functions. It is an evidence based tool to assess also the autonomic nerve system, dynamism of the breathing and the hormonal activity. It displays the unique combination of the specific multi-channel ECG and 3 frequencies (high, low and very low) HRV analysis delivering a color coded mapping cardio portrait image in two minutes. It transforms the big cardiovascular HRV data into intelligent diagnostic information, which can be used for monitoring the respiratory muscle training intervention outcome. Two records were performed by all patients in sitting position with natural breathing activity as a baseline and in about 20 minutes later after introduction of the new diaphragmatic breathing technique and 10 minutes of the respiratory muscle training. The Cardio Stress Index (CSI) ranging from 0 to 100% was calculated as a computerized algorithm including: analysis of ECG-intervals, pulse rate, Fourié Transformation, heart’s cohesion and HRV as a baseline and after. The values of the CSI below 20% were considered as the normal level of the cardiovascular stress. The majority of 78.6% patients showed an increased CSI, 41.45% in average, which was statistically significant reduced to 22.79% after respiratory muscle training intervention (p<0.001). The positive, statistically significant impact of the respiratory muscle training intervention on the heart and the cardiovascular stress level measured as the short term HRV can be an ultimate 21st century low-cost intelligent diagnostic analysis and a successful therapeutic intervention for the stress reduction.
Medical Editor(English), Japanese Society for Surgical Metabolism and Nutrition, Japan
Mary Shibuya is an experienced native English medical editor/writer of 32 years living in Japan with a background in chemistry and allergy research at Mayo Clinic (Rochester, MN). For 23 years she was the language editor of the journal Internal Medicine, published by the Japanese Society of Internal Medicine. In addition to editing and preparing research articles for publication in international journals, she attended various medical/scientific congresses as Press (interviews, transcription, summarizing). She also enjoys lecturing on scientific medical writing in English to graduate schools and pharmaceutical companies. She strives to encourage ESL doctors/researchers to publish in English.
In a world of changing linguistic forms and non-standardized scientific terminology, English manuscript preparation for submission to an international medical journal can be challenging for both native and non-native speakers. It is imperative to develop a composition style which is clear and concise, while including sufficient background for orientation and also research details to impress the reviewers. This seminar highlights the important specific aspects of writing a quality scientific manuscript for journal submission, from appearance and organization to rules on repetition. Revision, which follows the manuscript writing, is critical to distinguish the first draft errors which are obvious to a review board, but less well recognized by authors. These first draft errors can be categorized into the following: 1) Layout/style errors, such as, margins, spacing, font, headings, paragraphs, numbering, abstract structuring and incomplete title page, 2) Grammar errors including, proper nouns, verb tenses, topic sentences, transitioning, paragraph body, spelling and abbreviations, and 3) Numerical errors, such as, citations, totals, p values, references, symbols and mismatched data. Following revision, the all-important Cover Letter must be composed. The necessary points to include as a means to “sell” the manuscript to the journal editor-in-chief are discussed. This seminar is designed to not only inform, but also encourage first time and seasoned writers to achieve a submission-ready manuscript for journal publication.
- Young Research Forum
University of Hawaii, USA
Zara Berg is a PhD candidate in the Biomedical-Clinical Research Department at the University of Hawaii at Monoa. Currently, she is a Professor of Anatomy and Physiology at Kapioloni Community College. She was Chairwomen of Fort Peck Tribes IRB and on-site coordinator for community-based participatory research at Fort Peck Community College before further her education. Her interest includes environmental cardiology and gene-environment interaction. She has an MS in Interdisciplinary Toxicology from Texas A&M University and BS in Biology from Montana Tech of the University of Montana.
Occupational exposure to pesticides in the Honolulu Heart Program is significantly associated with total mortality. This study examines occupational exposure to pesticides on the job in relation to incident cardiovascular diseases. In the first 10 years, there was a positive correlation between age-adjusted CVD incidence and pesticide exposure. This relationship remained significant after adjustment for risk factors (p=0.05). There was no association for coronary heart disease or stroke and pesticide exposure when examined separately, possibly due to a smaller number of outcomes. Based on the OSHA exposure scale statistical, analyses were performed using a cohort of 7, 994 Japanese-American men from the Honolulu Heart Program. The biochemical mechanisms leading to CVD associated with risk factor will be discussed. These results are significant because the association between occupational exposure to pesticides and cardiovascular diseases have not been examined in this cohort. These findings are important in the prevention of cardiovascular diseases related to occupational exposures.
World Citi Medical Center, Philippines
Richultz C Montevirgen, MD, is a graduate of San Beda College of Medicine. He is currently taking his Internal Medicine Training at World Citi Medical Center. In future, he wants to pursue career in Interventional Cardiology
Acute limb ischemia of the upper extremity is the non-traumatic acute occlusion of arterial supply to a limb or organ presented with a constellation of symptoms specific to the tissue suddenly deprived of arterial perfusion. Irrespective of the arterial segment involved, this syndrome represents a vascular emergency. In every day clinical practice, acute arterial occlusion is synonymous with acute limb ischemia. Rapid recognition and treatment are required to prevent limb loss and life-threatening morbidity. Management of the syndrome has evolved, but the diagnostic skills required to recognize this clinical entity remain unchanged. We are presented with a case of a 65 year old, male, Filipino, who came in due to sudden right hand pain. The patient was presented initially with right hand pain that eventually developed numbness accompanied by pulselessness and cyanosis. The patient was then referred to a TCVS specialist for co-management, portable Doppler confirmed the absence of pulses in the radial and ulnar regions of the right hand. Anticoagulation using heparin bolus followed by heparin drip was initiated; the patient was then scheduled for emergency embolectomy. Intraoperative findings confirmed the presence of obstructing emboli in both radial and ulnar arteries of the right hand, freeing the obstruction resulted in immediate reperfusion of the affected limb. Post operatively, prothrombin and partial thromboplastin time was monitored. Warfarin 5 mg/tab was overlapped with the heparin drip while continuously monitoring the coagulation parameters for anticoagulant adjustments. This case highlights the importance of early recognition and emergent treatment of acute limb ischemia, which includes the paramount importance of proper history taking and physical examination, high index of suspicion, and non-invasive diagnostic tests that could give a quick but reliable impression to guide in the proper care of these kinds of patients are recommended. Prompt initiation of anticoagulation is the first line of treatment while embolectomy provides cure.
Karolinska Institute in Stockholm, Sweden
Fadiea Al-Aieshy is a certified Pharmacist working at Karolinska University Hospital and a PhD-student in Medical Science at Karolinska Institute in Stockholm, Sweden. The main aim of her research is to evaluate biomarkers for the new oral anticoagulants dabigatran, apixaban and rivaroxaban, to increase safety and efficacy in individual patients.
Background: The direct factor Xa (FXa) inhibitors apixaban and rivaroxaban are used for stroke prevention in patients with atrial fibrillation (AF). The FXa-inhibitors do not require routine laboratory monitoring in the same extensive way as warfarin, but as exposure, i.e. plasma concentration, correlate to efficacy and safety and it was important to establish both the methods to monitor when needed and typical exposure intervals.
Aims: The aim of this study is to show the typical exposure range of apixaban and rivaroxaban in real-life patients with AF, and further to evaluate different laboratory methods for these measurements.
Methods: We have included a total of 141 AF patients treated with either apixaban 2.5 mg/5 mg (n=10/60) twice daily or rivaroxaban 15 mg/20 mg (n=10/61) once daily. Trough plasma concentrations were measured by liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and Anti-FXa assays were calibrated with apixaban/rivaroxaban (STA® Liquid Anti-FXa (Diagnostica Stago, Asnieres, France)).
Results: Typical (10th-90th percentiles) exposure intervals were 43-118 ng/ml for apixaban and 13-63 ng/ml for rivaroxaban. The median trough apixaban plasma concentration measured by LC-MS/MS was 75 ng/ml (range 15-186 ng/ml). Patients who were treated with apixaban 5 mg twice daily had significantly higher drug levels than patients treated with the 2.5 mg dose. The median trough rivaroxaban plasma concentration measured by LC-MS/MS was 34 ng/ml (range 5-84 ng/ml). No significant difference in rivaroxaban concentration was seen between the 15 mg and 20 mg doses. Anti-FXa assays correlated strongly with LC-MS/MS for both apixaban and rivaroxaban (p<0.001).
Conclusions: Apixaban and rivaroxaban plasma concentrations varied substantially in AF patients. We here describe the range of exposures as well as typical exposure intervals for both drugs. We suggest that these typical exposure intervals may be used for dose guidance.
Gunma university , Japan
Hidenobu Matsuzaki is a student of Gunma university department of medicine. He has an inquisitive research mind and also an enthusiastic passion for clinical medicine.
Statement of the Problem: Selenium is one of the elements necessary for producing enzymes and proteins. Selenium facilitates antioxidant action. Therefore, the lack of the selenium leads to the risk of cardiovascular diseases, such as heart disease1). Also, it is reported that the status of selenium is related to the cancer2).
The significance of research: We want to determinate how the selenium status in the blood influences the prevalence of cardio vascular disease in Lampung, Indonesia. Such findings can lead to the key to identifying the method by which we can effectively reduce the risk of cardiovascular disease.
Materials and method: The location for this research is Lampung, Indonesia. There are some islands in Indonesia, and those areas have different prevalence. First, we use the data of selenium status in the blood in Jakarta, and also there are reports that the relation between selenium status and the concentration of selenium in the soil. Therefore, we use data of soil concentration in Jakarta and Lampung, expect the status of selenium in the blood in Lampung. Next, we make the figure of Mortality rate-selenium status, using the data of CDV mortality rate in Lampung.
Using these result, comparison of selenium status between other countries and thereby offer insight into possible means of disease risk factors.
The status of selenium in the blood in Lampung is enough but the mortality is high compare with other countries. It shows there is other reason of CVD. As for the accuracy of those data, we don’t obtain all data we needed. Therefore we can increase accuracy collecting other data.
Also, there are many risk factors associated with CVD. We can research other risk, and identify the cause of CVD in Lampung.
St. Luke’s Medical Center Global City Heart Institute, Phillipines
Sheryll D Santos is a graduate of Doctor of Medicine at the University of the East Ramon Magsaysay Medical Center, Philippines. She had her Adult Cardiology Fellowship at St. Luke’s Medical Center- Global City, Metro Manila, Philippines. She is currently undergoing Clinical Research Fellowship in Echocardiography in the same institution.
Transcatheter Aortic Valve Replacement (TAVR) is a well-established therapeutic option for patients with inoperable severe, symptomatic aortic stenosis (AS). The self-expanding and balloon expandable systems have dominated, and large clinical trials have established their safety and efficacy. Despite good clinical outcomes, these valves exhibit technical limitation mainly paravalvular leak (PVL) and valve malposition associated with poor prognosis. Second generation valves have been developed and among them is the Lotus valve which is repositionable and fully retrievable and is designed to minimize PVL. The objective was to evaluate the safety and performance of the lotus valve system in symptomatic severe AS patients and to compare outcomes with those of corevalve treated patients at 30 days based on VARC-2 criteria. A total of 89 patients with symptomatic severe AS (77.3±8.08 years of age, 56% males with mean STS score of 10.4±11) underwent TAVR from February, 2012 to November, 2016. Seventeen patients underwent lotus TAVR and outcomes were compared with corevalve treated patients. Procedural device success showed no significant difference between the two cohorts. Successful single valve deployment and significantly less contrast loading (p<0.000) were seen with the lotus group. No significant difference in the early safety and clinical efficacy parameters at 30 days was seen in both groups. Echocardiography showed a significant decrease in the mean aortic gradient and increase in the aortic valve area for both groups. The lotus group has less degree of PVL (p<0.004) and lower pulmonary arterial systolic pressure (PASP) (p<0.011) as compared to the corevalve cohorts. In this matched comparison of patients with severe AS who underwent TAVR, no significant difference with regards to mortality, safety and clinical efficacy at 30 days between the two groups was seen. Significantly less PVL, greater improvement in the PASP and less contrast loading were seen in the lotus cohort. The clinical significance of these differences needs to be tested in a larger clinical trial with longer follow-up period.
St. Luke’s Medical Center Global City Heart Institute, Phillipines
Fontini Christi C Cuenca is a graduate (Doctor of Medicine) at St. Louis University, Baguio City Philippines. She had her Adult Cardiology Fellowship at St. Luke’s Medical Center- Global City, Metro Manila, Philippines. She is currently undergoing Clinical Research fellowship in Echocardiography in the same institution.
Background: The safety and efficacy of transcatheter aortic valve replacement (TAVR) in symptomatic high risk tricuspid aortic valve (TAV) stenosis has been established. TAVR in bicuspid aortic valve (BAV) stenosis is currently considered as an off label application. Several studies with small sample size showed safety and efficacy of TAVR on BAV stenosis. There are currently no reports on Filipinos with BAV treated with TAVR.
Aim: The aim of this study is to assess the safety and efficacy of transcatheter aortic valve replacement among adult Filipinos with symptomatic severe stenotic bicuspid aortic valve.
Methods: Consecutive patients from February 2012 to November 2016 with severe symptomatic aortic stenosis who underwent TAVR in Saint Luke’s Medical Center-Global City were included in our study. Results were compared between patients who had TAVR on TAV stenosis versus TAVR on BAV stenosis.
Results: 89 patients were included in the study (n=89). 10 (11%) of these patients were identified as having BAV by multislice computed tomography and transthoracic echocardiography. No significant differences were noted in the aortic valve annulus size and aortic valve area (p=0.14) pre-operatively. BAV group received a relatively smaller bioprosthetic valve size (p=0.03). No significant difference was found between the BAV and TAV group procedural success. One patient in each group needed emergency open heart conversion (p=0.23). Post procedural echocardiographic assessment showed a higher mean pressure gradient (p=0.01) and increased PVL in the BAV group (1.01). There were no significant difference in the 30-day and 1-year cardiac mortality and all-cause mortality between the two groups (p=1.0).
Conclusions: TAVR in our limited experience represents a feasible and effective alternative treatment in patients with severe BAV stenosis. Procedural and 1-year outcomes are comparable to those patients with TAV stenosis. More research with larger population and long term follow up is needed to validate results.
Khoo Teck Puat Hospital in Singapore
Patrick John Cruz has completed his graduation in Medicine in Philippines. He underwent Internal Medicine Residency in Manila, Philippines. He is a Fellow of the Philippine College of Physician. He is also affiliated and currently a Resident Physician in the Department of Cardiology at Khoo Teck Puat Hospital, Singapore.
Background: In great majority of the cases, acute myocardial infarction (AMI) is due to atherosclerosis, resulting in critical coronary occlusion usually with plaque rupture. However, non-obstructive coronary artery may be found during angiography in minority of patients presenting with AMI.
Objective: To give an overview of the clinical characteristics and possible etiologies of AMI patients with non-occlusive coronary artery in Singapore.
Method: This is a single center, retrospective, descriptive study of all patients who presented clinically with AMI (STEMI and NSTEMI) from January 2014 to January 2016 who had non-occlusive coronary arteries on coronary angiogram. Clinical profiles of these patients were retrieved from hospital records.
Results: Of the 1,404 patients admitted for NSTEMI and STEMI, 46 patients were included, giving a prevalence of 3.28%. Of these, 23 were male and 23 were female. Most are of the Chinese descent (41%) were followed by Malays (28%) and Indians (20%). Average BMI was 25.6±5.5. None had renal failure, 46% have hyperlipidemia, 39% with hypertension, and 20% with diabetes mellitus. Only 10% have a history of IHD and/or angioplasty, 17% had family history of CAD and 19% had reduced ejection fraction. Of those with non-occlusive coronary arteries, 37% have normal coronaries while 63% have minor CAD. Being a smoker, hyperlipidemic, hypertensive, diabetic and having past history of IHD didn’t point to a predilection towards having a non-occlusive CAD. Minor CAD patients are significantly older and all those with history of ethanol use belong to normal coronary group. Cardiomyopathies were attributed in 20% of patients, 15% to coronary spasm, 10% to muscular bridging and 2% to myocarditis/myopericarditis, while in majority (52%), the cause is unknown.
Conclusion: Non-occlusive CAD in coronary angiogram, though infrequent, can be observed in patients who present with AMI. Hypertension, hyperlipidemia, diabetes mellitus were not significantly associated with non-occlusive CAD in AMI.