14^th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA

Biography:

Tamara Feygin is an Associate Professor of Clinical Radiology at University of Pennsylvania and Children's Hospital of Philadelphia. Her primary interests are fetal and neonatal imaging. She led the development and implementation of magnetic resonance “Fluoroscopy” in clinical practice for assessment of dynamic processes in fetuses. She is a dedicated Educator and Mentor of medical students, radiology residents and radiology and neuroradiology fellows. She has been invited to present her work nationally and internationally. She is a Member of the European Society of Neuroradiology, the Radiological Society of North America, the Society for Pediatric Radiology, and a Senior Member of the American Society of Neuroradiology.Tamara Feygin is an Associate Professor of Clinical Radiology at University of Pennsylvania and Children's Hospital of Philadelphia. Her primary interests are fetal and neonatal imaging. She led the development and implementation of magnetic resonance “Fluoroscopy” in clinical practice for assessment of dynamic processes in fetuses. She is a dedicated Educator and Mentor of medical students, radiology residents and radiology and neuroradiology fellows. She has been invited to present her work nationally and internationally. She is a Member of the European Society of Neuroradiology, the Radiological Society of North America, the Society for Pediatric Radiology, and a Senior Member of the American Society of Neuroradiology.

Abstract:

A variety of congenital heart diseases (CHD) may be diagnosed prenatally. Traditionally, the fetal heart was primarily assessed by fetal echography. However, fetal MRI has been proven as a helpful imaging tool in detection of cardio-vascular anomalies in utero. Numerous conditions, including transposition of great vessels, aorta coarctation, hypoplastic left heart syndrome, tetralogy of Fallout, cardiac aneurysm, pericardiac/cardiac tumors may be demonstrated on MR imaging. In addition, presence of other coexisting anomalies outside of the cardio-vascular system may be revealed. Some cardio-vascular anomalies may be more than an isolated problem and could be a part of an underlying systemic/genetic condition. Even in the absence of genetic abnormalities, infants with CHD are at increased risk of brain lesions (15-45%) or neurodevelopmental delay.  There is numerous data from autopsy reports, postnatal imaging and from more recent prenatal imaging research that congenital heart defects delay structural brain development in utero.  The demonstration of a full spectrum of fetal anomalies provides extremely valuable information to clinicians and parents-to be. Fetal MR may be a feasible addition for timely and precise diagnosis of cardiac disease and associated anomalies. Prenatal imaging therefore helps to predict pregnancy outcome, and prepares couples for the birth of a child with an abnormality.  The obtained information may also assist in thorough screening of fetal patients for eligibility for fetal treatment. It may help to prognosticate to some degree important issues of patient’s developmental outcome and quality of life.

Biography:

Hideko Kasahara completed her MD and PhD from Nagoya University and National Institute of Physiological Sciences in Japan, and postdoctoral studies from University of Michigan and Beth Israel Deaconess Medical Center/Harvard University. She is currently Associate Professor, University of Florida College of Medicine. She has published 48 papers, half of which are related to Nkx2-5 in reputed journals, and has been serving as an editorial board member of Laboratory Investigation.

Abstract:

Introduction: Heterozygous missense mutations in the homeodomain of human NKX2-5 lead to a high penetrance of diverse cardiac anomalies, including Tetralogy of Fallot, along with near complete penetrance of atrioventricular (AV) conduction defects, compared with mutations outside the homeodomain. We recently replicated a disease-causing missense mutation in the homeodomain in a knockin mouse model, Nkx2-5^+/R52G, which demonstrate a high incidence of cardiac malformations and AV conduction defects. Although these mutant mice were backcrossed over 8 generations and expected to have almost the same genetic codes, these mice demonstrate pleiotropic cardiac anomalies, suggesting the presence of non-genetic effects.

Hypothesis: Since maternal health conditions are critical for normal embryonic development, we hypothesize that cardiac defects in the mutant mothers affects embryonic cardiac development.

Methods: Heterozygous mutant and wild-type mice were mated in two different groups: (Group 1) female mutant Nkx2-5^+/R52G and male normal mice; (Group 2) female normal mice and male mutant Nkx2-5^+/R52G mice. The offspring were analyzed postnatal day 7 (P7) by which the mutant mice with severe cardiac anomalies are expected to die.

Results: The genotype of the offspring from Group 2 follows the Mendelian’s law (51% wild-type and 49% mutant, n=115). However the ratio of the genotype from Group 2 was 65% wild-type and 35% mutant (n=89), suggesting that half of the mutant mice died before postnatal day 7.

Conclusion: Our results indicate that when the mothers have heterozygous Nkx2-5 mutation, less number of mutant mice survive until P7, and lead to near 50% of loss of mutant offspring by P7. 

Biography:

Anil Om is an interventional cardiologist at McLeod Regional Medical Center in Florence, SC and Director of their cardiac cath lab.  He received his cardiology training from Virginia Commonwealth University in Richmond, VA and his interventional fellowship from Strong Memorial Hospital in Rochester, NY. He has published more than 25 articles in reputed journals.

Abstract:

Contrast-induced nephropathy (CIN) is one of the complications of contrast angiography.  Various measures have been tried to reduce CIN, but so far, pre-procedural good hydration and minimal contrast used in the procedure have been shown to be of real benefit.  This study reports performing percutaneous coronary intervention (PCI) with minimal contrast.

Twelve patients with base-line significant renal insufficiency, felt to be at higher risk of CIN, underwent thirteen separate PCI by a single-operator.  Their charts were retrospectively reviewed for amount of contrast used and follow-up creatinine. All patients had iso-ismolar contrast and underwent evaluation by intravascular ultrasound.

No patients had CIN (defined by increase in 20% of serum creatinine from base line) and there were no procedural complications.

PCI in patients with baseline significant renal abnormality can be safely undertaken with proper precautionary steps (beyond the scope of this abstract) during the procedure. 

Biography:

S Jamal Mustafa is the Professor of Physiology and Pharmacology at West Virginia University (WVU). He has received Dean’s Award for Excellence in Research from SOM in 2008 and became a Robert C. Byrd Professor in 2010 and received Chancellor’s Award for Outstanding Achievement in Research and Scholarly Activities from HSC, in 2013. He has published over 200 manuscripts. His past work has led to the approval of an A_2A selective AR agonist (Lexican®) for myocardial perfusion imaging. Currently, they are using AR and β adrenergic receptor KOs to better understand the relationship between these receptors in coronary flow regulation.

Abstract:

Adenosine increases coronary flow (CF) through the activation of A_2A and A_2B adenosine receptors (ARs). However, these mechanisms are not fully understood. We previously showed that adenosine-induced increase in CF is in part through NADPH oxidase (Nox), which is independent of A₁ or A₃ ARs. In this study, we hypothesize that adenosine-mediated increase in CF is through Nox activation and depends on A_2A but not on A_2B ARs. Functional studies were conducted using Langendorff mouse hearts. Hydrogen peroxide (H₂O₂) production was measured in isolated coronary arteries from WT, A_2A and A_2B AR KO mice using immunofluorescence. Adenosine-induced concentration-dependent increase in CF was attenuated by the specific Nox2 inhibitor gp91 ds-tat or reactive oxygen species (ROS) scavenger EUK134 in both WT and A_2B but not A_2A AR KO hearts. Similarly, the A_2A AR selective agonist CGS-21680-induced increase in CF was significantly blunted by Nox2 inhibition in both WT and A_2B AR KO, while the A_2B AR selective agonist BAY 60-6583-induced increase in CF was not affected by Nox2 inhibition in WT. In intact isolated coronary arteries, adenosine-induced (10 μM) increase in H₂O₂ formation in both WT and A_2B AR KO mice was attenuated by Nox2 inhibition, whereas adenosine failed to increase H₂O₂ production in A_2A AR KO mice. In conclusion, adenosine-induced increase in CF is partially mediated by Nox2-derived H₂O₂, which critically depends upon the presence of A_2A AR. These studies may lead to better understanding of the role of ARs in coronary disease and may lead to better therapeutic approaches.

Biography:

Abstract:

Introduction: The aim of the study was to evaluate the clinical outcome, 30 day- and longterm follow up in patients undergoing ECMO for refractory postcardiotomy cardiogenic shock.

Methods: We analyzed all patients undergoing ECMO-Therapie (n=1040; age = 55.8±20.8; 67.2% male) between 11/1997 and 12/2013 at our institution. Follow-up range was from 0 to 13.9 years and was complete in 100%.

Results: Patient mean body mass index was 26.6±5.4 kg/m², diabetes in 23.6%, pulmonary hypertension in 15.6%, active smoking in 25.1%, chronic obstructive pulmonary disease in 5.8%, peripheral arterial disease in 21.3%, preoperative intravenous inotropic in 9.2%, preoperative dialysis was in 4.6% and ejection fraction of 43.9±18%. Isolated CABG procedure was performed in 21% and isolated valve procedure in 12.2%. 30 day survival rate was 53±1.6%, 5 year survival rate was 19.8±1.5% and 16.4±1.9% after 10 years. Patient who were discharged from hospital had a 5 year survival rate of 60.6%±3.6% and 10 year survival rate of 50.3±5.3%. Additional surgery procedure increased mortality rate significant. Multivariate regression analysis revealed older age (p=0.01; OR 1.01 per year), preoperative beta blocker (p=0.005; OR 1.6) and active smoking (p=0.002; OR 1.7) as independent risk factors for mortality. Cox analysis revealed following predictors for long term mortality: preoperative calcium antagonist (p=0.01; OR 5.9), active smoking (p=0.013; OR 1.8), active endocarditis (p=0.013; OR 1.5), CABG operation (p=0.004; OR 1.3), aortic valve replacement operation (p=0.008; OR 1.3), mitral valve replacement (p=0.005; OR 1.4), replacement of the ascendens aorta (p=0.002; OR 1.5), postoperative cardiac arrhythmia (p=0.005; OR 5.6), symptomatic postoperative transitory psychotic syndrome (p< 0.001; OR 2.4), gastrointestinal complication (p=0.031; OR 8.9).

Conclusions: ECMO support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors. By high morbidity and mortality and also high resource management ECMO support must be definite by individual risk profile.

Biography:

Sweeney obtained his BSc and PhD in Pharmacology at University of Glasgow, UK. He then moved to the Hospital for Sick Children in Toronto as postdoctoral fellow. Sweeney is now Professor in the Department of Biology at York University. He has also served as Chief Scientific Officer and Diabetes Group Leader at Institut Pasteur Korea, a world-leading translational research institute. His research is funded by Canadian Institutes of Health Research, Canadian Diabetes Association and Heart & Stroke Foundation of Canada. Studies have resulted in publications in leading journals including Diabetes, Nature Reviews Cardiology, Proc Natl Acad Sci USA, Journal of Clinical Endocrinology & Metabolism, Endocrinology and Cell Metabolism. These studies focus mainly on diabetes and cardiovascular disease, in particular the mechanisms linking obesity with diabetes and heart failure.

Abstract:

The mechanisms of obesity- and diabetes-induced heart disease are multifaceted and remain to be clearly defined. There is currently great research and clinical interest in the effects of adipokines on the myocardium. This lecture will discuss the potential significance of adipokines in the pathogenesis of heart failure via their ability to regulate cardiac remodeling events including metabolism, hypertrophy, fibrosis, and cell death. As an example of a 'good' adipokine, the focus will first be on adiponectin which is known to confer numerous cardioprotective effects. Subsequently, lipocalin-2 is an example of an adipokine which mediates pro-inflammatory and pro-apoptotic effects. It is important when studying actions of adipokines to integrate cellular and mechanistic analyses and translate these to physiologically relevant in vivo models and clinical studies. However, assimilating studies on numerous cardiac remodeling events which ultimately dictate cardiac dysfunction into a unifying conclusion is challenging. Nevertheless, there is undoubted potential for the use of adipokines as robust biomarkers and appropriate therapeutic targets in heart failure.

Biography:

Abstract:

Objective: Evaluate the real-time tension adjusting to right ventricular pacing lead guided by transthoretic echocardiography during implantation procedure to the influence of long-term tricuspid insufficiency (TI).

Methods: Consecutive patients with following criteria were screened into the study:

1) Chronic three degree atriventricular conduction block. 2) Dual chamber pacemaker was intended to implant. 3) Without tricuspid insufficiency before procedure. 4) Right Passive fixarion ventricular lead from Medtronic Company could be used. Enrolled patients were randomized into TAF group (tension adjusting by fluorospy) and TAE group (tension adjusting by fluorospy plus echocardiography). All passive leads were fixed at right ventricular apex. After satisfied parameter measurement, Trans tricuspid lead tension was adjusted by fluorospy only in TAF group and by fluorospy plus echocardiography. In TAE group, lead tension was adjusten by fluorosoy at first. Then echocardiography was conducted to exam possible tricuspid insufficiency or valvular deformation until adjusting satisfaction. All patients were following up more than 12 months by regular echocardiography.

Results: Total 76 patients (63.8+－11.5 yrs, male 43) were enrolled. Thirty seven cases were randomized into TAF group (64.3+-9.6 yrs, male 21) and 39 cases into TAE group (62.9+-10.7 yrs, male 22). All procedures were successful without complications. In TAE group, mild to moderate TI were detected and rectified after primary floroscopy tension adjusting in 12 patients (30.8%). In TAF group, mild to moderate TI was detected within 24 hours after procedure in 9 patients (24.3%) and it was kept to the end of follow up. During the follow up of 17.5+－4.8 months, TI in TAE group was significantly less than that in TAF group (0.5% vs 24.3%, P<0.01).

Conclusions Echocardiography guided right ventricular pacing lead tension adjusting significantly decreases acute and long-term mild to moderate tricuspid insufficiency.

Biography:

Jin Hur is an associate professor of Radiology at Yonsei University College of Medicine. He has completed his PhD in 2010 in Yonsei University College of Medicine.  He is now a visiting faculty in the department of radiology of Stanford University School of Medicine. He has published more than 50 papers in reputed journals.

Abstract:

It is clinically important to differentiate cardiac tumors from cardiac thrombi because of the difference in therapeutic approaches for these two pathologies. The purpose of this study was to assess the diagnostic value of a volume based quantification using dual-energy cardiac computed tomography (CCT) for differentiating between cardiac tumors and thrombi and to compare quantitative CCT values with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) parameters. We prospectively enrolled 31 patients who had a cardiac mass on echocardiography or computed tomography (CT). All patients underwent dual-energy CCT (GE HD750) and 20 patients underwent LGE-CMR imaging. For quantitative analysis, the following parameters of the cardiac masses were measured: CT attenuation values in Hounsfield units (HU), iodine concentration (IC, mg/ml), and signal intensity (SI) ratio. A mixed effects model was used to evaluate the significance of differences in mean CT attenuation values, mean iodine concentration, and SI ratios between the cardiac tumor and thrombus groups. Diagnostic performance of each parameter was evaluated by a receiver operating characteristics (ROC) curve. There were a total of 17 cardiac tumors and 15 cardiac thrombi. The mean iodine concentration (mg/ml) was significantly higher in cardiac tumors than cardiac thrombi (3.405 ± 2.624 for cardiac tumors; 2.056 ± 2.793 for cardiac thrombi, p = 0.001). The diagnostic performance of the IC and SI ratio for differentiating cardiac tumors from thrombi was not significantly different (AUC; 0.822 vs. 0.945, p = 0.084). Dual-energy CCT using volume-based iodine measurements can be used to differentiate between cardiac tumors and thrombi.

Biography:

Mark Houston received his MD from Vanderbilt Medical School and Internal Medicine Training at UCSF.  He is an Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine, Clinical Instructor in the Department of Physical Therapy and Health Care Sciences  at  George Washington University (GWU), Director of the Hypertension Institute and Vascular Biology and Medical Director of the Division of Human Nutrition at Saint Thomas Hospital in Nashville, TN .

Dr Houston was selected as one of the Top Physicians in Hypertension in the US in 2008-2014 by the Consumer Research Council, and by USA Today as one of the Most Influential Doctors in the US in both Hypertension and Hyperlipidemia twice in 2009- 2010.  He was selected as The Patient’s Choice Award in 2010 -2012 by Consumer Reports USA.

He is triple boarded certified by the American Board of Internal Medicine (ABIM), the American Society of Hypertension (ASH) (FASH) and the American Board of Anti-Aging and Regenerative Medicine (ABAARM, FAARM).  He holds two Masters of Science degrees in HUMAN NUTRITION from the University of Bridgeport, CT and another in METABOLIC and NUTRITIONAL MEDICINE (University of South Florida School of Medicine-Tampa).  

Abstract:

This study was a randomized, double-blind, placebo-controlled and single-center trial of 40 patients, consisting of a screening visit, a 2-week run-in, and a 4-month treatment period with a combination nutritional supplement (LC). Advanced lipid testing and advanced cardiovascular inflammatory markers were measured.  LC® significantly reduced total cholesterol, LDL-C, VLDL-C, ox LDL, ApoB, TG, LDL-P, heart rate and diastolic blood pressure and increased HDL-P and increased LDL size compared to placebo at one month and four months.   In addition, LC® significantly reduced hs-CRP, TNF alpha, IL-6 within the treatment group from baseline. There were no adverse effects in the treatment group. LC® did not lower Co enzyme Q 10 levels or adversely affect any other lab parameters that were measured. These changes would be expected to reduce cardiovascular risk.  LC® is an effective and safe alternative to statins and other lipid- lowering drugs in the treatment of dyslipidemia.

Biography:

Khaled Sherif has completed his medical school at the age of 25 years from University of Tripoli/ Libya and Internal Medicine Residency from Texas Tech University Health Science Center, Lubbock TX. He is then has completed 2 fellowship training in Geriatric Medicine and Palliative Medicine before he starts working as internist in Covenant Medical Center, Lubbock TX. He is also a clinical faculty at Texas Tech University Department of Internal Medicine. He has published many papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Gastropericardial fistula is an acquired disorder that is associated with a high mortality rate. It is a rare complication of laparoscopic surgery for reflux disease and thoracic procedures. A 74-year-old lady with history of gastroesophageal reflux disease (GERD) and surgically repaired hiatal hernia presented with history of chronic dyspnea and cough. Physical examination was normal apart of a pericardial rub. Laboratory data showed leukocytosis and the chest X-ray showed a large left-sided soft mass. As result of the mass on chest x ray, chest and abdominal CT scan was done and showed large pericardial effusion with hiatal hernia and gastro-pericardial connection. Gastropericardial fistula is an uncommon complication but it has very high mortality rate. Among causes that result in this condition, hiatal hernia and esophagogastric surgery have been the most frequently reported. The occurrence of post-operative gastropericardial fistula is induced by the perihiatal scarring. In addition, recurrence of hiatal hernia or migration of the surgical wrap may also favor occurrence of fistulae. For gastropericardial fistula, contrast media-enhanced traditional examinations are the cornerstone of diagnosis. Abdominal CT may reveal the fistula. Surgical correction is the most effective form of treatment.

Biography:

Abstract:

Statement of the Problem: Extensive clinical observations over the past decade have inextricably linked diabetes (DM) to cardiovascular disease (CVD) to an extent that an estimated 70% of all diabetics die from CVD complications. Despite significant clinical advances in CVD treatment, morbidity and mortality due to DM-associated CVD remains an important clinical challenge. Evidence suggests that AT2R, encoded by Agtr2 gene, improves cardiac repair after myocardial infarction. AT2R is an angiotensin II receptor and a member of the anti-inflammatory branch of renin-angiotensin system (RAS). Clinically, loss of AT2R expression in men due to the intronic G1675A or A1818T polymorphism is associated with increased arterial stiffness, and impaired kidney function. We hypothesized that an AT2R agonist that can elevate cardiovascular AT2R expression and activation in conditions of DM will protect patients from DM-associated CVD progression. There are no such drugs currently in standard of care. We reported recently that NP-6A4, an AT2R agonist developed by Novopyxis Inc., could increase the survival and viability of nutrient-stressed mouse and human cardiovascular cells better than beta-blockers and AT1 receptor blocker losartan. This study was performed to determine whether the protective effects of NP-6A4 are translational to a cardiac-impaired animal model (male Zucker Obese, ZO-M rat) a translational model for human CVD and type 2 diabetes (T2DM). We treated 11-week-old ZO-M rats exhibiting CVD with NP-6A4 (1.8mg/kg/day by subcutaneous delivery) for 2 weeks. This treatment improved several cardiac parameters including circumferential strain of endocardium (p≤0.05), myocardial performance index (MPI) (p≤0.005), and E/E’ ratio (p≤0.002). NP-6A4 also reduced cardiomyocyte hypertrophy and fibrosis in ZO-M rats, and increased capillary density and AT2R expression in the heart (p≤0.05). Therefore, we conclude that NP-6A4 is an effective drug that can increase cardiovascular protective AT2R expression and mitigate DM-associated CVD.

Biography:

He has worked as associate professor in the Department of Psychiatry and a senior research scientist in the Central Scientific Laboratory at the Grodno State Medical University (Belarus). He has published more than 700 papers in English and Russian language peer-reviewed journals and 30 monographs focusing on the epidemiology of alcohol/drug-related problems in transitional society. He is a founding member of the International Society of Addiction Medicine (ISAM), presiding member of the International Academy of Sobriety (IAS), national representative for Belarus of World Suicidology Net and is an active member of National Association of Psychiatrists. He currently serves as an Editorial Board member for the European Journal of Medicine, Substance Use and Misuse, Journal of Psychiatry, Acta Psychopathologica, Journal of Addiction Medicine and Therapeutic Science, Journal of Addiction and Therapy, Journal of Sociolomics, Periodic Review of Drinking & Culture, Suicidology, Journal of Cardiology & Diagnostics Research. He is also the Editor-in-Chief of Sobriology.

Abstract:

Background: The mortality rate from cardiovascular disease in Russia is one of the highest in the world. It was repeatedly emphasized that alcohol provides the most plausible explanation for both the high rate and the dramatic fluctuation in Russian cardiovascular mortality rate during the last decades, while other traditional risk factors identified in epidemiologic studies had little predictive value. Objectives: The aim of the present study was to estimate the premature cardiovascular mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of mortality and alcohol consumption. Methods: Age-standardized sex-specific male and female cardiovascular mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. Results: The results of the analysis suggest that 36.1% of all male cardiovascular deaths and 25,8% female cardiovascular deaths in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 22,7% (75+ age group) to 60,8% (30-44 age group) and for women from 17,3% (75+ age group) and 62,4% (30-44 age group). Conclusions: The outcomes of this study provide support for the hypothesis that alcohol is a major contributor to the high cardiovascular mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia. Given the distribution of alcohol-related cardiovascular deaths, interventions should be focused on the young and middle-aged men and women.

Biography:

Abstract:

Objective: Evaluate the relationship between ablation dot number at pulmonary vein atrium (PVA) and long-term efficacy of paroxysmal atrial fibrillation (PAF).

Methods: Patients with PAF history more than 6 months were selected to isolate pulmonary veins (PV) at PVA. 3D mapping system (Carto-C3) and cool flow catheter (SmarTouch) were used to make the shell of atrium-PVA and ablation circle around PVA. Superior and inferior PVAs were ablated by single ablation circle. Maximal perpendicular diameters of the circle were measured. The ablation dot on the circle was counted and divided by the sum of two maximal circle diameters. Ablation dot number was defined as addition of left and right PVA ablation dot number. PVA isolation was defined as complete disappear of PV potential. PAF long-term efficacy was evaluated by regular clinical check and Hotter monitoring at 6 and 12 months after procedure.

Results: 160 patients with PAF (65.7+-8.6 yrs, male 110) and with PAF history of 15.7+-9.3 months were enrolled into the study. All PVs in each patient were isolated successfully by single procedure. Ablation dot number per circle and per patient was 32.6+-7.3 and 61.7+-9.1 respectively. During the follow up of 16.5+-3.3 months, 131 patients (81.9ï¼…) were free of PAF. PAF was recurrence in 29 patients (18.1ï¼…) in 4.2+-2.7 months after procedure. Ablation dot number was significantly different between patients with and without PAF recurrence (56.3+-5.7 vs. 63.8+-7.1, P<0.01).

Conclusions: Ablation dot number around PVA is positively related to the long-term efficacy of PAF. Dot creation per patient more than 63 significantly decreases PAF recurrence.

Biography:

Adeola Animasahun is a competent & seasoned Healthcare Professional, her greatest successes have been achieved in the areas of Electrocardiography, Echocardiography, and Diagnostic & interventional Pediatric Cardiology. She has more than 10 years of experience in all facets of Leading a Medical Unit, Operations Management, Training & Development, Consultative Services and overseeing Administration for demanding, high stress and fast paced Healthcare facilities. She promotes academic research initiatives and accurately employ research outcomes into relevant academic activities. She is a versatile contributor with experience in all core Pediatric Interventional Cardiology functions, problem-solving skills, and the ability to make difficult decisions.

Abstract:

Transposition of the great arteries is the most common cyanotic congenital heart lesion in the newborn. . Palliative and definitive interventions to manage children with transposition of the great arteries is currently not available in Nigeria and there are limited reports on it in Africa and sub-Saharan Africa. A prospective and cross sectional study involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Pediatric Department of Lagos State University Teaching Hospital, Lagos Nigeria as part of a large study between January 2007 and December 2015. There were 51 cases of TGA within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10,000 among population of children who presented to center during the study.  Its proportion amongst children with congenital heart disease was 4.9% , while it  was 15.4% among those with cyanotic congenital heart disease. The mean age +   SD of the subjects was 10.3±21.8. Up to 70% of the patients were less than 6 months of age at initial presentation. The most common mode of presentation in our subjects was cyanosis. The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56% of the patients.

Transposition of the great arteries is as common in Nigeria as in the other parts of the world. The most common mode of presentation was cyanosis. There is an urgent need to establish Pediatric Cardiac centers in Nigeria if these children are to be salvaged.

Biography:

Hari Babu completed his DM( Interventional cardiology) in 2014 as state topper of Rajiv Gandhi university. He did his post-graduation in Internal Medicine from M. S. Ramaiah Medical college. He also did his under graduation from Dr. B R Ambedkar Medical College. He was awarded second best scientific paper in Asia pacific Indialive International conference in Delhi 2014. Three scientific papers are under research, that will be published shortly.

Abstract:

Aim:-Tetralogy of fallot(TOF) is a most common cyanotic congenital heart disease encountered in clinical practice. Right ventricular function is an important determinant of post operative outcomes in these patients. Cardiac Magnetic Resonance Imaging is a gold standard in evaluating right ventricular function. However this technique is expensive, has limited availability, and requires significant expertise to acquire and interpret. Hence we would like to use 2D-Echo which is easily available.  Most of the parameters used in 2D-Echo in evaluating right ventricular function are load dependent except for isovolumic acceleration (IVA) and myocardial performance index(MPI). Hence in view of lack of data on Isovolumic acceleration on pre-operative evaluation in Congenital Heart Disease, we used this parameter in evaluating the post-operative outcomes in (TOF). Isovolumic acceleration is a ratio of peak velocity during isovolumic contraction and time to peak.

Methods:-Sixty three consecutive TOF patients planned for intracardiac repair referred for pre-operative Echocardiographic evaluation were studied. Their mean age was 9+/-3 years. All patients were in sinus rhythm with stable hemodynamic condition during Echocardiographic examination. Doppler tissue imaging technique was used to determine IVA. Recordings were made at a sweep speed of 50 to 100mm/s. Values are presented as means of 3 consecutive beats. The sample volume of 6mm. From the basal right ventricular free wall IVA was measured. These patients were followed up with IVA for 2 weeks and at 1 month.  We correlated preoperative IVA to length of ICU stay and 30 day mortality using chi-square test. A P value of <0.005 was considered significant.

Results:-Sixty three TOF patients were divided into four groups based on IVA values. Group 1 consisted of 19 patients who had IVA > 2.2m/s² were used as controls. Group 2 consisted 12 patients who had IVA between 1.5 and 2.2m/s². Group 3 consisted of 17 patients who had IVA between 1 and 1.5m/s². Group 4 consisted of 15 patients who had IVA <1m/s². Each group was further subdivided based on length of ICU stay and mortality. Group 1 and group 2 had no mortality nor the postoperative ICU stay was more than a week. In group 3, twelve had ICU stay for more than a week and three died in hospital. Group 4, thirteen patients had ICU stay for more than 1 week and 11 died in hospital.

Conclusion:-Our studied showed there is a significant association of pre-operative IVA to post operative outcomes in TOF patients and those patients whose IVA values < 1m/s² had high 30 day mortality with significant P values < 0.0001. Hence IVA can be used as a prognostic marker in TOF patients who are planned for intra-cardiac repair.