Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 6th International Conference on Clinical & Experimental Cardiology San Antonio, USA.

Day 1 :

Keynote Forum

Anthony Martin Gerdes

New York Institute of Technology-College of Osteopathic Medicine, USA

Keynote: What you should know about cardiac remodeling

Time : 09:00-09:30

OMICS International Cardiology 2015 International Conference Keynote Speaker Anthony Martin Gerdes photo
Biography:

Anthony Martin Gerdes has done PhD in Anatomy (1978), from University of Texas Medical Branch at Galveston. He was the Professor/Chair of Anatomy, University of South Dakota. Also the founding Scientist for Sanford Research-University of South Dakota. His Current position is Professor/Chair Biomedical Sciences, NYIT College of Osteopathic Medicine, Old Westbury, NY, 2011-present. Publications: ~120 peer reviewed journal articles. 2013 Distinguished Alumnus, Graduate School of Biomedical Sciences, UTMB at Galveston Anthony Martin Gerdes developed a precise method to determine cardiac myocyte shape. He then provided a comprehensive understanding of how cardiac myocytes remodel during growth, maturation, aging, cardiac hypertrophy, and heart failure (HF) from many etiologies. After demonstrating that low thyroid hormone function alone can cause heart failure, he showed remarkable beneficial changes in myocyte shape and vascular remodeling, reduced fibrosis, and improved LF function after thyroid hormone treatment of various models of HF (including ischemia, diabetes and hypertension).

Abstract:

The "Age of Cardiac Remodeling" began in the mid-1990s with the realization that drugs leading to improved ventricular remodeling were doing something remarkable in cardiac patients. This created an experimental need for high quality assessment of changes in cardiac tissue composition, including myocyte shape, myocardial fibrosis/collagen, and vascular remodeling. Many working in the field today have little or no training related to recognition of fixation artifacts or common errors associated with quantitative morphology. Unfortunately, such skills had become somewhat of a lost art during the ages of cardiac physiology in the mid-20th century and molecular biology, gaining prominence by the mid-1970s. Consequently, cardiac remodeling studies today are often seriously flawed to the point where data are not reproducible and subsequent researchers may be chasing the molecular basis of a non-existent or erroneous phenotype. The current unacceptably high incidence of irreproducible data is a serious waste of time and resources as noted recently in comments by the NIH Director. The goal of this talk is to share some lessons I have learned during nearly 40 years of assessing morphological changes in the heart. It is possible for any lab to routinely publish highly reproducible morphologic data that stand the test of time and contribute to our fundamental knowledge of cardiac remodeling and the molecular mechanisms that drive it.

OMICS International Cardiology 2015 International Conference Keynote Speaker Louis Samuels photo
Biography:

Louis Samuels received his Undergraduation education at the University of Rochester in New York and attended Medical School at Hahnemann University in Philadelphia. He completed his General Surgery and Cardiothoracic Surgery training at Hahnemann and. joined the faculty in 1995, assuming the Directorship of the Heart Transplant and Ventricular Assist Device Program in 1997. In 2001, Samuels and his team implanted the world’s fifth total artificial heart (AbioCor). In 2003, Samuels joined the Main Line Health System at Lankenau Medical Center (Wynnewood) as the Surgical Director of Heart Failure and rose to the rank of Full Professor of Surgery at Thomas Jefferson University School of Medicine (Philadelphia) in 2009.rnSamuels has published more than 100 peer-reviewed manuscripts, has participated as Principle or Co-Investigator in numerous Ventricular Assist Device (VAD) trials, serves as the medical monitor for and Clinical Events Committee member of VAD trials, and continues to engage in a busy clinical practice. rn

Abstract:

Acute Cardio-Respirtory Failure refractory to conventional therapy has been perceived of as a therapeutic exercise in futiluty for over half a century. In the 1950s, cardiopulmonary bypass (CPB) was introduced by Dr. John Gibbon Jr at Thomas Jefferson Hospital in Philadelphia, PA. While the use of CPB for surgical procedures has flourished, important “spin-off” technologies began to be conceived of and considered for use beyond the operating room—hence, Extra-Corporeal Membrane Oxygenation (ECMO). ECMO came into existence approximately four decades ago primarily through the efforts of its pioneers Drs. JD Hill and Robert Bartlett. However painful and disappointing the results were initially (and for several decades thereafter) these investigators and others persisted in the belief that this technology was life-saving and not likely to be discarded.rnIn 1983, only three institutions regularly performed ECMO (Medical College of VA, University of Michigan, and University of Pittsburgh). By 1986, nineteen institutions provided ECMO support for neonates. And by 1989, the Extra-Corporeal Life Support Organization (ELSO) was established. It would take another two decades before ECMO for adults was more formally adopted, particularly for respiratory failure. In 2009, two important events occurred: 1) The CESAR Trial was published and 2) The H1N1 Flu epidemic. The CESAR Trial compared ECMO therapy versus Conventional Ventilatory Support for respiratory failure and showed superior outcomes in the former. At the same time, the treatment for ARDS related to the Flu epidemic also showed improved outcomes with ECMO support. As a result of these findings, rescue ECMO therapy for respiratory failure in a variety of clinical conditions (i.e. pre- and post-lung transplant, sepsis etc.) has exploded in popularity. Similar findings began to be observed in the cardiac failure categories, both medical (e.g. AMI-Shock) and surgical (e.g. Post-Cardiotomy Shock).rnAs of 2014, there are 278 ECMO Centers that are members of and report to the ELSO Organization. The number of cases for calendar year 2014 was 6510! The latest ELSO Registry Data (July 2015) reported that—for adults—the survival for Respiratory, Cardiac, and E-CPR ECMO were 58%, 42%, and 30% respectively. These results, compared to the outcomes four decades earlier, represent a monumental improvement with every reason to believe that further success is ahead.rnAmong the reasons for continued opimism with ECMO therapy is the progress made in education and technology. With the help of the ELSO Organization, data driven quality measures are being reported and presented at national and international meetings. Every aspect of ECMO application is being critiqued, including patient selection, technical issues, and post-cannulation managment. Furthermore, commercial industry has contributed to marked improvements in the device itself, particularly the pump-oxygenator unit along with the monitoring safeguards that go along with it. Lastly, innovative strategies combining ECMO with other tecnologies—hybrid mechanical support-- may prove worthwhile in selected cases.rnIn summary, ECMO in general and Adult ECMO in particular is emerging as something much more than an exercise in futility. It is evolving into a standard of care for acute cardio-respiratory failure refractory to conventional therapies.

  • Track 3: Heart Diseases & Track 7: Current Research in Cardiology
Speaker

Chair

Yoshiaki Omura

New York Medical College, Heart Disease Research Foundation, USA

Speaker

Co-Chair

Anthony Martin Gerdes

New York Institute of Technology-College of Osteopathic Medicine, USA

Speaker
Biography:

Yoshiaki Omura received Oncological Residency Training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia University. He published over 265 original research articles, many chapters and 9 books. He is currently Adjunct Prof. of Family & Community Medicine, New York Medical College; Director of Medical Research, Heart Disease Research Foundation, New York; President and Prof. of International College of Acupuncture and Electro-Therapeutics, New York; Editor in Chief, Acupuncture & Electro-Therapeutics Research, International Journal of Integrative Medicine, which is indexed by 17 major international Indexing Periodicals. Currently he is also Executive Editor of Integrative Oncology. Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan and China.

Abstract:

Introduction: The author successfully detected biochemical changes, bacterial and viral infections, and identified the exact location of the infections of different part of the heart by ECGs. Similar results were found at different parts of the brain by ECGs during the last decade. Recently the author found that using ECGs, cancer information can be detected not only on different part of the heart but also in the rest of the body. Method: Various cancers existing in patients were detected from the rapidly changing part of QRS complex as well as the rising part of T-wave of every recorded 12 lead ECGs of the patient by detecting maximum Electro-magnetic Field (EMF) resonance phenomenon between 2 identical molecules with same amount using simple method which received a U.S. patent in 1993. From recorded ECGs, EMF resonance phenomenon between specific cancer microscope tissue slides and ECG were only detected from rapidly changing part of QRS complexes of ECGs and also from a part of slowly rising part of T-waves. Rapidly changing parts of QRS complexes of ECG contain invisible information of specific cancers that exist in the same person. This information is detected at relatively large dV/dt of QRS complex of ECGs. Large dV/dt of QRS complexes is due to the large numbers of ventricular muscle excitation which generate relatively large electrical current and voltage with rest of the ECG, which has very little dV/dt with exception of slowly rising part of T-waves of ECGs which correspond to "the Vulnerable Period of Ventricular Fibrillation" or "Commotio Cordis" in spite of relatively small dV/dt. Result: Using ECGs, the author was able to detect cancers of various organs including lung, esophagus, breast, stomach, colon, uterus, ovary, prostate gland, common bone marrow related malignancies such as Hodgkin’s Lymphoma, Non Hodgkin’s Lymphoma, Multiple Myeloma as well as Leukemia and even brain tumor such as anaplastic astrocytoma and glioblastoma. In addition the author was also able to find when the patient has more than one different cancer at different parts of the body. Also, most of drugs taken within 10 hours before taking ECG can be detected from rapidly changing part of QRS complex & rising part of T-waves. Among 50 ECGs of various cancer patients examined without knowing diagnosis, 2 patients with different diagnosis were found from ECGs and later diagnosis from ECG was found to be correct. Furthermore, in 3 cancer patients, additional cancers were also detected from ECGs. Discussion: Thus, by comparing the same lead of ECGs before and after any treatment, the therapeutic effect of specific cancers can be evaluated. In addition, if 12 lead ECGs is taken periodically, we can find approximately when cancer information starts appearing in the ECGs. Maximum information from cancer can be found in rapidly changing QRS complex where dV/dt is relatively large. This new concept and method can be applied any recorded ECGs for detection and screening of the cancer. Consequently, ECGs can provide not only information on the heart but also can detect any single cancer or multiple cancers, which exist in the same individual. ECGs cannot only be used to detect cancer but also can be used to reveal undetected cancers or misdiagnosed cancers as well as detection of medication patient is taking.

Anthony Martin Gerdes

New York Institute of Technology-College of Osteopathic Medicine, USA

Title: A new treatment for heart failure right under our nose for over 60 years?
Speaker
Biography:

Anthony Martin Gerdes has done PhD in Anatomy (1978), from University of Texas Medical Branch at Galveston. He was the Professor/Chair of Anatomy, University of South Dakota. Also the founding Scientist for Sanford Research-University of South Dakota. His Current position is Professor/Chair Biomedical Sciences, NYIT College of Osteopathic Medicine, Old Westbury, NY, 2011-present. Publications: ~120 peer reviewed journal articles. 2013 Distinguished Alumnus, Graduate School of Biomedical Sciences, UTMB at Galveston Anthony Martin Gerdes developed a precise method to determine cardiac myocyte shape. He then provided a comprehensive understanding of how cardiac myocytes remodel during growth, maturation, aging, cardiac hypertrophy, and heart failure (HF) from many etiologies. After demonstrating that low thyroid hormone function alone can cause heart failure, he showed remarkable beneficial changes in myocyte shape and vascular remodeling, reduced fibrosis, and improved LF function after thyroid hormone treatment of various models of HF (including ischemia, diabetes, hypertension).

Abstract:

In 1950, a study showed that Thyroid Hormone (TH) treatment significantly reduced cardiovascular mortality and rates of myocardial infarction in three patient groups. Rather than extend these findings, subsequent poorly designed larger clinical studies using toxic doses of TH analogs convinced the medical community that TH treatment of heart diseases was too risky, primarily due to increased risk of inducing arrhythmias. Due to a steady stream of positive new information, however, this issue has not gone away. Over the years, we have learned many things about low thyroid function and heart diseases. In many studies, low TH function has been linked to increased mortality in patients with various heart diseases. Many short term clinical studies also show improvement in cardiac patients treated with THs. A key animal study clearly demonstrated that hypothyroidism alone can eventually cause heart failure with maladaptive myocyte remodeling and impaired coronary blood flow. Cumulatively, animal studies suggest that all types of heart disease lead to low cardiac tissue T3 levels. One has to ask the question, why is there so much opposition to a drug that improves systolic/diastolic function, improves coronary blood flow, inhibits myocardial fibrosis, reverses fetal gene expression, and reduces arrhythmias (yes, really)? There are good reasons to be apprehensive. But, is fear of over treatment unreasonable? Is there a safe, therapeutic window for TH treatment of heart diseases, including heart failure? Over the past few years, animal research in our lab has focused on answering the critical questions that have blocked progress to translation in this field. These results will be discussed.

Speaker
Biography:

Galya Naydenova Atanasova completed her PhD training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Medical University, Pleven, Bulgaria. She is PhD in Cardiology, Cardiologist, General Practitioner, and Assistant Professor at Pleven Medical University, Bulgaria. She has attended to many International Events and presented her research work. She did many researches on metabolic syndrome ,myocardial infarction, and genetic markers. Dr. Atanasova also serves on several national and international committees. She has served on the Editorial Board of International Journal of Clinical Cardiology, etc. She was nominated by the Foundation Photon for research contributions with Academic Excellence Award-2015 and Photon Innovations-2015 Award.

Abstract:

Objectives of this study were to evaluate opportunities of using of mean arterial pressure (MAP) as a component of the metabolic syndrome (MS) instead systolic and diastolic blood pressures (SBP and DBP) and to create a model, using logistic regression. A total of 104 persons without any apparent disease were selected. Among these people MS was found in 35, according to NCEP-ATP III definition. One way ANOVA test, multiple comparison tests of means and multiple logistic regression analyses were used. The MAP was obtained by the formula MAP=SBP/3+2DBP/3. The four groups used in ANOVA were men and women with and without MS. The ANOVA F-statistic is 17.71 with p-value less than 0.00001. Multiple logistic regressions were used to determine odds ratio (OR) of MS. The first model included the following components of MS - waist (WS), HDL cholesterol, blood glucose (GLU) and serum triglycerides (TG). The second model included WS and TG. MAP was used as the last variable in the both models. The p-values for overall models fit statistic was less than 0.00001. The values of regression coefficients and corresponding p-values were calculated. Thresholds for OR above which the decision about presence of MS should be made, were found. The results indicated strong relation between value of MAP and MS. The proposed model showed a reliable determination of MS, using only one biochemical marker.

Speaker
Biography:

Sergey Suchkov, MD, PhD, male, was born in 11.01.1957, researcher-immunologist, clinician, graduated from School of Medicine, A.V.Lunacharskii Astrakhan State Medical University, Russia, in 1980. Suchkov has been trained at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, National Center for Immunology (Russia), National Institutes of Health Bethesda, USA) and British Society for Immunology to cover 4 British university facili-ties. Dr Suchkov worked for the Central Laboratory at Lenin’s Mausoleum, then at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, for the Institute of Devel-opmental Biology, Russian Academy of Sciences (RAN), Helmholtz Institute of Eye Diseases, and for Moscow Regional Clinical Research Institute including a position of the Immunologist-in-Chief of the Health Services of the Moscow Region. Since 2005, he has been working as Pro-fessor of A.I.Evdokimov Moscow State Medical & Dental University and I.M.Sechenov First Moscow State Medical University. From 2007, Suchkov was the First Vice-President and Dean of the School of Preventive and Personalized Medicine of the University of World Politics and Law. In 1991-1995, Dr Suchkov was a Chief Scientific Secretary of the Editorial Board of the International Journal “Biomedical Science” (issued by the Russian Academy of Sciences and Royal Society of Medicine, UK). In 1995-2005, Suchkov was a Director of the Russian-American Program in Immunology of the Eye Diseases. Dr Suchkov is a member of the Advisory Board, EPMA (European Association of Predictive, Preventive and Personalized Medicine), Brussels, EU, member of the Editorial Boards, Open Journal of Autoimmunity, EPMA J., Personalized Medicine Universe, American J.Cardiovascular Res. Dr Suchkov has published more than 500 papers. He is known as an author of the Concept of postinfectious clinical and immunological syndrome, co-author of the concept of abzymes and their impact into the pathogenesis of aotuimmunity conditions, and as one of the pioneers in promoting the Concept of Predictive, Preventive and Personalized Medicine.

Abstract:

Development of PIFAS as a post-infectious autoimmune syndrome (PIFAS) to illustrate a new combinatorial and integrated biomarker of the immune-mediated (including latent) disorders is featured with a progression of chronic relapsing diseases of post-infectious origin. We have investigated the syndrome-like immunopathology as applicable to chronic inflammatory processes including chronic myocarditis. In view of the structural homology immune response caused by a microbial pathogen to balance between two categories of epitopes (self-epitopes and microbial epitopes) is being developed through both autoreactive T-cells and auto-Abs. The identification of such pathogen is restricted by some difficulties. Thus, for autoimmune myocarditis (AIM) to make a bridging link with the infection is established for two-thirds of all patients, and transformation of primary (infectious) phase into PIFAS is initiated by mimicking epitopes of, for instance, Coxsackievirus (CVB3) and/or Herpesviridae (CMV), herewith presence of cardiomyosine autoreactive CTLs (CM-auto reactive CTLs) and anti-CM auto-Abs, damaging myocardium to release sequestered autoAgs and to facilitate the induction and/or development of PIFAS is required. We can stress that a tandem of two mutually mimicking epitopes (microbial and self-epitopes) is implicated in the pathogenesis of PIFAS. The therapeutic strategy for such patients should be different. And the identification of the primary pathogen or microbial associate is no less im-portant part of the protocol being used, for what we applied immunodiagnostic screening com-bined with molecular diagnostics. There are no obvious clinical and laboratory criteria to get the syndrome validated. An application of transgenic models to suit the aims of clinical practice will give an opportunity to reveal the events gapped between induction and progressing of PIFAS and will allow to pre-select spe-cific targets to control induction and progression of PIFAS and thus chronification of the clinical illness to prevent the latter in time.

Speaker
Biography:

Scott Willoughby obtained his PhD in 1999 from the University of Adelaide. From June 1999 to June 2001 he was a Post-doctoral Fellow at the Whitaker Cardiovascular Institute, Boston University Medical Centre and Boston, Massachusetts under the mentorship of Prof Joseph Loscalzo (current Editor in- chief Circulation). Willoughby is the Head of the Thrombosis and Vascular Biology Laboratory at the Centre for Heart Rhythm Disorders, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, Australia. Dr Willoughby’s research focuses on understanding the integrative physiological mechanisms controlling inappropriate thrombus formation in conditions of increased cardiovascular risk. Dr Willoughby’s work has been published his work in leading journals such as Proceedings of the National Academy of Sciences of The United States of America, Arteriosclerosis Thrombosis and Vascular Biology, Journal of the American College of Cardiology, Heart Rhythm, Circulation Arrhythmia and Electrophysiology and European Heart Journal. He has published more than published 40 papers and serves on the editorial board of 3 journals. He has also received several awards during his career and has received more than $3 million in personal and collaborative research funding.

Abstract:

Introduction: Nonvalvular atrial fibrillation (AF) confers a five-fold increased risk of stroke. Whether catheter ablation (CA) subsequently decreases prothrombotic risk is unknown. Objective: The purpose of this study was to define the time course of inflammation, myocardial injury, and prothrombotic markers after radiofrequency ablation for AF and its relation to AF recurrence. In addition, we assessed the long-term effects of CA for AF on prothrombotic risk. Results and conclusions: Patients undergoing radiofrequency ablation for AF exhibit an inflammatory response within 3 days. The extent of inflammatory response predicts early AF recurrence but not late recurrence. Prothrombotic markers are elevated at 1 week after ablation and may contribute to increased risk of early thrombotic events after AF ablation. Catheter ablation and successful maintenance of SR leads to a decrease in platelet activation and improvement in endothelial function in patients with AF. These findings suggest that AF is an important determinant of the prothrombotic state and that this may be reduced by successful catheter ablation.

Speaker
Biography:

Matthews is a full-time faculty member of Morehouse School of Medicine, Department of Surgery in Atlanta, Georgia, where he serves as Associate Professor of Clinical Surgery. Matthews serves as Director of Surgical Critical Care. He received his medical degree from the University of Mississippi and completed his surgical residency training at Morehouse School of Medicine. He completed a two year surgical critical care fellowship at the Mayo Clinical College of Medicine in Rochester, Minnesota. He is a published author on landmark vitamin D-deficiency manuscripts.

Abstract:

Often overlooked, are the roles that chronic inflammation/oxidative stress play in the pathogenesis of myocardial infarctions. We hypothesized that vitamin D (a secosteroid hormone with anti-inflammatory capabilities) would reduce the incidence, length of stay, and hospital costs in surgical intensive care unit patients. We performed a prospective study of 565 patients divided into two groups admitted to the surgical intensive care unit at Grady Memorial Hospital between August 2009 and August 2012. Group 1 was treated with vitamin D 50,000 international units weekly. Group 2 was treated with vitamin D 50,000 international units daily. Primary outcomes were incidence of myocardial infarctions, length of stay, and cost. There were not any statistical differences between the two groups in terms of demographics: age, gender, race, serum albumin, CD4 count, or baseline vitamin D levels. The number/incidence of myocardial infarctions in Group 1 was 22 (7.8%) and 11 (3.9%) in Group 2 (p value 0.047). The length of stay for the 22 patients in Group 1 who had a myocardial infarctions was 36.1 days and 8.2 days for the 11 patients in Group 2 (p value 0.007). The intensive care unit cost for the 22 patients in Group 1 who had a myocardial infarction was $138,991 and $31,549 for the 11 patients in Group 2 (p 0.0005). Our study demonstrates that vitamin D deficiency is associated with an increased incidence of myocardial infarctions, cost, and length of stay. Further studies are needed to fully assess the impact of vitamin D on cardiovascular health.

Speaker
Biography:

Veena Dhawan has completed her Department of Experimental Medicine and Biotechnology, Research Block-B, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, INDIA. She is the senior faculty (Professor) in the Department of Experimental Medicine and Biotechnology. She has published more than 50 papers in national and International journals.

Abstract:

The bark extract of Terminalia arjuna is used traditionally, as a cardioprotective agent in Ayurvedic system of medicine. Coronary artery disease(CAD)attracts morbidity and mortality worldwide and inflammation plays a pivotal role in pathophysiology of CAD. Besides use of several drugs like statins, inflammation persists in these patients. The present study demonstrates the anti-inflammatory and cardioprotective effects of Terminalia arjuna in vitro in a human monocytic cell-line (THP-1 cells and its validation in stable patients of coronary artery disease. THP-1 cells were exposed to pro-inflammatory cytokine IL-18 and the effect ofan aqueous extract of Terminalia arjuna was evaluated in vitro on the expression of inflammatory molecules.The observations of the in vitro study were further validated in a randomized, placebo-controlled, double-blind clinical trial in 50 subjects with stable CAD who received either placebo or T. arjuna (500 mg twice a day; Himalaya) and were followed up to 6 months. Expression of inflammatory genes eg. CXCL3, COX-2, DUSP-1 and OSM was significantly reduced in vitro in a dose and time-dependent manner by Terminalia arjuna. TA utilized MAPKs and NF-ΚB pathways for its mode of action. These findings were validated in medicated stable-CAD patients who were given Terminalia arjuna. Our data advocates use of Terminalia arjuna as an adjuvant therapy that helps to prevent and ameliorate CAD via its anti-inflammatory and cardioprotective effects. Future studies are warranted in a larger population setup using Terminalia arjuna as an adjuvant therapy to assess its efficacy.

Speaker
Biography:

Emile Toby is a Sierra Leonean and graduate from Njala University who has been working with difference organization in the fight against HIV/ AIDS. He started his campaign in 2010 when he formed the Children and Youths in Development to sensitize young on HIV/AIDS. He has attended many national conferences on HIV has partnered with the national aids secretariat in Sierra Leone in organizing sensitization programs on STDS. Mr. Emile Toby started as an HIV peer educator before later became a coordinator so he has gained lots of experience in STDS education. He served as accountant for the International Education and Resource Network (IEARN).

Abstract:

Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries. We conducted this systematic review to determine awareness and knowledge of school-going male and female adolescents in Sierra Leone of STDs and if possible, how they perceive their own risk of contracting an STD. Results of this review can help point out areas where STD risk communication for adolescents needs to be improved Over the period 1992-2014, a general increase of gonorrhea and syphilis infections was noted in Africa, both in the general population and among adolescents. From the mid-2000s however, increases in the diagnoses of sexually transmitted diseases, in particular syphilis and gonorrhea have been reported in several African countries, especially among teenagers 16-19 years old. The problem with most STDs is that they can occur symptom-free and can thus be passed on unaware during unprotected sexual intercourse. On an individual level, complications can include pelvic inflammatory diseases and possibly lead to ectopic pregnancies and infertility. The declining age of first sexual intercourse has been proffered as one possible explanation for the increase in numbers of STDs. According to data from different African countries, the average age of first sexual intercourse has decreased over the last three decades, with increasing proportions of adolescents reporting sexual activity before the age of 16 years.

  • Track 4: Cardiovascular Drugs & Track 6: Interventional Cardiology
Location: San Antonio

Session Introduction

Jose Antonio Franchini Ramires

University of São Paulo Medical School, Brazil

Title: Inflammation, coronary artery disease and liver: what is the relationship?
Speaker
Biography:

Jose Antonio F. Ramires has completed his Ph.D. at the age of 31 years from University of São Paulo (USP) Medical School. He was the Director of the Heart Institute-INCOR of the University of São Paulo, from 1997 to 2012, where is Head Professor of Cardiology. He was President of the Council to evaluate all the University Professor at USP. He was President of the undergraduate Committee of USP Medical School. He has published more than 480 papers in reputed journals and has been serving as an editorial board member of repute. He was President of the Society of Cardiology of the State of São Paulo, Brazilian Heart Foundation, Brazilian Society of Cardiology, and vice-President of the Interamerican Cardiology Society.

Abstract:

The liver is recognized as a metabolically active organ, responsible for the synthesis of protein, cholesterol and large glycogen storage. Moreover, when stimulated by cytokines released by any inflammatory process, produces and releases proteins into the circulation in response to inflammation, eg fibrinogen, serum amyloid A, C-reactive protein and others. But, while these proteins show the intensity of the inflammatory process they also should serve as a protective response. However, increased fibrinogen may predispose to thrombosis and the pentameric CRP synthesized by the liver becomes monomeric as it is involved in the local inflammation, there becomes the aggressor. With this, we conclude that the liver integrity is important for defending the body, producing inflammation markers and eventually determining aggression. If this reasoning is correct in severe liver disease we would lose the protection, without production of inflammatory response proteins. However, when we compare the presence and characteristic of atherosclerotic plaques of coronary arteries, in four groups of patients: 1-coronary artery disease, 2-liver pre-transplantation, 3-patients with other diseases (non-cardiac or liver) and 4-post-accident or gun, evaluated by necropsy, it was observed that the plaques have different content and different inflammatory response. The most interesting was the finding of the plaque of the row of transplant patients, having the lower cholesterol content, many fibrosis and, practically, absence of intraplaque bacterial agents or hemorrhage. So the question is: several liver failure is a protector of atherosclerosis ?

Speaker
Biography:

Vincenzo Cianci is senior registrar in cardio thoracic surgery at the University of Swansea in UK, previously was staff resident of cardiac surgery at the University of Sacred Heart in Campobasso (Italy). He obtained his medical degree at University of Naples (Italy), and he completed his post graduate training at University of Milan. Cianci began his surgical career as fellow at Humanitas Gavazzeni clinic in Bergamo, after he was staff resident at University of Pavia for five years. In 2011 he was senior registrar in cardiothoracic surgery at Queen Elizabeth Hospital at University of Birmingham (UK). In 2012 he was staff resident in cardiocentro Ticino Lugano (Switzerland). His past clinical practice has encompassed the full spectrum of adult cardiovascular and thoracic surgery including experience in heart and lung transplantation, left ventricular assist device. His current practice focuses on minimally invasive coronary Bypass graft , thoracoscopic epicardial atrial fibrillation . He collaborates actively with Prof. Benetti for the development of Hybrid coronary revascularization with a novel surgical technique.

Abstract:

We describe our initial experience in one stop hybrid coronary revascularization using MINI-OPCABG with PCI DES-stenting on the other non-LAD vessel. The large variability in hybrid coronary revascularization techniques makes it difficult to draw firm conclusions from the currently available evidences, but the hybrid strategy using MINI-OPCABG appears to be a promising and cost-effective alternative for CABG in the treatment of multi-vessel coronary artery disease. In this paper we want to point out the methodology and our initial experience. Materials And Methods: Five patients were treated with hybrid revascularization, the average age was 69 ±6.2, one patient had left main and right coronary lesion, four patient three vessels disease and one patient double vessels disease. The average Euroscore II was 7.40% (range 0.33-19.34), the average Sintax score was 34.8 (range33-41) Three patients received Circumflex and right coronary stenting, other two patients only right coronary stenting. We start with surgery (MINI-OPCABG), and in a range of 6 hours patient was undergone to PCI with DES in single stage. Surgical technique: As was described 1 a skin incision is made from the xiphoid up to the level between the third or fourth intercostal space. The sternum is opened and the left table is lifted to dissect the left mammary artery (LIMA). The LIMA was dissected up to the third intercostals space with scheletonized technique The angle of the superior part where the LIMA is attached to the sternum needs to be below 20 % to avoid any potential kinkink. LIMA distance was measured with the pericardium closed if it achieves the diaphragmatic reflection of the pericardium means that LIMA length is correct. The retractor is changed and two stitches around 2 cm deep in the left border of the pericardium was placed with a distance of a 5 to 7 cm with better exposure Lad area , we decided to perform anastomosis with stabilizer always with the opening part towards the head of the patient to avoid any problem of damaging the graft when you need to take it Results: No in hospital mortality was reported. All patients completed hybrid procedure and there wasn’t any conversion to full sternotomy. Mean intubation time was 1, 5 ±3.2 hrs and length of hospital stay was 3.2±1.2 days , one patient received PRBC transfusion , hospital MACCE was 0%. During PCI procedure angiographic evaluation LIMA grafting was routinary performed and LIMA patency rate was 100%. At one year follow up patients freedom from MACCE was 100%. Discussion: In 1997 we performed for the first time in the world an ambulatory coronary surgery using xiphoid approach. 2 We modified this technique opening a small distal part of stenum and we call MINI-OPCABG to this technique. The potential advantage of the MINI OPCABG versus MIDCABG operation is : 1) MINI OPCABG operation is easy to convert to full sternotomy, 2) patients were less painful 3) potential faster recovery 4) reduction of hospital cost The introduction of DES with lower rates of restenosis and better clinical outcomes may make hybrid coronary revascularization a more sustainable and feasible option than previously reported. 3 Nevertheless, this hybrid approach has not been widely adopted because practical and logistical concerns have been expressed. These concerns implicate the need for close cooperation between surgeon and interventional cardiologist, logistical issues regarding sequencing and timing of the procedures and the use of aggressive antiplatelet therapy for DES. We believe that with MINIOPCABG can solve this issues because this surgical technique reduces the surgical trauma without opening pleural space with less discomfort for the patient , moreover the partial dissection of LIMA reduces the risk of post operative bleeding giving the possibility of starting in a range of only 6 hours the PCI procedure. The HCR procedure was associated with short hospital stays (including ICU stay and intubation time), low MACCE and 30-day mortality rate, low PRBC transfusion requirements. 4 This study has limitations because it was based on the retrospective design, moreover patients for one stop hybrid coronary revascularization were also carefully selected and our good results should be interpreted with caution. However there is a small sample size and long term follow-up and randomized multi-center trial comparing one stop hybrid revascularization with MINI-OPCABG with conventional CABG should be needed.

Speaker
Biography:

Jean C. Bopassa has completed his PhD at the age of 31 years from Claude Bernard University, Lyon1, France and postdoctoral studies from Harvard University and Unviversity of California at Los Angeles. Currently, he is Assistant professor in the Department of Physiology, in the school of medicine at UTHSCSA. He has published more than 17 papers in reputed journals and has been serving as an editorial board member of several reputed journal.

Abstract:

We recently found that acute pre-ischemic estrogen-induced cardioprotection against ischemia/reperfusion injury was mainly mediated via G protein-coupled estrogen receptor1 (GPER1) activation but not through classical estrogen receptors: alpha (ER) and beta (ER). We investigated whether acute post-ischemic estrogen (PI-E2) treatment can also induce cardioprotective effect via GPER1 activation in the intact animal subjected to ischemia/ reperfusion injury. Male and ovariectomized female were subjected to 35 min of the left anterior descending (LAD) artery occlusion, followed by 180 min reperfusion. An E2 bolus (50 mg/kg) or PBS (same volume) was applied via the femoral vein 5 min before reperfusion and a GPER1 antagonist, G15, was given 10 min before E2. Myocardial infarct size was assessed by TTC staining method. Mitochondrial Ca2+ retention capacity (CRC) required to induce mitochondrial permeability transition pore (mPTP) opening was assessed after 10 min reperfusion. Expression of ubiquitinated; acetylated; calpains1 and 10 proteins were measured by Western Blot in mitochondrial fractions. We found that PI-E2 treatment reduced myocardial infarct size and increased mitochondrial CRC. PI-E2 treatment reduced mitochondrial protein acetylation, ubiquitination and also calpain10 levels in mitochondrial fractions as compared to control, respectively. Interestingly, all these of E2 effects were abolished by addition of G15. Acute PI-E2 treatment induces cardioprotection against ischemia/reperfusion injury via GPER1. PI-E2 effects through GPER1 involve the reduction mitochondrial proteins acetylation, ubiquitination, and calpain10 levels and is associated with the inhibition of the mPTP opening.

Speaker
Biography:

Jorge C. Trainini is Surgeon, Chief of Cardiac Surgery Hospital "Presidente Peron" of Avellaneda, Province of Buenos Aires, Argentina. His writings were published trials of blood circulation (Medical Aventis, 2003) and The Crucified thought (Master Eos, 2004), along with some notes appeared in newspapers and magazines. It also has some unpublished works , as Rasinari and desolate geographies. In Lumen Sundown he published his Utopia (2008) test, and his work Pedro Cossio, the Nobel was not (2007), product of his research into the life and work of the eminent Argentine cardiologist, of which he was a disciple.

Abstract:

The Torrent Guasp concept postulates that the ventricles are formed by a continuous muscle band that begins at the level of the pulmonary valve and extends to the aortic root, limiting in this way the two ventricular chambers. This specific anatomical arrangement would support the interpretation of two fundamental aspects of left ventricular dynamics: 1) the torsion mechanism and 2) the physiology of rapid diastolic filling by the suction effect. To investigate the electrophysiological basis of this mechanism, the left ventricular activation sequence was studied by 3D electroanatomical mapping (EAM) in five patients, during radiofrequency ablation of arrhythmias associated to probable abnormal epicardial pathways. As the descending band segment is endocardial and the ascending band segment is epicardial, two approaches were used to perform the mapping.

Conclusions: 1) 3D endo-epicardial mapping shows electrical activation of the apical loop concurrent with synchronic contraction of the ascending and descending band segments; 2) The simultaneous and opposing activation of the ascending band segment to the starting point of its radial activation from the descending band segment, at the point where both band segments cross, is consistent with the clockwise and anticlockwise ventricular torsion of apical and basal areas; 3) Late activation of the ascending band segment, compatible with persistent contraction of the ascending band segment during early isovolumic diastole (basis of the suction mechanism) is produced without need to postulate electrical activation beyond the QRS. The novel activation sequence of the Torrent Guasp band found in this study would explain the previous process triggering the ventricular torsion and suction mechanism. Moreover, this work demonstrates that activation of the ascending band segment completes the QRS. This finding explains the persistent contraction of this muscle segment during early diastole, rejecting the traditional concept of passive relaxation.

Speaker
Biography:

Abdulaziz Joury has completed his medical degree in 2014 obtained from King Saud University, Riyadh, Saudi Arabia. He got his scholarship in internal medicine and cardiology sciences from Ministry of Health, Saudi Arabia. Currently he is working as a research fellow and clinical observer in the George Washington University, Washington, DC. He has been awarded as the best moderated presenter in the European Society of Cardiology Congress that held in Barcelona, Spain in 2014. Joury is interested in cardiology and cardiac sciences and interested to be one of the leaders in future of cardiology.

Abstract:

Fibrosing mediastinitis (FM), also known as sclerosing mediastinitis, is an uncommon but serious disease involving the mediastinal structures. A high index of suspicion is essential to establishing the diagnosis of FM and starting the appropriate therapy for patients. Here, we report a case of a young female who presented with chest symptoms and subsequently underwent different laboratory and radiologic investigations and an excisional biopsy. The findings of these investigations were consistent with the diagnosis of idiopathic FM. Her disease was associated with complete occlusion of three pulmonary veins and the left main pulmonary artery. The patient was treated with initial high-dose steroids followed by maintenance steroid and methotrexate therapy with very good long-term disease control. Clinical response, high-sensitivity C-reactive protein (Hs-CRP) and erythrocyte sedimentation rate (ESR) were used to monitor disease activity and response to therapy.

Khaled Sherif

Texas Tech University Health Sciences Center, USA

Title: Iatrogenic norepinephrine-induced Takotsubo cardiomyopathy
Speaker
Biography:

Khaled Sherif has completed his M.B.B.Ch at the age of 26 years from University of Tripoli/ Libya and has completed his residency training at Libya in 2008 before he came to USA and finish another residency training in Internal Medicine at Texas Tech University, Lubbock- TX and Geriatric/ Palliative Medicine at University of Oklahoma. He is going to be director of Internal Medicine / Palliative Medicine clinic at Covenant Medical center, Lubbock/TX. He has published more than 15 papers and abstracts in reputed journals and has been chosen as an editorial board reviewer of repute.

Abstract:

Introduction: Stress-induced cardiomyopathy is a syndrome of transient cardiac dysfunction with no clear pathophysiology. It is thought to be secondary to catecholamine surge. The mechanism by which catecholamine can induce transient cardiac dysfunction is unknown. Case: We report a 76 year-old woman who was admitted to the hospital with diverticulitis. Two units of packed RBC with furosemide were ordered. After the patient received blood, norepinephrine 4mg IV was given instead of furosemide due to a nursing error. Soon after that, the patient started complaining of chest pain with dyspnea. Electrocardiogram showed new ST segment and T wave changes in the precordial leads. The cardiac biomarkers were elevated. TTE showed ejection fraction of 25-29%. A coronary angiogram was performed and showed evidence of apical ballooning with no evidence of any coronary artery blockages. The diagnosis of Takotsubo cardiomyopathy was made. The patient was treated with beta-blockers, ACE inhibitors, and aldosterone antagonist for heart failure. Clinically, she improved over time and repeated TTE 6 months later showed EF 50-55%. Discussion: The prevalence of TCM in the general population is estimated to be between 1.7% and 2.2% in patients who present with suspected acute coronary syndrome. It is possible that high doses of catecholamines are directly toxic to myocardial cells. This is supported by histological findings from animal studies and autopsy that document myofibril degeneration, contraction band necrosis, and leukocyte infiltration. In our case, the patient accidentally received a high dose of norepinephrine, which stimulates alpha and beta-1 adrenergic receptors, produces both positive ionotropic and vasodepressor effects. TCM is not a very rare disease but we want to raise awareness of the possible harmful effects of catecholamine on the cardiocytes. To the best of our knowledge, this is first case report about Stress-induced cardiomyopathy secondary to iatrogenic norepinephrine injection.

Speaker
Biography:

Usama A. Omar has completed his FEBIC at the age of 35 years from National Heart Institute, FEBC at age of 31 y and MSc from Cairo School of Medicine. He is the director of Cath Lab at International Medical Center IMC, a largest militery hospital in Egypt . He has published two papers in reputed journals.

Abstract:

One of the important properity of Gadolinium has a higher atomic number (Z = 64) and a higher k edge (50 keV) than iodine (Z = 53; k edge, 33 keV). These properties allow gadolinium and iodine to absorb x rays in the diagnostic energy spectrum. the higher k edge of gadolinium allows the use of imaging at a higher kilovolt peak level (in the range of 96 kVp) without the loss of contrast, as compared with a lower kilovolt peak level used for imaging with iodinated media (in the range of 73 kVp). So, radiographic images of similar volumes of gadolinium exhibit one-eighth to one-fourth strength iodine preparation ,However, gadolinium chelates are limited as an angiographic contrast media because of the relatively low concentration of gadolinium chelate molecules in the preparations available in the United States. Gadolinium, occupying central position in the lanthanide series has 7 unpaired electrons and gives excellent signal in MRI. Adding gold chelates can give rise to nanosystems detectable both by X-Ray CT and MRI. They encapsulate gold nanoparticles with a multilayered organic shell composed of gadolinium chelates bound to each other with disulfi de bonds .This nanoparticle complex could be served both as X-ray and MRI contrasting agent due to presence of radiopaque gold and superparamagnetic gadolinium ions Beam hardening results in increased image contrast for a given concentration of gadolinium relative to that of iodine and accounts for some of the differences noted between theoretical models and calculations and in vivo observations of image contrast.which give us an idea about viable tissue with enhaced gadolinuim ,this gives a great evidence based medicin of sucessfule reperfusion and tissue viability by post procedure MRI.

  • Track 1: Clinical cardiology & Track 5: Pediatric heart diseases
Location: San Antonio
Speaker
Biography:

Khaled Sayed Mahmoud El Maghraby has completed his M.D. at the age of 34 years from AL Minia University. He is the associate professor of cardiology. He has published more than 26 papers in reputed journals.

Abstract:

Background: Neopterin, an immune modulator, produced by activated macrophages. Neopterin and many other proteins implicated in disruption, and plaque progression.
Aim: To investigate the association between plasma neopterin levels and the complexity of coronary angiographic lesions
Patients and methods: During a 12-month period, Forty five patients(Pts) had acute coronary syndrome without ST segment elevation and 15 age matched healthy subjects serve as control group were included in our study. None of the included subjects had ongoing systemic or cardiac inflammatory processes. All underwent a detailed clinical evaluation, routine laboratory investigations, troponin I, electrocardiogram and echocardiography. Quantitative assay of neopterin was measured using enzyme linked immunosorbent assay (ELISA) technique. Angiographic extent and severity of coronary artery disease were assessed and scored according to a Syntax score.
Results: There was a significant difference in neopterin level in pts with high syntax score (14.66±2.81 nmol/L) and those with Intermediate syntax score (11.12±1.5 nmol/L) when compared with low syntax score Pts (8.91±1.59 nmol/L) P value 0.001. Also this significance was noted when high syntax score Pts were compared with intermediate score (P value 0.03)
Conclusion: Serum neopterin concentration is associated with the presence of angiographically demonstrated complex lesions in patients with acute coronary syndrome. Our results suggest that neopterin level may be useful for risk stratification in patients with coronary artery disease

Speaker
Biography:

Rohit Sane, Pioneer of Ayurvedic non- invasive cardiology in India with those 200+ Ayurvedic physicians team treated more than 20,000 CHD patients.

Abstract:

Introduction: National Commission on Macroeconomics predicted that by year 2015, India will have nearly 61 million coronary heart disease (CHD) cases which would to lead to 3.4 million of deaths. Many novel pharmacotherapeutics and non-pharmacotherapeutics options are currently ceasing the worsening of cardiac conditions, however, these options especially pharmacotherapeutics bring in lifetime dependency in patients. Affordability and side effects of the treatment remains the major concern for mass patient population. In such scenarios, Sampurna Hriday Shudhikaran (SHS), a novel Ayurvedic non-interventional therapy, of six days can be believed to give in genuinely promising and convincing outcomes. Therefore, present study was aimed to assess the effectiveness of SHS retrospectively in chronic heart failure (CHF) patients after three years.
Materials and Methods: SHS consisting of four major procedures - Snehan, Swedan, Hridhara, Basti procedure were carried out in the same order two times a day on patients for six consecutive days. Highly efficacious naturally medicated oils and other formulations were topically used in this treatment. In this retrospective cohort study, 690 patients who were admitted in Madhavbaug centres across Maharashtra during the year 2010-2011, were contacted by phone, out of which 542 patients were willingly to participate in this survey and were consented verbally. Primary data was collected using a tailored questionnaire over phone and analysed for mortality, survival and re-hospitalization rates. Secondary data analysis was done for outcomes like 6 Minute’s Walk Test (6MWT) in meters and Metabolic Equivalents (METs) done before and after the patients were treated with SHS therapy.
Results: SHS showed remarkable improvement in study population where 72.32% patients improved from NYHA Class II and III to NYHA Class I, 12.96% still possessed NYHA Class II, III and IV symptoms and 14.76% were dead. The re-hospitalization rate was 9.39% which covered elderly age group 50-59 years. The mean improvement after six days of SHS therapy was found to be 65 meters in 6MWT and 1.6 METs value.
Conclusions: This treatment has proven to improve functional capacity & quality of life in CHF patients to a significant extent. Positive cardiovascular health outcomes even after three years indicates long lasting cardioprotective effects of SHS.

Speaker
Biography:

Khaled Sayed Mahmoud El Maghraby has completed his M.D. at the age of 34 years from AL Minia University. He is the associate professor of cardiology. He has published more than 26 papers in reputed journals.

Abstract:

Background: Heart failure continues to be a major challenge to healthcare; several resting and exercise electrocardiographic parameters have been investigated to predict the left ventricular diastolic dysfunction (LVDD).
Objectives: We aimed to study different parameters in resting and exercise stress test to evaluate whether they can predict left ventricular diastolic dysfunction (LVDD).
Methods: One hundred and forty patients, classified into 2 groups according to LVDD, were assessed by measurement of normal and corrected QT interval, T wave peak to T wave End and P wave dispersion in resting ECG. Exercise stress test looking for hump sign (upward deflection of the ST-segment) was done. The relationships between these ECG parameters and LVDD were investigated.
Results: We found significant occurrence of hump sign in patients with LVDD, and there was a significant difference between both groups regarding QTc and P wave dispersion. P wave dispersion was significantly higher in patients with LVDD. Sensitivity and specificity of the ST hump sign in prediction of LVDD were 86% and 78% respectively. We also concluded that P wave dispersion at cutoff value about 0.045 ms had the highest sensitivity (sensitivity 98%, specificity 64%) while QTc at cutoff value 0.395 ms had the highest specificity (sensitivity 81%, specificity 79%).
Conclusion: P wave dispersion and hump sign were the most sensitive ECG signs for the prediction of LVDD.

Speaker
Biography:

Amira Esmat El Tantawy has completed her PhD in Pediatrics from Kasr Alainy School of Medicine Cairo University, she is a Professor of Pediatrics and Pediatric Cardiology Consultant in Cairo University. She is the Director of Pediatric Cardiology training in the Department of Pediatrics, Abo El riesh Children’s specialized Hospital. She is one of Coordinators of Quality Assurance Cairo University. She is a Board Member founder of Ministry of health Pediatric Cardiology Fellowship. She won Cairo University Award of the best PhD thesis in 2012. She has more than 20 publications of which 6 are recognized internationally.

Abstract:

Cardiovascular disease accounts for the majority of deaths in children with chronic kidney disease (CKD) and post renal transplantation. The main objective of this work was to study the prevalence of the different cardiovascular risk factors presented either before or after renal transplantation measuring the LV function using conventional 2D , M mode echocardiography (left ventricular mass index (LVMI), pulsed Doppler (E/A ratio) and tissue Doppler imaging ( E’, A’, E’/A’ , and E/E’). This Cross-sectional, observational study included 30 children with renal transplantation and 10 normal children as control. Patients age of ranged from 5-14 years. Significant improvement in risk factors: Anaemia, Hypercholesterloaemia and hypertension HTN (p value 0.002, 0.005, and < 0.001 respectively) after renal transplantation was observed. Among transplanted patients, Prevalence of left ventricular hypertrophy was 93.3%. Patients have significant increase in left ventricular mass index (LVMI) than controls ( p<0.001), significant higher E/A ratio (p 0.014), and Significant lower A’ (p <0.001), Presence of HTN pre and post renal transplantation was the only risk factor significantly affecting the diastolic cardiac function with significant E/E’ (p 0.001 and p<0.001).

Speaker
Biography:

Sahar Sheta has graduated M.B.B.Ch from the Faculty of Medicine ,Cairo, EGYPT 1989 and was signed up excellent. M.Sc in Pediatrics1994 . M.D in Pediatrics and Pediatric Cardiology 1998. Professor of Pediatrics and Pediatric Cardiology in the Department of Pediatrics since 2009 .Head and Director of Non Invasive Echocardiography Lab., Cairo University Children’s Hospital 2014. She has published more than 15 papers in reputed journals both nationally and internationally.She has been an invited speaker and chairperson in several international Pediatric cardiology conferences in USA, Europe and Middle East .

Abstract:

Background: Two Dimensional transthoracic echocardiography ( 2D –TTE) has been standard diagnostic imaging in patients with pulmonary valve stenosis ( PVS) .Recent advances has been the development of real time three dimensional transthoracic echocardiography (RT 3D-TTE) matrix-array transducers. Right ventricular outflow tract and pulmonary valve was not studied before by RT 3-D TTE among children. Objective: To determine the feasibility of RT 3D-TTE in the evaluation of PVS and measurement of pulmonary valve annulus (PVA), assess its reliability, reproducibility when compared with the standard 2D-TTE and invasive transcatheter angiography measurement. Methods: Prospective clinical study included 30 pediatric patients with mean age 2.76 years diagnosed with pulmonary valve stenosis were assessed by 2D-TTE, 3D-TTE and transcatheter angiography. Results: Transcatheter angiography sizing of (PVA) diameter had higher Pearson's correlation coefficient with RT 3-D TTE measurements (r = 0.909 & 0.812 respectively) than for 2-D TTE (r = 0.752). Measurements of PVA by the three techniques were compared with the reference standard by means of a Bland–Altman plot. Smallest mean absolute difference was obtained between (PVA) measurement trans catheter angiography (0.01(-0.07) cm) and RT 3D TTE diameter (0.01(-0.09) cm) rather than 2D TTE (0.11 (-0.06)cm). Interobserver reproducibility was calculated by means of intraclass correlation coefficient (ICC) of 2D-TEE was 0.983 (CI 95% 0.969 - 0.991; P < 0.001). Similarly, the value obtained with 3D-TTE was 0.981 (CI 95% 0.965–0.990; P < 0.001). Conclusion: RT 3D-TTE assessment of PVA is a feasible, reliable and reproducible imaging among children with PVS.