Day 2 :
San Camillo-Forlanini Hospital, Italy
Keynote: The hypothesis of enhancement of noncoronary collateral myocardial blood flow and endovascular internal mammary artery occlusion in refractory angina: A new research field
Time : 09:30-10:10
Marco Picichè (MD, Ph.D.) graduated with a degree in medicine from the University of Florence in 1995 and completed his cardiac surgery residency at the Tor Vergata University of Rome in 2000, both summa cum laude. He has worked as an assistant at Saint Luc Hospital, Catholic University of Louvain, Brussels (1999–2001), as a clinic head/hospital assistant at the universities of Clermont-Ferrand (2003–2004) and Montpellier (2004–2007). He held regular teaching appointments at the university of Montpellier school of medicine, obtained certification by the French Board in cardiac surgery (Paris, 2007), earned his research master in surgical science (Paris, 2007). In Canada he authored a research project on ‘‘Noncoronary collateral circulation,’’ which was submitted to the annual research competition at Québec Heart & Lung Institute, Laval University, and received the competition’s highest grant. In September 2011 he received a doctor of philosophy (Ph.D.) in therapeutic innovations from Paris-Sud University. He is the Editor in Chief of the book : « Dawn and evolution of cardiac procedures : research avenues in cardiac surgery and interventional cardiology » (Springer-Verlag publishing house). Currently he is a consultant cardiac surgeon in Italy.
Noncoronary collateral myocardial myocardial blood flow (NCCMBF) or noncoronary collateral circulation (NCCC) is a virtually ignored topic. Few studies have been published to date and we still know little of its nature and almost nothing of its potential benefits in clinical applications. It consists of a micro-vascular network arising from mediastinal, esophageal, bronchial, and intercostal arteries. Blood reaches the myocardium through small channels connected with aortic and pulmonary artery vasa vasorum, and with channels located within the pericardial reflections surrounding the pulmonary and systemic veins. Some phenomena suggest the existence of alternative ways for blood to reach the heart, for no other easy explanation exists. For example, during aortic valve surgery, arterial blood can be seen to flow out from the coronary ostia, while during coronary surgery blood may flow out from the incised coronary artery, despite adequate venting and correct aortic cross-clamping. It is not even rare for patients to show an ejection fraction equal to or greater than 55%, despite occlusion of the right coronary artery and sub-occlusion of the left main artery. It has been demonstrated that collateral branches of the internal thoracic arteries (ITAs) are a source of NCCMBF. In fact, connections exists between ITAs and native coronary arteries both in living patients and cadavers. One study demonstrated these connections by postmortem angiography in 12% of cases. Furthermore, several examples show the potential of the ITAs for developing collateral vessels spontaneously in the presence of an ischemic stimulus. Currently, not all patients suffering from ischemic heart disease benefit from conventional myocardial revascularization techniques; and it is in this context that the concept of ITA occlusion has been promoted again since 2010. May NNCMBF represent a valuable alternative source of myocardial blood supply for no-option patients? Herein, the nature and hypothetical benefits of NCCMBF are discussed.
Vilela Batista Heart Foundation, Brazil
Keynote: SURGICAL TREATMENT OF EISEMENGER
Time : 10:10-10:50
Will be updated soon...
Patients with congenital heart diseases, with left to right shunts, develop pulmonary hyper resistant hypertension, reversing to right to left shunt! Situation called "Eisenmenger"! Patients become cyanotic and the treatment today is heart-lung transplant! In most places this treatment is not done because of 100% mortality! Even at the best Heart Centers the mortality is very high! Consequently these patients are left to die at home with no treatment!
It is written in the textbooks that the reason for this transformation is pulmonary "hyperflow" due to left to right short-circuit! This theory didn’t make sense to me because i’ve done many pneumonectomies and the patients did not develop hyperesistant pulmonary hypertension in the remaining lung with doubled flow. I did then experiments on pigs to prove that what makes the lungs increase resistance was oxygen and not flow!
The treatment of this pathology is based on this new theory - That is: extracting oxygen from the pulmonary artery we can reverse the high resistant pulmonary lesions! I’ve operated 42 Eisenmenger patients who will be presented and discussed during this meeting!