Day 2 :
Transplant Surgeon Papworth Hospital, United Kingdom
Time : 09:30-10:15
Marius Berman is a Consultant Cardiothoracic and Transplant Surgeon at Royal Papworth Hospital, Cambridge, UK. His main interests are management of acute cardiogenic shock, and inter-hospital transfer of patients on VA ECMO as bridge to recovery or therapy.
In an era of PPCI, mortality due to AMI has fallen substantially over the past three decades. Nevertheless, patients with post-infarction ventricular septal defect (PIVSD) carry a grim prognosis and resource demanding. The management of PIVSD is complicated, and requires substantial critical care, imaging, interventional, and surgical expertise. It is therefore advisable, when clinically feasible, to transfer these patients to regional centers with adequate individual experience in the care of these patients. Traditionally, the main stream of treatment was surgery, pending hemodynamically stability and size of left to right shunt. There is no clear evidence to guide the surgical management of patients who are in shock, as all approaches have shown extremely high mortality. Possible strategies include emergency surgery, a period of mechanical circulatory support in the form of IABP or ECMO, prior to a delayed surgical or percutaneous intervention, or emergency placement of a percutaneous closure device to reduce the shunt. Often, there is a natural selection when pathway chosen was optimized, with those surviving a healing phase proceeding to therapy. Percutaneous closure may also be a viable option for patients in the sub-acute to chronic period whose comorbidities preclude surgical repair, and whose septal anatomy is favorable to device placement. We encounter incidences of percutaneous closure post-surgical closure where the patch dehisced due to further progression of the ischemic insult. We favor the establishment of a multidisciplinary PIVSD team, including interventional cardiologist, cardiac surgeon, anesthetist and radiographer in order to tailor patient specific treatment based on presenting symptoms and co-morbidities.
University of Mississippi Medical Center, USA
Charles H Gaymeswas has completed his graduation from High School with top honors and attended the University of the West Indies Medical School, graduating class of 1978. He completed Residency in Pediatrics at the University of Mississippi Medical Center in 1989 and was “Outstanding Resident” in 1989. He completed his Pediatric Cardiology Residency at MUSC, South Carolina in 1992. He has been on faculty at UMMC 1992 – Present. He was “Outstanding Pediatric Faculty Member” in 1995. Currently, he practices as a Professor of Pediatrics/Cardiology and Director of Children Arrhythmia Services.
Introduction: Ninety-five percent of hypertrophic cardiomyopathy are related to defects present in four genes MYH7, MYBPC3, TNNT2 and TNN13. The cause of sudden cardiac arrest (SCA) in hypertrophic cardiomyopathy has not been determined. The guidelines for risk stratification for SCA and AICD implant from the ACC and AHA are not based on any large studies in children. Anecdotal cases do not support their usefulness. We report our data base analysis of a cohort of patients with HCM followed at a single center from 1995-2017 and found no consistent risk factors for SCA.
Methods: We reviewed our database for all hypertrophic cardiomyopathy patients followed by pediatric cardiac electrophysiology. Data was tabulated for presenting symptoms, EKG finds, ambulatory monitoring, and echocardiogram measurements. In decreased patients, autopsy results were also compiled and tabulated.
Results: Total of 57 candidates (37 male and 20 female) of age 1-29 (mean 19) years with 3 syncope 6 SCA as first symptom (3 resuscitated) and palpitations 20/57 were included in the study. 7/57 had family history of HCM 3/57 (SCA). 16/57 had no sustained VT (ambulatory monitor). 5/47 AICD received appropriate therapy (only 1/5 met guidelines for AICD) 2/47 patients inappropriate therapy. 1/47 with AICD died from ventricular fibrillation (patient within guidelines for AICD).
Conclusions: We could not identify specific criteria for risk stratification of SCA/AICD implantation in our population of patients with hypertrophic cardiomyopathy. The current guidelines are not sensitive or specific enough in children to guide AICD implant. The risk for SCA likely resides in the cellular dysfunction and may be related to the genetics. Until larger studies could better risk stratify SCA the decision for AICD should be discussed with the patient and a decision made even if the guidelines are not met.
- Hypertension | Cardiac Pharmacology | Heart Devices | Cardiology - Future Medicine | Heart Regeneration | Cardiologists | Nuclear Cardiology
Location: Meeting Place 4+5
Soochow University, China
Li Dong is a grade 2 Master’s student, who was admitted to Soochow University for a 3-year Master’s degree program, majoring in Nursing at School of Nursing of Soochow University in September 2016.
Objective: To explore the current situations of anticoagulation treatment and related factors in patients with nonvalvular atrial fibrillation.
Methods: From January 2017 to September 2017, eligible participants were recruited from two hospitals in Suzhou. We analyzed the basic characteristics, clinic data and medical treatment plan of enrolled patients.
Results: A total of 453 patients were enrolled, 80.57% of whom were the CH2DS2-VASc score ≥2. There were 19 (5.2%), 87 (23.8%) and 119 (32.6%）non-valvular atrial fibrillation patients who received new oral anticoagulants, warfarin and aspirin, respectively. Age between 60 to 69, mild and moderate symptoms was associated with usage of anticoagulation treatment in high risk of stroke.
Conclusion: The rate of anticoagulant therapy was still low, and the measures should be taken to improve this condition.
Soochow University, China
Yuan Xue is a Grade 1 Master’s student, who was admitted to Soochow University for a 3-year Master’s degree program, majoring in Cardiovascular Nursing at School of Nursing, Soochow University in September 2017.
Objective: Objective of the study is to investigate the status of the quality of life (QoL) in patients with different clinical features of atrial fibrillation (AF).
Methods: A total of 572 patients with AF from 7 hospitals in Jiangsu Provence were investigated by using AF-QoL-17 questionnaire and analyze the status of QoL in patients with different clinical features of AF.
Results: Mean age of AF patients at admission was 71.28 ± 11.16 years; 52.8% of these patients were male. Patients with paroxysmal, persistent and permanent AF were 368 (64.3%), 155 (17.8%) and 38 (6.6%), respectively. 11 patients didn’t indicate the type of AF. QoL score in patients with AF was 46.00 ±13.53. Univariate analysis showed that there were significant differences in the score of QoL in comorbidities, LVEF class, anticoagulant and antithrombotic therapy, the severity of AF symptoms, and the score of CHA2DS2-VASC (P<0.05). From the subgroup analysis shown, QoL score of patients at high risk of stroke with anticoagulant therapy was significantly higher than that of patients at high risk of stroke without anticoagulation therapy (P <0.01). QoL score of paroxysmal AF patients at high risk of stroke with anticoagulant therapy was significantly higher than that of paroxysmal AF patients at high risk of stroke without anticoagulation therapy (P <0.05).
Conclusion: For patients at high risk of stroke without anticoagulant therapy, especially patients with paroxysmal AF, quality of their lives may be improved by carrying on clinical intervention under the premise of reducing the risk of stroke.
Cardiac Care Clinics and Hospitals, India
Rohit Sane is the first to conceptualize the idea that ancient Indian Medical Science, Ayurveda, can play a big role in chronic cardiac disease. He is the founder of Madhavbaug Clinics & Hospitals in India, used his education in Modern Medicine and undertook a meticulous research into Ayurveda. Extensive experimentation and delving deeper into every minute aspect of his study led him to find scientific evidence to substantiate this novel idea. His effort resulted in a combination of modern medical science and the well-established therapies prescribed in Ayurveda, which could prove highly effective alternative way to treat chronic heart failure.
Ischemic heart disease (IHD) incidence has increased in India at a rapid speed and shows regional variations, early onset, greater mortality and poor management. Stress thallium test is useful in diagnosing IHD early in patients who may be at risk for a heart attack. The aim of the present study was to assess the cardiac muscle activity in IHD patients before and after ischemic reversal programme (IRP). The present open label study involved 14 IHD patients who underwent IRP (21 IRP sittings) in Madhavbaug clinics (multicentric). The inclusion criteria were subjects with known IHD, age group between 40-70 yrs, BMI > 20 kg/m2, and stress test positive for inducible ischemia. However, subjects with recent myocardial infarction/ known hypo- or hyper- thyroidism/ chronic kidney disorder were excluded. Stress thallium test was performed after enrolment, 21 IRP sittings and 25-30 IRP sittings. VO2max and time of ischemia after stress test were also recorded in all the patients. Further, Seattle Angina Questionnaire (SAQ) was taken via telephonic conversation by research coordinators. Observations from stress thallium test showed significant difference in Summed Stress Score [SSS] (13.5±10.3, baseline vs. 10.7±10.1, post 21 IRP sittings; p=0.01) as well as Summed Difference Score [SDS] (8.9±6.2, baseline vs. 6.2±6.3, post 21 IRP sittings; p=0.03) in IHD patients. Similarly, we observed increase in VO2max levels (12.8±5.7, baseline; 19.4±7.8, post 21 IRP sittings and 23.6±6.0, post 25-30 IRP sittings) and time of ischemia in seconds (370.7±201.1, baseline vs. 597.8±201.9, post 21 IRP sittings and 702.0±138.0, 30-days follow-up). Further assessment of SAQ scores showed significant improvement post IRP (30.2±3.6, baseline vs. 32.7±3.5, post 21 IRP sittings) whereas, ejection fraction score was not found to be significantly changed post IRP as compared with baseline. Results of the present study suggest an improvement in cardiac muscle activity after IRP in IHD patients and depicts positive role of IRP in IHD management.