International conference and Expo on

Cardiology and Cardiac Surgery

April 04-06, 2016, Dubai, UAE

Scientific Programme(Day 2 : Apr-05-2016)

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Heart Diseases & Cancer and Heart

Session Introduction

Time: 11:30- 12:10 PM
Helene von Bibra
Municipal Hospital Bogenhausen, Germany
Title: Diastolic dysfunction/heart failure - update of echocardiographic detection, etiology and therapy

Biography: Helene von Bibra studied medicine in Munich, Germany. She worked at Klinikum Großhadern, Munich, Kings College and Brompton Hospital , London, Municipal Hospital München-Schwabing and Klinikum rechts der Isar, Technical University Munich receiving the Internal medicine and the Cardiology board certifications in 1983 and 1993. She became appl. Professor for Internal Medicine/Cardiology of the Technical University, Munich in 1999 and continued her scientific work as visiting professor in Linköping, Sweden, from 1998 – 2002 at the Karolinska Hospital in Stockholm and at the Municipal Hospital Bogenhausen, Munich on the echocardiographic evaluation of myocardial function and perfusion in diabetic patients.

Abstract: Heart failure is an ongoing epidemic of growing dimensions in western civilization due to the rising incidence of its predisposing risk factors age, diabetes and obesity. Approximately half of these patients have predominantly diastolic dysfunction and preserved left ventricular ejection fraction (HFpEF) and have as poor a prognosis as in systolic heart failure but no known effective treatment. This stems from several factors such as incomplete understanding of the underlying pathophysiological mechanisms and a lack of consensus how to define and to diagnose DD. As to the former problem, all known risk factors for diastolic dysfunction/HFpEF may be taken as associated with insufficient myocardial energy availability: age, hypertension, coronary artery disease, diabetes, insulin resistance, obesity, anemia, COPD, sleep apnea, renal insufficiency. As to the latter problem, the dominant impact of age on diastolic function E’ (by tissue Doppler) requires mathematical unmasking by comparing the actually measured E’ to a regression equation of Enorm over age from healthy individuals. This reference data allows the definition of diastolic dysfunction and the evaluation of age-independent structural, hemodynamic or metabolic risk factors for diastolic dysfunction. The respective risk factors were defined by multivariate analysis as vascular stiffness, diastolic blood pressure and insulin resistance for non-diabetic individuals and for type 2 diabetics as insulin resistance diastolic blood pressure and vascular stiffness. This approach unmasks the importance of metabolic risk on one hand and offers on the other hand, via the potential reversibility of insulin resistance, new options of therapy and of studies with well defined inclusion criteria.

Time: 12:10- 12:30 PM
Michael Kirby
University of Hertfordshire, United Kingdom
Title: Cancer and the heart- Primary/secondary care interface

Biography: Professor Michael Kirby worked as a GP in Letchworth, Hertfordshire from 1973 until 2007, and was Director of the Hertfordshire Primary Care Research Network from 1998 until 2007. The practice provided an open-access echocardiography service for patients with heart failure. He is now Visiting Professor to the Faculty of Health and Human Sciences at the University of Hertfordshire. His clinical work is now at the Prostate Centre in London, where he deals with complex medical problems. He is a Fellow of the Royal College of Physicians. He has published more than 400 clinical papers and 30 books.

Abstract: Abstract. Cancer and the heart. Primary/Secondary care interface Improvements in cancer treatment and earlier diagnosis have contributed to increased survival. Unfortunately, many cancer treatments carry an increased risk of cardiovascular disease (CVD). The CVD risk is of particular consideration in an ageing population of cancer survivors who may have co-morbidities which also exacerbate this risk, and in adult survivors of childhood cancer treatment who may present with CVD symptoms at a relatively young age. Heart disease following cancer treatment may be the result of direct CV damage, caused by the treatment or may be due to the development of cancer treatment-related CV risk factors. Working with other professionals when necessary, GPs, community pharmacists and nurses are in a good position to follow-up people affected by cancer to ensure that CV risks are monitored, preventative action is taken, CVD is diagnosed and appropriate treatments are initiated. Summary of primary care monitoring of heart health in cancer patients How should the patient be monitored in primary care? People with CVD risk factors, even if asymptomatic, should be regularly screened (at least once a year) for CV risk factors/co-morbidities .Advice on smoking and physical inactivity (as appropriate) and on the benefits of an overall healthy lifestyle. Annual Cancer Care Review in primary care. Which patients should have regular cardiovascular risk assessment? • Patients starting anti-androgen or anti-oestrogen therapy should be reviewed for CV risk factors within 3 months of starting therapy. Continue annual monitoring for the duration of hormonal therapy (often 5 years+). This is especially important in those with previous CV disease, diabetes or chronic kidney disease. Which patients should have surveillance for heart failure? • Surveillance (cardiac function testing) depends upon which cardiotoxic cancer treatments were received, eg anthracycline chemotherapy; radiotherapy involving the heart. Surveillance (by primary or secondary care) of patients who have had high risk cardiotoxic cancer treatment should begin no later than 6 months after completion of cardiotoxic cancer treatment and continue thereafter at 5-yearly intervals,providing 6 month assessment normal and patient asymptomatic . Advise patient with new CV symptoms to discuss them with their GP. When should the patient be referred to Cardiology? Primary care professionals should consider referral to Cardiology specialists for the following: • Individuals who have abnormal cardiac function or CV symptoms detected during surveillance. Any new cardiac abnormality in symptomatic patients with established CVD. Women treated with cardiotoxic chemotherapy or radiotherapy involving the heart and are pregnant or planning to become pregnant. Patients treated with cardiotoxic chemotherapy or radiotherapy involving the heart and who wish to compete at a high level of exercise.

Emad Al Jaber
Centro cardiologicomonzino, Italy
Title: Minimally invasive cardiac surgery with no patient selection. Should port-access be the standard approach for mitral and tricuspid valve surgery?

Biography: Centro cardiologicomonzino ,milan, Italy

Abstract: OBJECTIVE: Over the past 15 years Minimally Invasive Cardiac Surgery Approach (MICS) grown up, especially for mitral valve (MV) disease. In selceted High volume Centres MICS became standard approach for MV surgery. Nevetheless MICS candidates are strictly selected and still undergoing a specific preoperative assessment. Aim of the present study is to report our experience with the totally Videothoracoscopic Port-Access as standard approach for mitral valve surgery. METHODS: From January 2010 to nowadays every patients presenting mitral, tricuspid, sub aortic stenosis or with atrial pathology including atrial septal defects (ASD) and tumors are surgically treated with totally Videothoracoscopic Port- Access by a single surgeon without any additive preoperative assessment. Patients needing for revascularization are excluded.

Lunch Break- 12:50- 13:30PM

Time: 13:30- 13:50 PM
Tao Zhao
National Center for Cardiovascular Diseases, China
Title: Prognostic significance of fibrosis evaluated by magnetic resonance imaging and hypertrophic morphology in patients with hypertrophic cardiomyopathy in Chinese han population

Biography: Dr. Tao Zhao, Male, 34 yrs old, graduated from PLA Medical School and Peking Union Medical College and majored in cardiovascular imaging and surgery for congenital heart diseases in Anzhen Hospital, Beijing, China. He is guided by many famous cardiovascular professors in China and has much clinical experience in the diagnosis and treatments for congenital and achieved cardiovascular disease. As a welcomed doctor, he spent most of his time in the clinical work, be praised by the patients and the colleagues.

Abstract: Background Hypertrophic cardiomyopathy(HCM) is the most frequent cause of sudden cardiac death(SCD) in the young, and the prognostic role of myocardial fibrosis and morphology still need more research. Methods 286 HCM patients were followed prospectively for 3.23±0.81 years.Parameters such as wall thickness and late gadolinium enhancement (LGE) were evaluated by cardiac magnetic resonance (CMR). Patients were divided into three groups according to LGE amount: LGE negative, LGE amount<15%/LV and LGE≥15%/LV. In order to investigate the effect of hypertrophic morphology, we also divided patients into mixed type and apical type. Primary endpoints included cardiovascular death and heart transplantation, sudden cardiac death (SCD)/aborted SCD, sustained ventricular tachycardia(SVT) and appropriate implantable cardioverter defibrillator (ICD) discharge. Secondary endpoints included patients who had occurrence of progressive heart failure symptoms and unplanned cardiovascular admission. Results Patients with higher amount of LGE had a higher burden of hypertrophy as well as a history of arrhythmias more frequently, such as atrial fibrillation (Af) and non-sustained ventricular tachycardia (NSVT).The maximum wall thickness between mixed and apical HCM was 21.9±6.7mm and 15.6±3.0mm, respectively (p<0.01). There were 29 patients in the mixed type with extreme wall thickness (>30mm) while none in the apical group had.The mean fibrosis burden was 14% (range 1%~57%) in the mixed type group, while apical group was only 2% (range 0~13%). 35 patients (12.2%) reached primary endpoints and 61 patients (21.3%) reached the secondary endpoints. Multivariate Cox regression showed that the LGE amount and mixed-type morphology were independent determinants associated with the combined outcomes. Receiver-operating Characteristic (ROC) curve shows satisfying prognostic value of fibrosis in predicting combined outcomes.

Time: 13:50- 14:10 PM
Galya Atanasova
Pleven Medical University, Bulgaria
Title: Risk assessment models for myocardial infarction

Biography: Galya Naydenova Atanasova completed her Ph.D. training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Pleven Medical University, Bulgaria. She is a Cardiologist, Assistant Professor at the Department of Internal Medicine, Medical University, Pleven. She is a General Practitioner in Pleven. She specialized in Cardiology from Pleven Medical University during 2015, and General Medicine from Pleven Medical University, Bulgaria during 1993. She has attended to many International Events and presented her research work. She did many researches on metabolic syndrome and myocardial infarction of heart.

Abstract: In a number of epidemiological studies, elevated blood pressure (BP) has been identified as a risk factor for coronary artery disease, heart failure,cerebrovascular disease, etc. The object of the study is to assess the degree of influence BP as a risk factor for myocardial infarction (MI) by logistic regression analysis. During year 2012 study in 99 subjects with survived MI, inhabitants of Pleven region in Republic of Bulgaria was conducted. The following biomarkers are tested (fasting): HDL-cholesterol, serum triglycerides (TG) and total cholesterol (TC). Data processing is a logistic regression analysis.

Time: 14:10- 14:30 PM
Mostafa Alshamiri
King Khalid Univesity Hospital, Saudi Arabia
Title: When patients with asymptomatic severe mitral regurgitation undergo surgical intervention?

Biography: Mostafa Qaid Ahmed Al-Shamiri is an assistant professor in the department of cardiac science at King Khalid university hospital, Saudi Arabia. He holds several positions as head of adult cardiology king fahad cardiac center (2015), consultant cardiologist at king fahad cardiac center, head of KFCC quality (2009-2011), head of coronary care quality team (April 2013- present), director of coronary care unit (1998- early 2012), director of college of medicine, KingKhalid university hospital (july 2013- present). He was awarded as a best teacher in king fahad cardiac center (2007), college of medicine (1998), medical college and king fahad cardiac center (2015). He has membership with several associations like Saudi heart association (since 1996), European heart rhythm association (since 2004), European society of cardiology (since 2001), European society of heart failure (since 2010), regular reviewer of the Saudi heart association Journal (since 1996) and contributed in establishing Saudi hypertension guideline. He have 26 articles published in local and international journals.

Abstract: Background/Introduction Asymptomatic severe MR , is up till now there are no consensus on the management , some supporting observation and waite the other consider intervention is important as the delay of intervention will lead to heart failure arrhythmias and death. Aims/Objectives to review the litreture and the guideline about the management of asymptomatic severe mitral regurgitation and the timing for intervention with surgery. Method google search up on asymptomativc severe mitral reguetation and when surgery should be done.

Time: 14:30- 14:50 PM
Koyu Sakai
Department of Cardiology, Hiroshima City Hospital, Japan
Title: Catheter-based reperfusion therapy for acute myocardial infarction

Biography: Dr. Koyu Sakai has completed his Ph.D at the age of 33 years from Kyoto University and postdoctoral studies from the Department of Cardiology, Kokura Memorial Hospital, and has been elected as the Fellow in the Society for Cardiovascular Angiography and Interventions (FSCAI, 2006), the Fellow of the American College of Physicians (FACP, 2006), the Fellow of the American College of Cardiology (FACC, 2007), and the Fellow of the American Heart Association (FAHA, 2008). . He is the director of the Department of Cardiology, Hiroshima City Hospital, and has published more than 20 papers in reputed journals.

Abstract: Acute myocardial infarction is the leading cause of death all over the world. Although the high-risk patient population comprises the majority of fatalities associated with acute myocardial infarction, most randomized clinical trials have enrolled few high-risk patients. In studies involving interventional strategies, high-risk patients have been screened-out to comply with rigid entry criteria and, therefore, poorly represent the average patient who often has significant comorbid conditions. As a result, data available to guide clinical practice is scanty. Catheter-based reperfusion therapy, primary percutaneous coronary intervention (PCI), has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed rapidly by expert teams, and has been shown to be superior to fibrinolytic therapy in reducing morbidity and mortality in STEMI. Its benefits might be more impressive in high-risk patients. In our institution, an experienced investigational cardiac center, primary PCI can be performed swiftly 24 hours/day, with on-site cardiac surgery. I would like to address the fundamental issues of primary PCI for STEMI and other important topics which will be presented and discussed.

Emad Al Jaber
Centro cardiologicomonzino, Italy
Title: Feasibility of minimally invasive completely thoracoscopic approach in urgent and emergent patients

Biography: Centro cardiologicomonzino, milan, Italy

Abstract: OBJECTIVE: The minimally invasive cardiac surgery (MICS) technique for urgent patient has not been previously examined. Aim of the study is to determine safety of MICS in this kind of patients. METHODS: Over the four past years 1223 patients underwent minimally invasive cardiac surgery with a completely videoguidedthoracoscopic approach, of them 193 (15.7%) were emergent or urgent cases. All operation were performed by the same equip.

Emad Al Jaber
Centro cardiologicomonzino, Italy
Title: All mitral valve surgery can be performed in a minimally invasive fashion

Biography: Centro cardiologicomonzino, milan, Italy

Abstract: BACKGROUND AND OBJECTIVE: Over the past 15 years Minimally Invasive Cardiac Surgery (MICS) have been increasingly used, especially for mitral valve surgery. Aim of this study was to report our experience with a totally video-guided “port-access” approach to mitral valve surgery as a routine approach, without patients selection and regardless the underlying pathology. METHODS: From January 2010 to September 2015, 1204 unselected consecutive patients (786, 48% Male, mean age 62 ± 15; range 23-90) underwent totally videothoracoscopic Port-Access Cardiac Surgery.). Femoro-femoral cannulation and direct aortic cross-clamp were achieved. One thousand and one hundred and three consecutive patient underwent first time or redo mitral valve surgery (954 repair and 149 replace). Indication for surgery were: 750 (67.9%) cases were degenerative mitral valve regurgitation (MR), 25 (2.2%) active endocarditis; 83 (7.5%) functional MR and 70 (6.3%) prostheses dysfunction. Associated procedures were: tricuspid surgery in 186 patients (16.8%); atrial fibrillation ablation in 106 patients (9.6%). Intraoperative conversion to MV replacement constituted failure.

Coffee Break- 15:30- 15:50 PM

Congenital Heart Diseases & Diabetis and Heart Conditions

Session Introduction

Time: 15:50-16:10 PM
Muhammad Yasir Qureshi
Mayo clinic, United States
Title: Implementing stem cell therapy in congenital heart disease

Biography: Yasir Qureshi is currently an Assistant Professor of Pediatrics and Associate Consultant in Division of Pediatric Cardiology. Dr. Qureshi’s research work is focused on better utilization of advanced cardiac imaging tools in diagnosing and monitoring congenital heart disease. Dr. Qureshi has practical knowledge and experience in advanced echocardiography as well as cardiac computed tomography and magnetic resonance imaging. His research work centers on better quantification of right ventricular function and early detection of right heart failure. By utilizing novel imaging techniques, his goal is to identify the patients at risk of developing right heart failure early in the disease course, so that the regenerative therapies such as stem cell treatment can be instituted in a timely manner. This early prediction of right heart failure, will allow time for regenerative strategy to be optimally effective, as well as allow time to institute preventive medical therapy.

Abstract: Stem cell therapy for ventricular dysfunction holds great promise for therapeutic interventions of a wide variety of conditions affecting the heart muscle. Most of the patients with congenital heart disease are at risk of developing right heart failure either directly or indirectly. When progenitor cells are applied to a sick myocardium in diseased heart, they may differentiate into myocytes and/or assist the dysfunctional myocardium through paracrine mediated regeneration. For such regenerative strategies to work, it is critical to develop animal models and in-vitro tests to assess the safety and efficacy of these therapies. Optimally designed clinical trials are the next step in this direction. Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome is a comprehensive program dedicated to development of diagnostic and therapeutic alternatives for patients with ventricular dysfunction in complex congenital heart diseases, such as hypoplastic left heart syndrome. The presenter will exhibit the challenges and successes to date, in implementing stem cell therapy in congenital heart disease from bench work to animal studies and finally to human clinical trials.

Time: 16:10-16:30 PM
Chandramohan Govindasamy
King Saud University, Saudi Arabia
Title: Influence of kaempferol, a flavonoid compound, on membrane-bound ATPases in streptozotocin-induced diabetic rats

Biography: Chandramohan Govindasamy has completed his Ph.D. at the age of 28 years from Annamalai University, India. He is currently working as an Assistant Professor in the Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia. He is having one patent for his novel antidiabetic drug invention. Senior Research Fellowship and University Research Studentship have been awarded for his doctoral research by Indian Council of Medical Research and Annamalai University respectively. He is very active in participation in scientific meeting and he has attended many scientific meetings. He has also served as a Session Chair Person and organizing committee member in various scientific international meetings. He has published a good number of papers in reputed international journals. He is serving as an editorial board member and reviewer in reputed journals.

Abstract: Kaempferol is a flavonoid found in many edible plants (e.g. tea, cabbage, beans, tomato, strawberries, and grapes) and in plants or botanical products commonly used in traditional medicine. Numerous preclinical studies have shown that kaempferol have a wide range of pharmacological activities, including antioxidant, anti-inflammatory, anticancer, cardioprotective, neuroprotective, and antidiabetic activities. The present study investigates the effect of kaempferol on membrane-bound ATPases in erythrocytes and in liver, kidney, and heart of streptozotocin (STZ)-induced diabetic rats. Diabetes was induced into adult male albino rats of the Wistar strain, by intraperitoneal administration of STZ (40 mg/kg body weight (BW)). Kaempferol (100 mg/kg BW) or glibenclamide (600 mg/kg BW) was administered orally once daily for 45 d to normal and STZinduced diabetic rats. The effects of kaempferol on membrane-bound ATPases (total ATPase, Na+/K+-ATPase, Ca2+-ATPase, and Mg2+-ATPase) activity in erythrocytes and in liver, kidney, and heart were determined. In our study, diabetic rats had significantly (p50.05) decreased activities of total ATPases, Na+/K+-ATPase, Ca2+-ATPase, and Mg2+-ATPase in erythrocytes and tissues. Oral administration of kaempferol (100 mg/kg BW) or glibenclamide (600 mg/kg BW) for a period of 45 d resulted in significant (p50.05) reversal of these enzymes’ activities to near normal in erythrocytes and tissues when compared with diabetic control rats. Thus, obtained results indicate that administration of kaempferol has the potential to restore deranged activity of membrane-bound ATPases in STZ-induced diabetic rats. Further detailed investigation is necessary to discover kaempferol’s action mechanism.

Time: 16:30-16:50 PM
Tao Zhao
National Center for Cardiovascular Diseases, China
Title: Mid-term results of a new transannular monocusp patch repairing the right ventricular outflow tract in patients with tetralogy of fallot

Biography: Dr. Tao Zhao, Male, 34 yrs old, graduated from PLA Medical School and Peking Union Medical College and majored in cardiovascular imaging and surgery for congenital heart diseases in Anzhen Hospital, Beijing, China. He is guided by many famous cardiovascular professors in China and has much clinical experience in the diagnosis and treatments for congenital and achieved cardiovascular disease. As a welcomed doctor, he spent most of his time in the clinical work, be praised by the patients and the colleagues.

Abstract: Objective Chronic pulmonary regurgitation (PR) has deleterious effects on right ventricular (RV) function in repaired tetralogy of Fallot (TOF). Different transannular patch (TAP) have been designed to with anti-PR effect, though there are various short-term complications. The aim of this study is to introduce a new bovine pericardial TAP with monocusp and its mid-term results. Methods 118 TOFpatients who need TAP-repairfrom January 2007 to November 2008 were enrolled and randomly assigned into three groups using different TAP. Group 1 refers to autologous pericardial patch withpericardial monocusp in 38 patients, group 2 refers to bovine jugular veins with venous valve in 40 patients and group 3 refers to bovine pericardiumpatch with sewn monocusp in 40 patients, which was covered by a layer of polyethylene terephthalates outside. All patients were followed up for 7.5±0.6 years (range 6.9 to 8.1years).Echocardiography was performedat one to two years interval during the follow-up, andCMR was performed at the last time of follow-up when all the patients reached about 7 to 8 years old. Parameters such as right ventricular function and PR were recorded and compared. Clinical events such as cardiovascular death, patients who had occurrence of progressive heart failure symptoms and unplanned cardiovascular admission were recorded.

Time: 16:50-17:10 PM
Ramush A. Bejiqi
University Clinical Centre of Kosovo, Albania
Title: Long – term heart complications in patients after surgical treatment of the tetralogy of fallot - single center experience

Biography: Ramush Bejiqi was born in 1961, in Rama Baje, Medvedja, Yugoslavia. He has graduated medicine 1981-1986 at the Medical Facality in Nish, Serbia, where he completed Master of Scineces in imunology and alergology (1986 – 1988). He also finished his pediatric specialisation (5 years) in Nish, Serbia (1991 – 1995), as well as subspecialization in cardiology (2 years) in Belgrade, Serbia (1995 – 1997). He defended his PhD in area of congenital heart disease, titeled: “Congenital Heart Disease in Neonates with Central Cyanosis” in Tirana, Albania (2010). He was trained in transthoracic echocardiography, transesophageal echocardiography, 3D, 4D; fetal echocardiography; interventional pediatric cardiology; and abdominal echosonography. He started his professional carrea in 1986-1991 at Medical Center, Leskovac, Medvedja, Serbia. From 1991 and onward he is employed at the Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo. From March, 2010 he is President of Pediatric Association of Republic of Kosovo. He is Member of European Association of Pediatric Cardiologist; Member of American College of Cardiology; Fellow of American College of Cardiology, New Orelans, USA; Member of Editorial Board of Medical Journal “Medicus”, Republic of Macedonia. In March 2011 he was elected as a Director of Pediatric Emergency in Prishtina; in September, 2011 he was elected as a Director of Board for developing Cardiac Surgery Center in Prishtina; and Director of 1st Pediatric School of Pediatric Association of Republic of Kosovo. Dr Ramush has been elected since September 2015 as a member of editorial board of Open Access of Macedonian Journal of Medical Sciences. Dr Ramush is the author of more than 33 scientific articles published in different indexed and journal with impact factor.

Abstract: Background Late heart complications after surgical repair of tetralogy of Fallot (TOF) as arrhythmias, pulmonary insufficiency and right heart failure are not rare and depend from age, quality of surgery and possibility of damage during the interventions. Objective of this presentation is to describe outcome and heart complications in our adult cohort underwent TOF repair ˃ 10 years after surgery. Methods and material Retrospectively we analyzed the data of 57 patients (34 adult and 23 teenagers) seen at our institution between 20010 – 2012. Clinical, echocardiogram and echocardiographic data were documented.