Day 2 :
Keynote Forum
Howard Weber
Penn State Hershey Children’s Hospital
Keynote: Correction of congenital heart disease in the current era: From the operative room to the catheterization lab
Time : 09:45-10:25
Biography:
Howard S Weber completed his fellowship in Pediatric Cardiology at Yale New Haven Hospital in 1989 and immediately began his career as an Assistant Professor of Pediatrics at the Penn State Hershey Children’s Hospital and also Director of the catheterization lab. He has published more than 50 articles in various national and international peer reviewed cardiology journals and serves on numerous editorial boards of these same journals. He has been an invited lecturer at numerous interventional pediatric cardiology meetings both nationally and internationally.
Abstract:
Since the introduction of the first interventional pediatric catheterization technique of balloon pulmonary valvuloplasty in the early 1980’s, the field of interventional pediatric cardiology has expanded exponentially. Cardiac catheterization for congenital heart disease prior to the 1980’s was utilized entirely for diagnostic purposes which currently has been replaced by non-invasive imaging modalities such as two dimensional echocardiography, magnetic resonance imaging and ultrafast CT scanning. As a result, many patients with congenital heart disease do not require a diagnostic cardiac catheterization prior to surgical repair. In contrast, the majority of cardiac catheterization procedures performed in children and adults with structural congenital heart disease today are for therapeutic purposes. This lecture will focus on the current strategies and therapies that have been developed over the past thirty years for the treatment various congenital heart defects which can be corrected in the catheterization lab thereby avoid the need for invasive cardiac surgery and cardiopulmonary bypass. A description of various procedures and results will be presented including several specific techniques that have been developed at the Penn State Hershey Children’s Hospital.
Keynote Forum
Sonia El Saied
Cairo University, Egypt
Keynote: Clinical course and prognosis of hypertrophic cardiomyopathy in Egyptian children
Time : 10:25-11:05
Biography:
Sonia El-Saiedi Graduated from Medical School, Cairo University in 1987. She was trained in Boston Children Hospital in 1998. Currently, she is working as Professor of Pediatric Cardiology in Cairo University Children Hospital, Egypt as well as she is the Director of Pediatric Cardiac ICU and Cardiomyopathy Clinic.
Abstract:
Background: Hypertrophic cardiomyopathy (HCM) is an important cause of disability and death in patients of all ages. Egyptian children may differ from Western and Asian patients in the pattern of hypertrophy distribution, clinical manifestations and risk factors.
Objectives: The present work aimed to register the clinical characteristics and outcomes of our children with HCM over a period of 7 years and to determine whether reported adult risk factors for SCD are predictive of outcome in these affected children.
Study design & Methods: A retrospective study that reviewed the clinical data of 128 HCM pediatric patients. These data included personal and family history, physical examination, baseline laboratory measurements, ECG, Holter and echocardiographic results. Logistic regression analysis was done for detection of risk factor of death. rnrnResults: Fifty-one out of 128 patients died during the period of the study. Extreme LVH (interventricular septal wall (IVS) thickness or posterior wall (PW) thickness Z score>6, presence of sinus tachycardia and supraventricular tachycardia (SVT) were independent risk factors for prediction of death in patients of HCM.
Conclusions: In our Egyptian tertiary care center, HCM has a relatively worse prognosis. Infants have a worse outcome than children presenting after the age of one year. A poorer prognosis in HCM is predicted by extreme LVH, presence of sinus tachycardia and SVT.
Keynote Forum
Amir A Sepehri
CAPIS, Belgium
Keynote: Heart Sound Auscultation, Past, Present and Future
Time : 11:25-11:55
Biography:
Amir A Sepehri has received his PhD from ‘Faculte Polytechnique de Mons’ (Mons University, Belgium), in Digital Audio Signal Processing. He has worked on a special research program on ‘Computerized Screening of Congenital Heart Disease. The program was aimed toward obtaining a special diploma known as ‘l’Agregation de l'Enseignement Superieur’ in the same university. The result of his research work is formulated as Arash-Band and it is internationally patented. He has several publications on the CHD screening and detection. He is currently Director of CAPIS Biomedical R&D department.
Abstract:
Heart sound auscultation has been used as a screening technique for investigating cardiac condition over thousand years. There are evidences showing that this technique was used during ancient Persian and Egyptian civilization to verify heart condition but, the biggest breakthrough came on 1816 when the French physician, René Laennec, invented the first stethoscope by curving a wooden cylinder. After the invention of stethoscope, many diagnostic features of this technique were understood by the physicians and later, the phonocardiography became an important tool for cardiac diagnosis in the 1950s. This tool provides a plot of heart sound recording on a rolling paper. However, after the creation of cardiac ultrasound imaging in Lund, Sweden, phonocardiography became less appreciated by the cardiologists due to the informative graphical representation, provided by echocardiography, which is still recommended by the pertinent associations as the tool with central role in diagnosis. In Doppler echocardiography, disease diagnosis is based on the direct and indirect measurement and calculation of the operator. This attributes a subjectivity to the approach, even though it has been objectively accepted by the cardiology community, which is considered as a drawback of the approach that limits its application to the expert clinicians, and access to such expert clinicians is not easy specially in the rural places. Heart sound auscultation is therefore, employed in all the medical settings as the first screening approach, which is by far a less expensive method. rnDue to the progresses in signal processing and artificial intelligence, many studies aimed to associate intelligence with the heart sound auscultation technique in order to improve screening accuracy in cardiac auscultation specially, in children, where the accuracy is substantially impaired by innocent murmurs. A study in Johns Hopkins University, USA, showed that the screening accuracy in pediatrics cases is as low as 40% in family doctors, which can be rather improved by using computer-assisted auscultation. Our previous study revealed that development of an automated tool for screening congenital heart disease in children is achievable by using our unique processing method, named Arash-Band, that has been internationally patented. Such a processing method was incorporated into appropriate graphical user interface and installed on a portable processing unit, to be employed by the practitioners or nurses in primary healthcare centers for an improved screening. This automated system, which we called digital phonocardiograph, was tested by a trained layman operator over a large number of voluntaries from nursery and elementary schools and, also from a referral hospital, and the results showed a great compliance of more than 90% with the echocardiography. Our proposed digital phonocardiograph is now available on the market. One of the interesting capability of the system is its discrimination power in separating innocent murmurs from the pathological ones, and hence offers low values for the both positive and negative errors. Further efforts have been made to lift applicability of the digital phonocardiograph from the screening to diagnosis by adding intelligent algorithms for the disease detection. In a study, we concluded that the digital phonocardiograph is capable to detect children with bicuspid aortic valve. Further studies toward disease diagnosis i.e. aortic stenosis, showed promising results for the commercialization. The Arash-Band method is easily implementable on the smartphones and web technology, which will result in a homecare system for pediatric heart disease screening. It is implied that the digital phonocardiograph tends to provide rather diagnostic information in the future and avails echocardiography to those of need, where decision for an appropriate therapeutic is critical.
- Special Session
Location: Rivieria
Session Introduction
Guy Hugues Fontaine
Universite Pierre et Marie Curie, France
Title: An ARVCs overview: Right ventricular cardiomyopathy
Time : 14:25-15:05
Biography:
Guy Hugues Fontaine has made 15 original contributions at the inception of cardiac pacemakers in the mid-60s. He has published more than 900 scientific papers including 201 book chapters. He is included in the Profiles in Cardiology (W Hurst 2003) book of the 216 individuals who have made a significant contribution to the study of cardiovascular diseases since 14th century. He has been included in the book “500 greatest Geniuses of the 21st century” of the American Biographical Institute (ABI 2005). He was the Reviewer of 17 journals both in clinical and basic science. He has served for 5 years as a Member of the Editorial Board of Circulation. He has been invited to give 11 master lectures of 90 minutes each during three weeks in the top universities of China (2014).
Abstract:
Arrhythmogenic Right Ventricular Dysplasia (ARVD) most frequent form is due to PKP2 desmosomal mutation with increased RV size with thinness of the free wall and segmental anomalies of contraction. This is in contrast with increased trabeculations at the RV apex. It is the result of the presence of apoptosis, fat and interstitial fibrosis mostly observed in the RV free wall and LV apex. This disease is frequent in the general population but become clinically apparent in a small number of cases. Disease starts in the embryo in the mediomural layers and has been detected in one case by Echo sonography. It is also the result of a unique PLN mutation. Clinical presentation is mostly ventricular arrhythmias which can lead to unexpected sudden cardiac death especially in young people and during endurance sports. Biventricular form is less frequent but caries a poorer prognosis. Some of these patients seen at a late stage of the disease can be misclassified as IDCM. Pathology of Heart Tx will re-establish the diagnosis. Fatty non-compaction (FNC) is common in the general population (60%) due to the presence of an excessive amount of fat in the RV free wall up to typical ARVD but without fibrosis. It is a determinant of prognosis in case of LV failure. Mutation is unknown. Brugada syndrome (BrS) has a unique ECG pattern of coved type observed only in lead V1. Structural changes are sometimes suggesting ARVD. However, BrS and ARVD are two different entities with some degree overlap both phenotypically and genotypically in a small number of cases. The vast majority in each entity has its own unique features. RVOT VT is generally benign but one personal case of SD with pathologic documentation demonstrated a localized infundibular anomaly suggesting ARVD with fragmentation of potentials by needle infundibular transmural electrode in another case. Uhl’s anomaly shows a huge RV with apposition of epicardium against endocardium. However, this can be a differential diagnosis with an extreme form of ARVD. Naxos disease originally detected by Echocardiography is the most impressive form of these RVCs because of its genotype in which both parents are affected by the same mutation of a desmosomal protein called Plakoglobin. However, the heterozygous form shows only minor ECG changes but no clinically significant disease. All of these cardiomyopathies can be affected by a wide clinical spectrum of superimposed myocarditis (which has also in some cases) a genetic background, frequently the determinant of prognosis. However, in some rare patients, the disease can stop completely spontaneously its progression.
- Sessions: Pediatrics Healthcare | Pediatric Pulmonology | Coronary Heart Diseases | Heart Surgery | Advance Therapies | Interventional Cardiology
Location: Rivieria
Chair
Randy Richardson
St Josephs Hospital and Medical Center, USA
Co-Chair
Sonia El Saiedi
Cairo University, Egypt
Session Introduction
Randy Richardson
Creighton University School of Medicine, USA
Title: Impact of pre-procedural simulation and planning using 3D resin (solid) and photopolymer (flexible) models on interventional cardiac procedures
Time : 11:55-12:25
Biography:
Randy Richardson is the Chairman of radiology at St. Joseph's Hospital and Medical Center and the Associate Dean for Creighton University School of Medicine Phoenix Campus. He is Professor of radiology for the Creighton Schools of Medicine and Adjunct Professor at Arizona State University School of Biological and Health Systems Engineering. He is the author of a textbook, 31 book chapters, 11 syllabi, 44 scientific exhibits, 24 scientific papers, 22 peer reviewed journal articles, 3 websites and 14 multimedia presentations. His area of expertise and research has been in the field of cardiac MRI and CT imaging in children.
Abstract:
Pre-surgical planning using imaging in pediatric congenital and acquired heart disease has played a vital role in patient outcomes for many decades. With advances in 3D printing technology we are now able to take patient specific imaging data and create 3D patient specific physical models. These models can be used to for pre-procedural patient specific simulations of cardiac procedures. We have successfully performed pre-procedure simulated procedures on physical modelsina patient with aortic stenosis undergoing percutaneous aortic valve placement where the size of the valve was in question, two patients with VSD from myocardial infarction that needed a device closure and to predict compatibility of donors and recipients for heart transplants. In all cases the simulated procedure had a significant impact on the actual procedure resulting in decreased time of procedure compared to standards, influenced the choice of the device chosen and was key in predicting correct sizing of implant. All though the numbers are small the impact seems to be significant.
Marie-Pierre Flament
University of Lille, France
Title: Multi-particulate dosage form for pediatric use
Time : 12:25-12:55
Biography:
Marie-Pierre Flament obtained a PhD (1994) in Pharmaceutical Technology from the University of Lille by studying nebulization for pulmonary delivery of alpha 1 protease inhibitor. She became Lecturer at the University of Lille in 1995 and Professor in Pharmaceutical Technology in 2012. She is Vice-dean of the Faculty Engineering and Health Management (Lille) since 2015. She is a member of the research unit INSERM U 1008 “Controlled Drug Delivery Systems and Biomaterials”. Her research activity focuses mainly on pulmonary drug delivery and paediatric formulations but also on powder characterization, extrusion-spheronization, compression and coating.
Abstract:
In recent years, regulations on pediatric medicines have induced an increased need for research into novel child - appropriate dosage forms. Indeed, children cannot be considered as “small adults” as they present different anatomical and physiological characteristics. Whatever the route of administration, the age-appropriateness of the formulation is of major importance and has to be taken into consideration. The development of new pediatric dosage forms encounters technical complexities such as dose modification, ease of administration/swallowing, taste-masking, chemical and physical stability, preservation, considerations of a multi-phase and/or multi-use product, packing, providing/designing the measuring device. Innovations are important and the research of new ways to deliver medicines tends to improve compliance, convenience and pharmacokinetics. Recently, the World Human Organization recommended that small sized solid forms or orally disintegrating solid forms should be favored. Solid multi-particulate systems such as pellets have the advantage to cover a broad range of doses for different patients. Dose adjustment can be accurately done by means of dosing device such as a multi-particulate counting device. Developing multi-particulate dosage form with fast disintegration can be useful for children as they present both advantages of solid and liquid formulations. This led to the concept of Orally Dispersible Tablet which disintegrates rapidly in the mouth into small particles or pellets. Their small size enables them to be well distributed along the gastrointestinal tract improving the bioavailability while reducing local drug concentration, risk of toxicity and side effects. They offer easy swallowing and dose flexibility for pediatric patients and caregivers.
Yousef Etoom
University of Toronto, Canada
Title: Sudden cardiac death (SCD) in children
Time : 12:55-13:25
Biography:
Dr. Etoom is an Assistance Professor at University of Toronto, Department of Paediatrics. Staff Physician, Paediatric Emergency Medicine at the Hospital for Sick Children,Toronto. Staff Paediatric Cardiology and Post-Graduate Medical Education Director, Paediatric Department at St. Joseph Health Center, Toronto. He received his Medical degree from Jordan University of Science and Technology and earn his Fellowship training in Paediatric Intensive Care, Cardiology, and Paediatric Emergency at The Hospital for Sick Children, Toronto.
Abstract:
Sudden cardiac death (SCD) and Sudden cardiac arrest (SCA) in children and adolescents are rare. The underlying cardiac disease associated with SCA varies with age. For children two years old or younger, congenital heart disease is the predominant cause of SCA. For older children and adolescents, there is no dominant cause of SCA. Cardiac disorders include congenital heart disease, primary arrhythmias. Genetic cardiac diseases associated with SCA and SCD include cardiomyopathies, ion channelopathies resulting in conduction defects, and familial Wolff-Parkinson-White syndrome. The immediate cause of SCA and SCD appears to be a life-threatening and often lethal ventricular tachyarrhythmia. Although SCA is often the initial presenting event, warning signs or symptoms (eg, chest pain, fatigue, seizures, and syncope/ lightheadedness) are noted in at least 40 percent and up to 70 percent of individuals prior to SCA. Other disorders that need to be distinguished from an underlying cardiac disease include vasovagal syncope, migraine headaches, seizures, musculoskeletal conditions that present with chest pain, asthma, near-drowning, and sudden infant death syndrome (SIDS). Preventive strategies to reduce SCD include primary screening to identify and manage at-risk individuals, and secondary prevention with successful resuscitation of individuals with SCA.
Chun-Ming Jiang
The First Affiliated Hospital of Nanjing Medical University, China
Title: Ligusticum wallichii elevates the proliferation of hypoxia-stimulated human microglia through promoting HIF-1α-mediated MET expression
Time : 15:05-15:35
Biography:
Chun Ming Jiang has completed his MM from Wenzhou Medical University and MD studies from Nanjing Medical University of Medicine. He is the Attending Doctor and Senior Researcher of the Affiliated Hangzhou Hospital of Nanjing Medical University. He has published more than 10 papers in peer-reviewed journals and has been serving as an Editorial Board Member of repute.
Abstract:
During the hypoxia-involved neonatal stroke, microglial cells take part in endogenous defense mechanisms to prevent the brain injury. Thus, the reasonable therapeutic intervention in this disease may be the increase of microglia proliferation. In our study, we primarily found that Ligusticum wallichii enhances the proliferation of hypoxia-stimulated human microglia by increasing the cell cycle. Furthermore, Ligusticum wallichii differentially regulated the expression of a lot of genes, in which MET gene, encoding a cell surface receptor tyrosine kinase for recognizing hepatocyte growth factor ligand, acts an important down-stream effective molecule for Ligusticum wallichii in treatment with hypoxia-induced human microglia by using RNAi technique. Moreover, Ligusticum wallichii enhances the binding of HIF-1α to the promoter of MET gene in hypoxia-treated human microglia, providing the rational explanation why Ligusticum wallichii plus hypoxia-administrated human microglia have highest MET expression. Collectively, we have identified a potential mechanism by which MET regulated by HIF-1α contributes to Ligusticum wallichii-mediated increase of proliferation of hypoxia-induced human microglia. Thus Ligusticum wallichii and targeting MET should be considered as two potential strategies for enhancing the hypoxia-stimulated human microglia.
Takashi Sasaki
Kanagawa Children’s Medical Center, Yokohama, Japan
Title: Prenatally planned hybrid cardiac procedure in critically ill neonates with complex congenital heart disease
Time : 15:35-16:05
Biography:
Takashi Sasaki graduated from Nippon Medical School in 1998. After cardiothoracic residency, he studied optimal cardiopulmonary bypass management for neonates with arch anomaly at Stanford University. Then he completed pediatric cardiac surgery fellowship at British Columbia Children’s Hospital. He came back to Japan in 2012 and is currently working at Nippon Medical School and Kanagawa Children’s Medical Center.
Abstract:
Objective: To review the outcomes of hybrid cardiac surgery for critically ill neonates with complex congenital heart disease.
Methods: Retrospective review in five hybrid cases performed between 2010 and 2015.
Results: Age at surgery was as follows; within the first 90 minutes after birth in 3, 1 day in 1 and 2 days in 1. All but one was diagnosed prenatally and planning for hybrid procedure was made before birth. There were hypoplastic left heart syndrome (HLHS) with severely restrictive atrial septal defect (ASD) in 3 and critical aortic stenosis (AS) with borderline left ventricular function in 2. All procedures were performed through a median sternotomy. In neonates with HLHS, ASD was created with a stent inserted through the right atrial wall followed by bilateral pulmonary artery banding (PAB). In neonates with AS, bilateral PAB was performed followed by balloon aortic valvotomy via the brachiocephalic artery. ASD was created in one of two patients with critical AS for LV rehabilitation. One died of coronary hypoperfusion after ASD stent insertion presumably due to sinusoidal communication. There were two late deaths including one in HLHS caused by peripheral pulmonary venous obstruction and one in AS due to hemorrhage during balloon dilatation of PA. One completed Fontan and one completed biventricular repair.
Conclusions: Hybrid procedure enabled us to perform ASD creation and regulation of pulmonary blood flow as well as aortic valvotomy simultaneously without use of cardiopulmonary bypass immediately after birth in critically-ill neonates. Prenatal diagnosis was useful in planning hybrid procedures before birth. A highly advanced collaboration among a multidisciplinary team must be a crucial step to further success.
Makoto Nabetani
Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
Title: Experiences of therapeutic hypothermia therapy on six cases with persistent pulmonary hypertension and moderate to severe hypoxic ischemic encephalopathy using inhaled nitric oxide therapy
Biography:
Makoto Nabetani is currently working in the department of Neonatal Medicine at Osaka Medical Centre and Research Institute for Maternal and Child Health, Japan.
Abstract:
We experienced six cases that could undergo therapeutic hypothermia (TH) therapy combined with inhaled nitric oxide (iNO) therapy and one persistent pulmonary hypertension (PPHN) case who could undergo and stop TH during 2002-2014. We experienced no complication in these six cases. We have compared perinatal factors, MRI findings around one-year-old, Gross Motor Function Classification System (GMFCS) and developmental quotient around one and a half year old between 6 cases who underwent TH therapy completely combined with iNO therapy (TH + iNO group) and 38 cases who underwent only TH therapy (TH group). There are no significant differences of perinatal factors, MRI findings, GMFCS and developmental quotient between (TH + iNO group) and (TH group). These results showed TH could be performed safely for HIE cases with PPHN combined with iNO therapy maintaining the stable condition of respiration and circulation. We need to investigate more PPHN cases with iNO therapy to clarify criteria which cases could be performed TH therapy safely.
Kobata Keisuke
Osaka Medical Center and Research Institute, Japan
Title: Experiences of therapeutic hypothermia therapy on six cases with persistent Pulmonary hypertension and moderate to severe hypoxic ischemic encephalopathy using inhaled nitric oxide therapy
Biography:
Dr. Makoto Nabetani currently working in the department of neonatal medicine at Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
Abstract:
We experienced six cases that could undergo therapeutic hypothermia (TH) therapy combined with inhaled nitric oxide (iNO) therapy and one persistent pulmonary hypertension (PPHN) case who could undergo and stop TH during 2002-2014. We experienced no complication in these six cases. We have compared perinatal factors, MRI findings around one-year-old, Gross Motor Function Classification System (GMFCS) and developmental quotient around one and a half year old between 6 cases who underwent TH therapy completely combined with iNO therapy (TH + iNO group) and 38 cases who underwent only TH therapy (TH group). There are no significant differences of perinatal factors, MRI findings, GMFCS and developmental quotient between (TH + iNO group) and (TH group). These results showed TH could be performed safely for HIE cases with PPHN combined with iNO therapy maintaining the stable condition of respiration and circulation. We need to investigate more PPHN cases with iNO therapy to clarify criteria which cases could be performed TH therapy safely.
Karapetyan N.G
Bakuolev Scientific center for cardiovascular surgery, Russia
Title: Rotational angiography and 3D modeling in diagnostics and treatment of CHD
Biography:
Karapetyan N G has completed his PhD from Bakuklev Scientific Center for Cardiovascular Surgery. He is a Practicing Physician. He has published more than 15 papers in different journals and has been serving as a Faculty in TCT Russia during 2015 and 2016.
Abstract:
3D rotational angiocardiography (3D RA) is a relatively new method in the treatment of CHD, number of publications is not very large, and there are still many unresolved issues.
Aim: The aim of the study was to evaluate the capability of 3D RA using in diagnosis and treatment of congenital heart disease, and its comparison with the standard angiocardiography.
Material & methods: From 2012 to 2015, in 150 patients with various CHD, 169 3D RA were performed and compared with standard angiocardiography. Patients were divided into 6 groups: Pulmonary artery (n=41), right ventricle outflow tract (n=50), great veins (n​=24), aorta (n=21), abnormal communication between major vessels (n=16), the left ventricular outflow tract (n=17). The criteria for the comparative analysis have been visualization quality, additional information, the radiation dose, the amount of contrast agent during the study and study time.
Results: The study resulted that 3D RA had visualization quality better than standard angiocardiography in patients with peripheraland bifurcation PA stenosis; in patients with communications between the main arteries; in patients with aneurysm of the right ventricular outflow tract, in patients with obstruction of the left ventricle outflow tracts and in patients with great veins examination. Radiation dose during 3D RA was 503.4±350 cGy/cm2, while during standard angiocardiography – 820.8±400 cGy/cm2 (p=0.036). Study duration was 14.1±10 minutes using 3D RA and 15.1±9 minutes using standard angiocardiography. The volume of used contrast agent was 49.9±35 mL in 3D RA group and 47.8±38 mL in standard angiocardiography, without significant difference. 3D RA contributed additional important information due to possibility of achieving three-dimensional models and obtain unlimited angulations.
Conclusion: 3D RA is high-quality and safe method of imaging of the heart and vessels in patients with a various CHD compared with standard angiocardiography. Using 3D RA often reveals important additional information about the anatomy area of examination.
Prof Sonia El Saiedi
Cairo University, Egypt
Title: Clinical Course and Prognosis of Hypertrophic Cardiomyopathy in Egyptian Children
Biography:
Prof. Sonia El Saiedi is working as Professor of Pediatric Cardiology in the Cairo University Children Hospital, Egypt as well as she is director of Pediatric Cardiac ICU and Cardiomyopathy Clinic.
Abstract:
Pulmonary atresia with intact ventricular septum is an infrequent but enigmatic disorder with significant morphological heterogeneity. In the absence of a right ventricular– dependent coronary circulation, pulmonary valvotomy is a good choice to save the right heart a biventricular repair instead of univentricular repair currently practice in our country. The use of percutaneous RF-assisted perforation of the atretic valve and subsequent balloon dilation provides an easy but expensive overall procedure. The procedure, while technically challenging, can be expected to establish ante-grade flow successfully through the pulmonary valve in most of patients. More than 65 patients presenting with PA-IVS presenting to Cairo University Children Hospital (CUCH) were taken for RF perforation using Baylis RFP 100 generator with trials for cost limitations. For example, to minimize expenses: We stopped using the Protrack microcatheter and replaced this in most cases by the “wire tracks a wire” technique. We also replaced the use of the micro snare from the arterial end to mark the pulmonary valve by looping a coronary wire. Telescopic Luma catheter was replaced by using Mullin long sheath 5 or 6F through which the 4F catheter is passed. Fixing the wire and trying to limit the number of balloons used, replacing the Tayshack Mini balloons which was not always available with regular coronary balloons which are readily available. In case of unavailable 4F sheath with special curve we mostly used either 4F VER and reshaped it. We resorted to Hybrid procedure with the surgeon opening the chest and fixing the sheath in RV directed towards the Pulmonary valve in case of failed peripheral vascular access. The challenges faced by the operator in the cath lab (especially in countries with less than optimal facilities) and the different solutions to overcome those challenges will be presented.
Jeffrey Hellinger
New York Cardiovascular Institute, Lenox Hill Radiology, USA
Title: Pediatric Cardiovascular CT Angiography: Maximizing Image Quality at Low Radiation Dose
Biography:
Jeffrey Hellinger MD, MBA FACC is a pediatric and adult radiologist with subspecialty fellowship training in Cardiovascular Imaging from Stanford University School of Medicine and Interventional Radiology from Emory University School of Medicine. Dr. Hellinger received his medical degree from the University of Miami School Of Medicine, interned in general surgery at Jackson Memorial Hospital / University of Miami and completed diagnostic radiology residency at Emory University. Dr. Hellinger has completed his master’s in business administration with a focus on healthcare management. Dr. Hellinger’s academic work focuses on radiation safety and appropriate use of imaging modalities. This work has led to multiple publications of original research, review articles, and book chapters. Dr. Hellinger has also contributed to multiple society guideline documents and consensus statements.
Abstract:
Imaging the pediatric cardiovascular system with computed tomography angiography (CTA) is dependent upon radiation. Patient centric CTA protocols are essential to balancing radiation safety and image quality. These protocols are designed to deliver an appropriate amount of radiation which will ensure acceptable high diagnostic quality and the lowest required radiation exposure for the pediatric patient. Optimal contrast delivery and iterative reconstruction are two strategies to optimize image quality while dialing down the radiation parameters. In this lecture, these and other CTA protocol strategies will be discussed and illustrated. By attending this lecture, the following learning objectives will be achieved:
- An understanding of patient and technological determinants for CTA protocol decision making
- An understanding of primary CTA strategies for low radiation exposure and optimization of image quality
- An understanding of secondary CTA strategies for low radiation exposure and optimization of image quality
Chiara Bernelli
Azienda Ospedaliera Papa Giovanni XXIII, Italy
Title: Impact of culprit plaque and atherothrombotic components on incomplete stent apposition in patients with ST-elevation myocardial infarction treated with everolimus-eluting stents
Biography:
Chiara Bernelli is an Interventional Cardiologist at Azienda Ospedaliera Papa Giovanni XXIII of Bergamo, Italy. She graduated from the Medical University of Genoa, Italy, in 2007 where she obtained the medical and the cardiology degree with honor. She also completed her fellowship in Interventional Cardiology at San Raffaele Scientific Institute, Milan, Italy. She has been published as a main author and co-author in several cardiology journals. Her research interests include left main coronary artery disease, drug eluting stents, acute coronary syndrome and percutaneous treatment of structural heart disease with a special interest for transcatheter aortic valve implantation. She is also specialized in intracoronary imaging with focus on optical coherence tomography. She has actively participated as a speaker at many key conferences including PCR, TCT and ESC . She has authored several article and chapter books in peer review journals as well as she is currently a reviewer for several cardiologic journals.
Abstract:
Objectives: To investigate the impact of culprit plaque and atherothrombotic components on incomplete stent apposition (ISA) in patients with ST-segment Elevation Myocardial Infarction. (STEMI) Background: The role of the culprit plaque and related atherothrombotic components on ISA occurrence after primary percutaneous coronary intervention (p-PCI) is unknown. Methods: STEMI patients undergoing p-PCI with everolimus-eluting stent (EES) were prospectively investigated with Optical Coherence Tomography (OCT) of the infarct-related artery before, after stenting and at 9-month follow-up. Data derived from serial OCT, histopathological analysis of thrombus-aspirates and serum inflammatory biomarkers were analyzed. Results: 114 patients with 114 EES-treated lesions were evaluated. Acute-ISA occurred in 82 (71.9%), preferentially in larger vessels, with a median area of 0.2 mm2 [IQR 0.1-0.4]. The presence of thrombus before stent implantation (OR 5.5, 95%CI [1.1-26.9], p=0.04) and the lipid content in the target segment (OR 1.3, 95%CI [1.0-1.5], p=0.04) independently predicted acute ISA. At 9-month, ISA persisted in 46 (56.1%) lesions, significantly predicted by the volume of acute-ISA (OR 1.3, 95%CI [1.1-1.5], p=0.01). Late-acquired ISA occurred in 39 (34.2%) lesions with a median area of 0.3 [0.1-0.4] mm2. Red/ mixed thrombus before stent implantation (OR 3.7, 95%CI [1.0-13.3], p=0.05) and length of the underlying ruptured plaque (OR 1.7, 95%CI [1.1-2.8], p=0.02) were independently associated with late-acquired ISA. Conclusions: In STEMI patients undergoing p-PCI, culprit plaque and atherothrombotic components of the infarct-related artery significantly contribute to the onset of acute- and late ISA. ISA persistency at follow-up depends on the initial volume of malapposition.
Rahul Rathod
Boston Children's Hospital, Boston, USA
Title: Advanced imaging in Fontans: How does the data help us?
Biography:
Dr. Rathod completed his medical school at Case Western Reserve University and his pediatrics residency at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. He also served for an additional year as Chief Resident. He subsequently completed his cardiology fellowship at Boston Children's Hospital, including serving as Chief Fellow. His cardiology training included a fourth year as Senior Non-Invasive Fellow. Dr. Rathod is staff cardiologist in the Department of Cardiology at Boston Children's Hospital and is an Assistant Professor at Harvard Medical School. His research interests focus primarily on the use of advanced CMR technologies in predicting outcomes of patients with complex congenital heart disease. Dr. Rathod has 31 publications in reputable journals, including 8 papers related to patients with single ventricle or Fontan physiology.
Abstract:
Patients with functional single ventricle congenital heart disease have complex anatomy and physiology. The final surgical pathway often culminates in the Fontan procedure. Despite improving clinical outcomes in the first several years of life, adverse outcomes are common and increase in frequency as these patients become older. These adverse outcomes include death and significant co-morbidities including protein-losing enteropathy, exercise intolerance, heart failure, arrhythmias, liver cirrhosis, thrombus, and stroke. The purpose of this talk would be a multi-modality review of advanced imaging in patients late after the Fontan operation. Non-invasive parameters that have been shown to be predictive of adverse outcomes would be highlighted and receive the most in depth review. This talk would include review of the utility of echocardiography, cardiac magnetic resonance imaging, and cardiac CT. The strengths and weaknesses of each modality would be reviewed in detail. Illustrative imaging case examples would be scattered throughout the talk. This would include some advanced techniques as well, including ventricular strain analysis, myocardial viability assessment, aortopulmonary collateral flow quantification, and 4D flow analysis. In addition to the cardiac imaging described above, a brief review of the non-invasive modalities to evaluate Fontan associated liver disease will also be discussed, including echocardiographic and magnetic resonance based liver elastography.
Biography:
Dr. Elissa Dyann Soriano completed her residency in Pediatrics last August 2015 from Jose R. Reyes Memorial Medical Center, where she handled the position of Associate Chief Resident for 6 months and Chief Resident for another 19 months. She has taken an interest in pediatric cardiology, aiming to undergo fellowship training in the said field.
Abstract:
Background: Student athletes are routinely screened by physicians prior to engaging in sports. In the Philippines, obtaining an electrocardiogram (ECG) is currently not a routine part of the sports clearance but has shown to detect potentially life threatening cardiac diseases that are responsible for the occurrence of sudden cardiac death. Objective: To determine the prevalence of ECG abnormalities in healthy male athletes aged 13-19 years in 2 high schools in Metro Manila. Research Design: Prospective cross-sectional study Methods: A questionnaire was given to the parents of the subjects to obtain information on the subjects’ demographic data. Physical examination and medical history was done based on the AHA Guidelines for Preparticipation Cardiovascular Screening of Young Competitive Athletes. ECG was obtained from all subjects. Findings were classified as having no findings, normal-variant ECG changes and uncommon ECG findings for athletes. Results: Out of the 61 high school athletes enrolled in the study, 3% had completely normal ECG and 25% have normal-variant ECG changes for athletes, most commonly sinus arrhythmia (47%) and sinus bradycardia (16%). The most frequently seen uncommon ECG finding is T-wave inversion in the right precordial leads (69%). Six athletes were identified to be needing referral to a specialist: 1 with biventricular hypertrophy and left atrial enlargement on ECG and a PE finding of a systolic murmur, 2 athletes with prolonged QT and 3 athletes with complete RBBB; none of them had significant findings on history and physical examination. Conclusion: ECG abnormalities requiring referral to a specialist were detected in about 10% of the athletes who were generally asymptomatic. Adding electrocardiography to the preparticipation screening done in young athletes may increase the chances of detecting potentially fatal cardiac conditions and athletes with or without identifiable risk factors may benefit from it.
Giacomo Pongiglione
Ospedale Pediatrico Bambino Gesù, Italy
Title: Pulmonary Valve implantation in the Native Outflow Tract
Biography:
After my fellowship in Pediatric Cardiology at the Hospital for Sick Children of Toronto (Canada) and after more than one year at the Children’s Memorial Hospital of Chicago I have worked for more than 20 years at the Istituto Giannina Gaslini Children’s Hospital, Genoa, Italy where I have been the Director of the Cardiovascular Department for 8 years. I then moved to Rome to be the Director of the Department of Pediatric Cardiology and Pediatric Cardiac Surgery of the Bambino Gesù Children’ Hospital from March 2009 to December 2015. My specific area of expertise is Interventional Cardiology and Big Data Management in pediatric Cardiology. I have been the clinical coordinator of the European funded project Health-e-Child, Sim-e-Child , MD-Paedigree, and responsible of Validation in Cardioproof. I have authored 122 papers with a total IF points of 376,98, a Research Gate score of 38,40 (>95th percentile), 21 h index.
Abstract:
RVOT reconstruction is a significant component of many surgical repairs and residual RVOT dysfunction (stenosis and/or regurgitation) forms the primary indication for reoperation. Percutaneous PV implantation has been introduced to reduce the number of operations needed in the total lifetime of the pts. with a RVOT dysfunction and hundreds of PV have been implanted in condouits. Pulmonary valve implantation is now current practice in the treatment of failing conduits in the RVOT. However, the vast majority of Tetralogy of Fallot received transannular patch repair of the RVOT. Pulmonary regurgitation is frequent after conduit insertion and is an inevitable consequence of transannular patching and/or pulm. valvotomy and will eventually compromise RV function. The patched outflow tract does not offer a rigid support for percutaneous pulmonary valve implantation, limiting the possibility of a catheter based treatment. From October 2010 through December 2014, a trans-catheter implantation of a prosthetic pulmonary valve has been performed succesfully on 45 patients, 27 of which had a transannula patch. A protocol of RVOT pre-stenting followed after 1-2 months by valve implantation has been utilized. One patient underwent surgery because of stent malposition, early in our experience, as well as 5 additional pts. in which the procedure was aborted because of coronary proximity or RVOT size. A succesful valve implantation was obtained in 21 patients. At a mean follow-up of 19 months all pts improved from NYHA II-III to I, there was no significant PV insufficiency or stenosis, mean RV pressure was 25±9 mmHg, and there has been no stent migration or stent fractures.