Day 2 :
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
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.
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for congenital heart disease prior to the 1980’s was utilized entirely for diagnostic purposes which currently has been replaced by non-invasive imaging modalities such as two dimensional echocardiography, magnetic resonance imaging and ultrafast CT scanning.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.
Cairo University, Egypt
Time : 10:25-11:05
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.
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.
Time : 11:25-11:55
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.
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.