15^th International Conference On Pediatrics and Pediatric Cardiology February 19-20, 2018 Paris, France(Holiday Inn Paris – Marne La Vallée Noisy-le-grand)

Biography:

Vladimir Rotrekl has completed his PhD from Masaryk University in Czech Republic and Max Planck Institute in Cologne (DE) and Postdoctoral studies from Health Science Center at San Antonio, University of Texas, USA. He is the Assistent Professor and Scientific Board Member at the Department of Biology, Masaryk University and Group Leader of Stem Cell and Disease Modelling group at the International Research Center (ICRC) at St Annes University Hospital in Brno, Czech Republic. He has published more than 20 papers in reputed journals.

Abstract:

Duchenne muscular dystrophy (DMD) is a genetic condition characterized by the lack of functional dystrophin. Majority of the DMD patients develops heart muscle fibrosis and cardiomyopathy, leading to heart failure. Although several molecular mechanisms leading to the DMD cardiomyocyte death were described during the recent decades, the link between dystrophin deficiency and delayed onset of cardiomyopathy is still unclear. Recent evidence suggests involvement of progenitor population failure: thus we focused on studying DMD stem cells. In order to dissect the mechanism of cardiac progenitor cells (CPCs) depletion in humans, we used DMD patient specific induced pluripotent stem cell model and human embryonic stem cells with dystrophin mutation introduced by CRISPR/Cas technology (DMD hPSC for both models). We observed that absence of dystrophin in DMD hPSC leads to dysregulation of nitric oxide synthase (NOS), resulting in excessive release of reactive oxygen species (ROS). ROS are in turn associated with increased DNA damage and elevated mutant frequency in DMD hPSCs. The inhibition of NOS or ROS scavenging, results in DNA damage reduction. Finally we observed dramatic increase in CPCs population in young adult (2-3 months) mdx mice hearts, followed by steep decrease in mature animals, which is in contrast to stable CPCs population in WT mouse hearts. CPCs depletion in mdx animal hearts is associated with elevated nuclear DNA damage. Based on these results, we suggest that elevated proliferation of CPCs together with NOS induced-ROS mediated-genomic instability leads to CPCs depletion, and subsequently to limited regenerative capacity of the heart muscle.

Biography:

Robert Gajda Director and Owner of Center for Sports Cardiology (CSC) at the Gajda-Med Medical Center in Pułtusk, Poland. He is a Cardiologist and respected Sports Medicine Physician. His main area of research interest include physiological adaptation to endurance training as well as to extreme endurance efforts. He cooperates with best Polish scientific institutes in this field and is an author or co-author of many papers and lectures including papers published in Scandinavian Journal of Medicine & Science in Sports and Journal of Cardiology. He is an active runner and record holder of Polish medics in marathon.

Abstract:

Millions of physically active individuals worldwide use heart rate monitors (HRMs) to control their exercise intensity. In many cases, the HRM indicates an unusually high heart rate (HR) or even arrhythmias during training. Unfortunately, studies assessing the reliability of these devices to help control HR disturbances during exercise did not exist. We examined 142 regularly training endurance runners and cyclists, aged 18-51, with unexplained HR abnormalities indicated by various HRMs to assess the utility of HRMs in diagnosing exertion-induced arrhythmias. Each athlete simultaneously wore a Holter electrocardiogram (ECG) recorder and an HRM during typical endurance training in which they had previously detected “arrhythmias” to verify the diagnosis. Average HRs during exercise were precisely recorded by all types of HRMs. No signs of arrhythmia were detected during exercise in approximately 39% of athletes, and concordant HRs were recorded by the HRMs and Holter ECG. HRMs indicated surprisingly high short-term HRs in 45% of athletes that were not detected by the Holter ECG and were artifacts. In 15% of athletes, single ventricular/supraventricular beats were detected by the Holter ECG but not by the HRM. We detected a serious tachyarrhythmia in the HRM and Holter ECG data with concomitant clinical symptoms in only one athlete, who was forced to cease exercising. We conclude that the HRM is not a suitable tool for monitoring heart arrhythmias in athletes and propose an algorithm to exclude the suspicion of exercise-induced arrhythmia detected by HRMs in asymptomatic, physically active individuals.

Biography:

Robert Gajda Director and Owner of Center for Sports Cardiology (CSC) at the Gajda-Med Medical Center in Pułtusk, Poland. He is a Cardiologist and respected Sports Medicine Physician. His main area of research interest include physiological adaptation to endurance training as well as to extreme endurance efforts. He cooperates with best Polish scientific institutes in this field and is an author or co-author of many papers and lectures including papers published in Scandinavian Journal of Medicine & Science in Sports and Journal of Cardiology. He is an active runner and record holder of Polish medics in marathon.

Abstract:

Millions of physically active individuals worldwide use heart rate monitors (HRMs) to control their exercise intensity. In many cases, the HRM indicates an unusually high heart rate (HR) or even arrhythmias during training. Unfortunately, studies assessing the reliability of these devices to help control HR disturbances during exercise did not exist. We examined 142 regularly training endurance runners and cyclists, aged 18-51, with unexplained HR abnormalities indicated by various HRMs to assess the utility of HRMs in diagnosing exertion-induced arrhythmias. Each athlete simultaneously wore a Holter electrocardiogram (ECG) recorder and an HRM during typical endurance training in which they had previously detected “arrhythmias” to verify the diagnosis. Average HRs during exercise were precisely recorded by all types of HRMs. No signs of arrhythmia were detected during exercise in approximately 39% of athletes, and concordant HRs were recorded by the HRMs and Holter ECG. HRMs indicated surprisingly high short-term HRs in 45% of athletes that were not detected by the Holter ECG and were artifacts. In 15% of athletes, single ventricular/supraventricular beats were detected by the Holter ECG but not by the HRM. We detected a serious tachyarrhythmia in the HRM and Holter ECG data with concomitant clinical symptoms in only one athlete, who was forced to cease exercising. We conclude that the HRM is not a suitable tool for monitoring heart arrhythmias in athletes and propose an algorithm to exclude the suspicion of exercise-induced arrhythmia detected by HRMs in asymptomatic, physically active individuals.

Biography:

Inge Schalkers has obtained her PhD degree in 2016 with the dissertation entitled “Quality of Paediatric Hospital Care. Understanding the Perspectives of Children and Families”. Now she works as a Policy Advisor for ‘De Hart &Vaatgroep’, a Dutch patient organisation representing the interests of people with cardiovascular diseases. Her area of interest lies in the organisation of patient participation in cardiovascular research. 

Abstract:

Children are not just small adults; they need to be diagnosed and treated in the context of their rapid growth and development. However, in guideline development, children’s needs and interests are still overlooked. This study aims to develop a tool that could stimulate guideline developers to take children into account on a more structural basis and to explore how to facilitate children’s participation in the process of guideline development. A three-phase multimethod sequential study design was used. Professionals involved in guideline development participated in interviews (n=12), filled in a questionnaire (n=60) and/or participated in the focus group meeting (n=11). The study results in a comprehensive understanding of the considerations that professionals take into account when deciding whether guidelines need to apply to children specifically. This resulted into a tool that assists guideline developers to make this assessment more accurately. It takes the form of a flowchart that guides users through a series of critical questions. The flowchart reminds guideline developers to consider children as a particular patient population when prioritizing and demarcating new guideline topics. It will help to ensure that clinical guidelines address children’s unique health care needs and perspectives. Facilitating children’s and parent’s participation in the process of guideline development is perceived as challenging; nevertheless, it should be the next step in making paediatric guidelines more child-centred and family-centred.

Biography:

Early detection of cardiac allograft vasculopathy (CAV) presents a challenge to pediatricians since symptoms of myocardial ischemia (eg, classic angina pectoris symptoms) are typically absent or atypical. Although rhythm disturbances are related to CAV, Sick Sinus Syndrome (SSS) remains an elusive sign of vasculopathy. An 18 year old male with history of heart transplant in 2011 secondary to myocarditis and associated dilated cardiomyopathy, presented to our pediatric emergency room due to chest tightness and shoulder pain on exertion without associated fevers, cough, leg swelling, or increased abdominal girth. Cardiac enzymes and electrocardiography (ECG) performed at that time were found within normal limits and patient was discharged home. Three days later, patient awoke from sleep with shortness of breath and dizziness, stating episodes of “slow beats” and near-syncope during the previous days precipitated during hot showers. He returned to ER where cardiac monitoring placed and noted with tachycardia/bradycardia paroxysms without ST segment changes on ECG. BNP and Panel Reactive Antibodies were sent and found elevated, therefore patient was transferred to Cardiovascular Center for suspected transplant rejection, allograft vasculopathy, and associated sick sinus syndrome. He was taken to cardiac angiography which revealed severe (>90%) stenosis of multiple segments of right coronary artery requiring bare-metal stent placement with immediate evidence of appropriate revascularization. SSS is defined by ECG abnormalities (eg, bradycardia, sinus pauses, sinus arrest) that occur in association with clinical signs and symptoms. It should be widely recognized and alarm primary physicians of serious underlying vasculopathies, particularly in the pediatric population.

Abstract:

Guillermo Torres Viera is a Medical Resident currently completing his fourth year in the Combined Internal Medicine-Pediatrics Residency Program of the University of Puerto Rico School of Medicine. He completed his MD at the University of Puerto Rico in 2014 and entered the first class of this combined specialty program to be created in Puerto Rico for the advancement of knowledge and skill in the effective transition from youth to adulthood. He is currently also pursuing his Master’s in Clinical and Translational Research focused towards the identification and prevention of early-onset cardiovascular disease.

Biography:

Megan Koehle is a medical student at Ludwig Maximilian University in Munich, Germany. She is currently pursuing her medical doctorate with the research group SFB 914 at said institution and is employed at the Munich Transplant Center.

Abstract:

We report the case of a 66 year old female who presented to our institution fourteen years after receiving a St. Jude Mechanical Mitral Valve Replacement. She presentedin refractory NYHA class IV congestive heart failure with comorbidities of acute renal failure, liverfailure, and mental status changes. She was found to have immobility of one of the mitral valvedisks with resultant severe mitral stenosis with a mean pressure gradient of 12 mmHg.

Evaluation and Management: The patient was found to have an STS predicted mortality of 39%with redo surgical MVR, and evaluation by the valve team led to a recommendation of a hybridsurgical and transcatheter procedure. The patient underwent femoral bypass and hypothermiawith a sternotomy and left atrial approach. The mechanical discs were removed utilizing needle drivers without removal of the St. Jude ring. Subsequently, a 26 mm Edwards Sapien XT valve wasdeployed under direct and fluoroscopic visualization.The patient had an event free post-operativ e course, and one year following the proced urehas had an outstandi ng clin ical r esponse with NYHA class II congestive heart fai lure. Her echocardiogram reveals normal valve function with a MPG of 4 mmHg without mitral regurgitation.

Conclusion: Transatrial hybrid TMVR within the ring of a St. Jude mechanical mitral valve appearsto be a feasible procedure which may be used in the future to decrease morbidity and mortalityassociated with high-risk redo-MVR in patients with mechanical mitral valve prostheses.We report the case of a 66 year old female who presented to our institu-tion fourteen years after receiving a St. Jude Mechanical Mitral Valve Replacement. She presented in refractory NYHA class IV congestive heart failure with comorbidities of acute renal failure, liver failure, and mental status changes. She was found to have immobility of one of the mitral valve disks with resultant severe mitral stenosis with a mean pressure gradient of 12mmHg.