15^th World Cardiac Surgery & Angiology Conference December 08-09, 2016 Philadelphia, Pennsylvania, USA

Giuseppe Petrone has completed his degree in medicina and surgery at the age of 24 years from Second University of Naples (Italy) and he is specialist in Cardiovascular surgery since May 2015. He worked as Registrar and Clinical Fellow in Hammersmith Hospital (Imperial College, London) for a year (from May 2014 to April 2015). He is Resident in the Cardiovascular Department of “Heart Centre – City of Alessandria”. He has been invited to discuss his research projects in occasion of important meeting (59th annual conference of the Israel Heart society, Tel Aviv 2012; 61st annual conference of the Israel Heart society, Tel Aviv 2014, Heart Valve Society meeting, New York 2014; Mitral Valve Conclave, New York 2015; EACTS,Amsterdam 2015; he has published 4 papers in reputed journals

Background: Since 1996, we have developed an innovative technique of ventriculoplasty, the “Twist Technique”(TT). The procedure performed has the purpose of preserving not only the volume and the shape of the LV but, above all, to restore the physiologic counterclockwise (CCW) twist of the cardiac apex through a rearrangement of its fibers, rebuilding the natural apical vortex of the LV. We present our experience in LV remodeling. Methods: From 1996 to 2015, 289 patients with post-infarction LV aneurysm underwent reconstructive procedures. Mean age was 56.4 ± 7.3 years. Average LV ejection fraction (EF) was 38.9% ± 11.6%. LV reconstruction was performed by using the TT in 265 patients (91.7%). Jatene technique is performed. Afterwards, the orifice closure is obtained performing the TT: a running 2-0 polypropylene suture orients cardiac fibers remodeling heart apex in a cone shape; stitches are outdistanced of 1 cm on the lateral side of the endocardial wall and of 1/2 cm on the endocardial septum. The distal and akinetic portion of the septum is folded and therefore excluded. In 257 patients (88.9%) concomitant myocardial revascularization was performed. Results: Perioperative mortality was 2.4%. Mean follow-up was 8.45 ± 4.2 years. Actuarial survival rate at 13 years was 73 %. The physiological movement of the new apex, that unfolds in a natural CCW twist, considerably improved LV EF. Mean post-operatively EF was 46.1 ± 9.3 %. Conclusion: LV remodeling using the TT reproduces physiological CCW torsion of the cardiac apex, it is a safe surgical procedure with low perioperative mortality and excellent long-term survival.

Sonjoy Biswas has completed his MS (Cardiothoracic Surgery) under University of Dhaka, Bangladesh in 2013 and FCPS (Cardiovascular Surgery) in 2015 under Bangladesh College of Physicians and Surgeons (BCPS). He has been exposed to almost every facets of both adult and congenital heart surgeries in Bangladesh. He worked as a Registrar in Cardiac Surgery at National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh while doing these case reports till December, 2015. Now, he has been working in United Hospital Limited, Dhaka, Bangladesh as a Specialist in the Department of Cardiac Surgery

Management of adult coarctation of aorta surgically is difficult. Moreover, concomitant acquired disease with it becomes more challenging and complex. Staged surgical procedures exhibit more complexity. We have depicted our experiences of single-staged surgery for those cases. From June, 2013 till to date we have performed 4 single staged repair for coarctation of aorta with concomitant acquired cardiac diseases at our centre. In this series, age ranged from 20 to 49 years, all were male. Out of four, one case of operated coarctation of aorta with severe MR died on the 11th post-operative day due to ARDS. Single-staged surgery for intracardiac procedure along with co-arctation of aorta is safe, cost effective and reproducible. Key wards: Coarctation of aorta, single-staged surgery, mitral regurgitation etc.

To be updated soon...

A 39 years old, 29 weeks pregnant, G8P7, (5-2-0-3) suffered from infective endocarditis with severe aortic regurgitation, severe mitral regurgitation and severe tricuspid valve in the background of rheumatic heart disease. Patient underwent emergency simultaneous low transverse caesarian section and bilateral tubal ligation for nonreassuring fetal status biophysical score of 2/10 and mitral and aortic valve replacement with St Jude Mechanical Aortic Valve size19 and St Jude Mechanical Valve size 27 and tricuspid valve annuloplasty with septal leaflet extension and Philippine Heart Center ring size 30 with intraoperative transesophageal echocardiography. Patients are both doing well and discharged improved

To be updated soon...

Background: Mitral valve repair in patients with mitral valve regurgitation is associated with an improved quality of life with less morbidity as well as better long-term survival as opposed to replacement. We assessed the characteristics and outcome of patients treated with conservative mitral surgery in our centers. Methods and Materials: We considered for enrollment in this study 62 patients with mitral valve disease who underwent mitral valve repair for moderate to severe mitral regurgitation, in two hospitals between January 2009 and December 2012. Patients who underwent concomitant surgery for other conditions were also included. 34 patients (55%) were men. Mean age was 57.5+-12.5 years. The primary outcome of interest was death, mitral residual regurgitation and need for reintervention. On admission, 79 % of the patients had heart failure NYHA III-IV. Severe mitral regurgitation was present in 40 (64.5%)patients. Median sternotomy was surgical aproach, using moderate hypotermia during bypass time. Surgical techniques used were implantation of a prosthetic ring in 95.2 %, quadrangular resection of posterior leaflet in 19.4%, cordal replacement in 6.5%, mitral commissurotomy in 14.5%, cordal transfer in 8%, Alfieri stich in 4.8% of patients. Patients were followed up for 1 and 6 months after the mitral surgical procedure. Evaluation of mitral valve repair is based in transthoracal and transesophageal echocardiographic examinations. Results: No deaths in early postoperative period. Early after surgery, 58 % of patients had no mitral regurgitation, 34% had mild mitral regurgitation; only one patient had moderate mitral regurgitation. After one month, only 1 (1.8%) patient had more than moderate mitral regurgitation.At six month follow-up only 2 (4%) patients had more than moderate mitral regurgitation. There were no deaths or reinterventions during 6-month follow up. Conclusion: Mitral valve repair for mitral regurgitation has been associated with good short to midterm results.

To be updated soon...

Objectives: The general purpose of the study was to examine the course of the early period after surgery, total cava-pulmonary anastomosis in children of different age groups with atresia of the tricuspid valve Material and methods: In the period from 2011 until 2015, the centre for paediatric cardiac surgery at Scientific Center of Surgery named after academician M. A.Topchibashev, together with the Scientific and Practical Center of pediatric surgery of the Republic of Belarus was carried out scientific research work. We compared the results of operations of the extracardiac modification of total cava-pulmonary anastomosis in 59 children of different age groups. At the time of surgery, patients average age was 49.4 ± 14.0 months. The average body weight was 15.4 ± 3.0 kg. The patients were divided according to age into two groups. The first group included patients younger than 4 years, and the second group of patients older than 4 years.There were 32 patients in the first group. The average body weight of patients was 13.48 ± 2.29 kg. There were 27 patients in the second group. In this group the average body weight of the patients were 16.3 ± 3.0 kg. All patients were performed extracardiac modification of the operation of total cavo-pulmonary anastosis. The results of the study: In the early postoperative period in the first group the mortality rate was of 6.25%. And mortality in the second group was 22.2%. In both groups the most frequent complications were heart failure and paresis of the dome of the diaphragm. Acute heart failure was found in 26% patients of the first group, and 47.6% of patients of the second group. Paresis of the dome of the diaphragm was noted in 30% of patients of the first group and 38.9% of patients of the second group. These two complications significantly influenced the course of the early postoperative period. In the same period between the two groups were compared, the performance factor of inotropic support, duration of ventilation and duration of leakage from the pleural cavity. In patients of the first group factor inotropic support was 8.7 (5,0-10,0), and the average length of transudation from pleural cavities was 6 (4-8,5) days.In the patients of the second group factor inotropic support was 12 (7,2-12,8), and the average length of transudation from pleural cavities was 9.0 (5.0 to 13.0) days. Conclusion: Thus, it is possible to note that the early, postoperative results were satisfactory in children under 4 years old.

Rahul K. Bhardwaj has completed his medical education from Government Medical College, Amritsar (India). Currently he is second year Internal Medicine Resident at Mt. Sinai Hospital, Chicago

Thymic cancer is among one of the rarest malignancy found in humans and accounts for less than 1% of all neoplasms. A rare variant is the basaloid subtype which has approximately 12 reported cases in literature. Treatment of such a malignancy is aimed at complete resection, incomplete resection, or a combination of chemotherapy, radiotherapy and resection. A 65 year old woman presented with shortness of breath. Initial chest x-ray revealed a marked elevation of the right hemidiaphragm vs subpulmonic effusion. Patient was started on antibiotics and placed on continuous BiPAP. A CT chest without contrast revealed an anterior mediastinal mass measuring approximately 3.6 x 4.5 x 5.8 cm. The patient underwent biopsy, which provided an inconclusive differential of: thymoma (type B), thymic carcinoma and lung squamous cell carcinoma. A repeat CT scan with contrast showed the anterior mediastinal mass measuring 4.2 x 4.9 x 5.2 cm. CT surgery performed a median sternotomy and was able to incompletely (85%) remove the mediastinal mass. The resection was limited due to the mass encasing right phrenic nerve and the pulmonary vein. Biopsy results of the mass showed: Thymic carcinoma-basaloid carcinoma subtype staging T4NxMx. Post-operatively patient had numerous complications requiring vasopressor support, going into A.fib with RVR, and having a cardiac arrest. Considering the patient’s poor prognosis, her family decided for full withdrawal of support after which patient passed away. This case illustrates the poor prognosis observed in patients with incomplete resection of basaloid subtype of thymic cancer when other structures are involved

To be updated soon...

“Torsades de Pointes” (TdP) ventricular tachycardia carry a high risk of sudden death even when it occurs in patients with structurally normal heart. Ultra short-coupled ventricular extrasystole (<300ms) has shown to be a trigger for TdP. This was first described in 1994 by Leenhardt et al and is known as Coumel sign. Case We present a 65-year-old man with medical history of cocaine abuse and coronary artery disease (CAD); who had just received 4 vessels coronary artery bypass grafts a week prior to his presentation. He presented to an outside hospital with palpitations and dizziness after using cocaine. His symptoms were due to fast polymorphic ventricular tachycardia (VT) with a rate of 230 beats per minute. He received eleven direct current cardioversion treatments. He was initially started on Amiodarone, which was changed to Lidocaine later as he continued to experience VT while on Amiodarone. His cardiac catheterization showed occlusion of one his bypass grafts for which medical management was recommended. Lidocaine was stopped upon arrival to our facility as patient’s mental status was declining and Lidocaine toxicity was suspected. The following day, patient started experiencing episodes of TdP and required intubation due to hemodynamic instability. Careful telemetry review of his TdP events showed that short-coupled monomorphic ventricular extrasystole triggered each TdP episode. Patient was immediately started on Verapamil with resolution of his events. Meanwhile, patient was evaluated for implantable cardiovertor defibrillator, but he expired during his hospitalization due to sepsis. Decision-making Recognizing short-coupled ventricular extrasystole or Coumel sign as a trigger to TdP is crucial as it affects the patient’s management. Verapamil has been reported to be effective in managing patients with TdP with Coumel findings. Conclusion Short-couple variant of TdP has a high incidence of sudden death. It is very important to identify it and treat it promptly. Long term Verapamil treatment is effective but still insufficient and patients should be considered for implantable cardiovertor defibrillator therapy

Rohan Ravindranath completed his BSc. (Hons.) from the University of Toronto in chemistry and biotechnology. He is currently pursuing his MSc. in chemistry under the joint guidance of Professor Michael Thompson and Professor Alexander Romaschin at the University of Toronto and at St. Michael’s hospital. He has presented his past research at various local conferences and was recently awarded a best poster prize at the 2013 Astra Zeneca summer poster competition

Stenosis is a symptom of coronary artery disease (CAD), and is caused by narrowing of arteries in the heart. Over the past several decades, medical implants such as cardiac stents have been deployed in patients to counter stenosis. In patients with stent implants, narrowing of the artery can reoccur (restenosis) due to an immune response towards the implanted ‘foreign’ device. Restenosis is a major health concern for patients who have undergone heart surgery for CAD. Recently, there have been promising new approaches to combat restenosis. One such approach is to promote re-endothelialization of the implanted stent surface by capturing circulating endothelial cells in blood. This is hypothesized to help reduce the stent-induced immune response launched by the body. Our investigation involved developing a novel proof-of-concept cardiac stent, with the ability to bind endothelial cells. Steel coupons were coated with a self-assembled monolayer (SAM) made of benzothiosulfonate (BTS). Whole anti-human CD144 (VE-cadherin) antibodies were immobilized on the steel surface, which was then incubated in a cell culture of human umbilical vein endothelial cells (HUVECs) for several days, in vitro. The cells that bound to the steel were fixed and stained with fluorescently labeled anti-CD34. Using fluorescence microscopy it was evident that the cells were able to adhere and proliferate on the coated steel. These results demonstrate that re-endothelialization of the stent surface was induced

Hooman Rahmani , 40 years old , heart specialist from 2011 in Iran , I have been the first student in medical school in 1998 ( IRAN) , and been selected for medical Olympiad in the same year and had an article in OMIC & USA magazine in “ CHF” in 2012 . It is about 5 years that I am practicing in Iran and apart from working in my office , I am currently working with “ MOHEBE MEHR “ Hospital in Tehran and also with 3 other hospital as “on call specialist”.

Introduction Cardiovascular diseases are the leading cause of morbidity and mortality worldwide . About 30% of patients with heart failure develops anemia that increase the rate of morbidity and mortality. Previous studies have shown the beneficial effect of treating underlying anemia on prognosis , survival and decreased hospitalization rate and treatment costs. We studied the prevalence of anemia in patient’s condition. Method: We studied on 206 patients with chronic heart failure (CHF). These patients were randomly selected on Framingham criteria . Information was collected via questioner and patients were followed for 4 months. Patients were categorized to three different groups based on type of anemia, group one with normal hemoglobin level , group 2 with anemia of chronic disease, group 3 with iron deficiency anemia . All patients were optimally treated for heart failure . Patients with anemia of chronic disease received folic acid while patients with iron deficiency anemia were treated with iron sulfate. We compared the results of Ejection fraction, functional capacity, hemoglobin level and MCV before and after treatment. Result: The prevalence of anemia in our patients was 36.4% with 10.7% of patients had iron deficiency anemia and 25.7% had anemia of chronic disease. With increasing age , the prevalence of iron deficiency anemia decrease while anemia of chronic disease increase. Mortality rate in anemia group was 4.9 times higher comparing to patients with normal level . After treartment , there was significant increase in hemoglobin level that was more prominent in iron deficiencyanemia (IDA) group EF increasedin all group but it was more conspicuous in IDA group MCH and MCHC treatment in IDA group and chronic disease group while plantelet count significantly decreased in these two group after treatment.