Day 2 :
Cardiac Sciences IVY Healthcare, India
Time : 10:00-11:00
Executive Director and Head Cardiac Sciences
Is Founder Chairman of Cardiomersion, a global group promoting Integrated approach to comprehensive Cardiovascular care . He has keen interest in Off Pump Coronary Revascularisation , Minimally Invasive Cardiac Surgery and Regenerative therapy with 65 publications in reputed national and international journals including chapter in book . Having presented more than 100 papers in conferences across the globe, he been invited faculty in several international conferences and organized more than 200 workshops as well as several international conferences promoting integrated approach, innovative techniques ,promoting new technologies and exchanging skills with experts across the globe. He has worked as Assistant Professor in Postgraduate Institute of Medical Education and Research Chandigarh, Additional Director CTVS at Fortis Healthcare , Director CTVS at Max Healthcare and has been visiting surgeon at University of Maryland Baltimore ,Swedish hospital Seattle as well as Leipzig Heart Center Germany.
Cardiovascular diseases account for 17.2 million deaths worldwide every year. Cardiac patients frequently have several co-morbidities like Hypertension,diabetes mellitus, obesity,dyslipidemias, hypothyroidism, nephropathy, chronic bronchitis, peripheral vascular disease . Rapid advancement in surgical techniques and intensive care in the last few decades and the delivery of comprehensive care requires involvement of various allied specialties like endocrinologist, pulmonologist, nephrologist,nutritionist, physiotherapist apart from the Cardiologist,Cardiac surgeon and Cardiac Anesthesiologist . Despite best efforts global burden of cardiovascular diseases is constantly rising and prevalence of Heart failure patients is also on the rise. . Future prospects of improving cardiovascular health need focus to be shifted towards less invasive yet safe cardiovascular interventions with more emphasis on prevention as 80% of cardiovascular diseases are preventable.
We established the concept of Cardiomersion in 2011, promoting integrated approach to comprehensive Cardiovascular care. We have been organizing awareness campaigns for primordial prevention , cardiovascular risk evaluation and early control of modifiable risks by promotion of healthy lifestyle, timely screening and early diagnosis, Heart team approach to deliver treatment, scope for development of minimally invasive and endoscopic/ Robotic assisted telemanipulation and hybrid procedures ,high quality intensive care facilitating early recovery minimising complications as well as ICU and hospital stay with proper rehabilitation and follow up program.Integrated approach also includes judicious utilization of alternate and unconventional therapies like yoga ,aerobics, zumba and music to improve outcome.
We have adopted this concept in 8 hospitals in our region and the popularity is spreading globally .Global conferences are organized annually to exchange updates on the integrated management of cardiovascular diseases by utilizing technology available and future advancements that can reduce the morbidities and mortalities relate to cardiovascular diseases are discussed.
- Heart Diseases | Arrhythmia | Heart Stroke | Interventional cardiology | Heart Diseases Diagnosis and Treatment
Cardiac Sciences IVY Healthcare, India
Bangabandhu Sheikh Mujib Medical University, Bangladesh
Dr Mohammad Abdul Matin, after completing graduation (MBBS) in 2005 dedicated him for higher education in Cardiology and completed post-graduate diploma in Cardiology (D-Card) in 2009 from Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and become one of the youngest cardiologist of the country at the age of 30 years only. Then entered in Govt. services and involved in emergency medical services ant gathered a lot of experiences. To achieve more knowledge in Cardiology he entered in postgraduate fellowship course (MD Cardiology) in National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh and achieved MD Cardiology in January 2017 which is considered as highest postgraduate degree in Bangladesh. Within these periods of service and fellowship course he gathered a lot of experience in different discipline of Cardiology mainly in transradial coronary intervention. He is now working as consultant Cardiologist and also involved in research work.
Background: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular Doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population. Objectives: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. Methods: This cross-sectional analytical study was done in the Department of Cardiology, NICVD from July-2015 to June-2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular Doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on Doppler study. Univariate and multivariate logistic regression analysis were done to evaluate the predictors of RAO. Results: On the day after the procedure, radial artery Doppler examination revealed RAO in 12 (09.6%) patients. On univariate analysis female gender (p= 0.038), diabetes mellitus (p= 0.024), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.003) were identified as predictors of RAO. Interestingly hypertension, low BMI, smaller radial artery diameter and use of reprocessed sheath were not identified as predictors of RAO. On multivariate analysis diabetes mellitus (p= 0.016), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.004) were found as independent predictors for RAO. Conclusion: Frequency of RAO was 09.6% after coronary procedure through TRA. Diabetes mellitus and hemostatic compression after sheath removal for more than 02 hours were identified as independent predictors of RAO. Strategies should be taken from patient selection for TRA to end of hemostatic compression removal to prevent RAO.
Frantz Fanon Hospital University, Algeria
Acute total occlusion of the left main (LM) is rarely encountered in the cathlab, its incidence is difficult to determine because most often fatal. This is a frightening situation where there is a paucity of data and that we might be led to meet.
We report 4 cases of total occlusion of the left main revealed by an acute coronary syndrome observed between the year 2015 and 2016 in our cathlab
The age of patients was between 29 and 72 years with tobacco as a common risk factor; three patients were admitted for NSTEMI at high risk and two for STEMI, one of whom was thrombolysed with failure. Of the 5 patients 3 presented in shock. The delay for revascularization was between 1 hour and 5 hours for the first four patients, this delay was
26 hours for the last one. The EKG of our patients was characterized by a labile aspect from one patient to another, the ST segment elevation in AVR was observed in all the patients. Only one patient had an LVEF altered at the echography. In the first three patients, coronary angiography showed a completely occluded LM (TIMI 0, RENTROP 0), (figure 1) they underwent instrumental thrombectomy under anti-GPIIbIIIa treatment with restoration of a satisfactory coronary flow at a first step, a delayed angiographic control of 48 hours showed a coronary arteries without significant lesion in one patient while the two others underwent angioplasty (figure 2). The fourth patient had a complete occlusion of the LM, a dominant RCA with a tight stenosis on its second segment overtaking the LAD (RENTROP II), an urgent surgical revascularization was performed for this patient (figure 3). For these first four patients the evolution was favorable. The fourth patient illustrates the severity of this lesion, the patient came late to our level after the failure of thrombolysis where coronary angiography revealed an occluded LM without collaterals (REnTROP 0), thrombo-aspiration associated with anti GpIIbIIIa therapy could restor a TIMI III flow but a bad LAD artery, alas he continued to degrade its cardiac insufficiency leading to the death at the 5th day of hospitalization (figure 4).
For this type of lesion angioplasty is a saving option; the prognosis is generally related to the right or left dominance, the development of collateral circulation and especially the celerity of revascularization. Delayed stenting seems to appear safe in order to reduce the risk of embolization and no reflow. Surgical revascularization is a reasonable attitude when the patient is stable with a low operative risk.
MGR medical university, India
Dr.Srinivasa Kumaran, has passion in both adult and paediatric cardiac surgery. Graduated from Dr. MGR medical university in the year 2006 and has 7 years’ experience in general surgery and 3 years’ experience in cardiothoracic surgery.
Statement of the Problem: Prosthetic valve thrombosis is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The incidence of prosthetic valve thrombosis varies according to the following variables: efficacy of anticoagulation; type and location of the implanted prosthesis; and presence of atrial fibrillation. Obstruction of the prosthesis is more frequent during the first postoperative year. The clinical findings vary from lack of symptoms to extreme cases of cardiogenic shock. The most common symptoms are progressive dyspnea on exertion, lipothymia, and syncope. Systemic embolism and acute pulmonary edema may also be the first manifestations of the disease. For any given patient, the risks of thrombolytic therapy, including bleeding, systemic embolism, and failure to restore valvular function, must be weighed against the risks of surgical intervention. Once the decision is made to operate, the choice of valve replacement versus debridement is best made intraoperatively, upon visual inspection of the valve apparatus. We report a case of a perimenopausal woman who underwent mitral valve replacement 4 years back presenting with symptoms of congestive cardiac failure. The patient was diagnosed with valve thrombosis from a transthoracic echocardiogram and underwent valve replacement. The relevant literature is reviewed.
University of Jember, Indonesia
Agung Anugerah is currently studying medicine in Faculty of Medicine, University of Jember. Interested in agromedicine and public health subject drives him to progressively learn toward particular subject. He is also interested in human rights issue especially in medical settings. He has conducted several training session at his university or in national scale with him being the trainer, therefore he is skilled in public speaking and conducting an oral presentation. He active writing scientific paper recently and passionate to learn more about scientific thinking, scientific writing, and progress in the scientific world.
Statement of the Problem: Cardiovasular disease hold the title for the biggest public health burden worldwide. It accounts for 17.3 million deaths each year and continuously increasing. Atherosclerosis is the leading pathological cause among millions of cardiovascular disease happened. Preventive measure must be taken to decrease atherosclerosis induced cardiovascular disease. A study from America reveals America has halved it’s cardiovascular incident in 20 years and 79% of the reduction is due to primary prevention. Methodology & Theoretical Orientation: A literature study was utilized on understanding the effect of coffee toward atherosclerosis progression and determining the strategic intervention to promote cardiovascular health, particularly about atherosclerosis. Findings: Coffee is infamous with it’s caffeine, which cause adverse impact on cardiovascular health. But coffee also contain a lot of cardioprotective substance like phenol, vitamin B3, magnesium, kalium, and fiber. An in vivo study in periodontitis rat model reveal that coffee halt and decrease atherosclerosis progression though increase in intima media thickness and density, also reduction in stenosis, fat deposition, and endothelia disintegration. Proving that the net effect of coffee as a whole is cardioprotective. Furthermore, caffeine and diterpenes substance can be removed through filtration. Consuming one to four cups of coffee each day is safe. Coffee is the most consumed drink, second only to water. While coffee is familiar worldwide, it’s strategic to promote cardiovascular health by promoting health coffee consumption. It’s also important to emphasize the overall effect of coffee, especially in countries where coffee consumption is decreasing. Coffee is identical with lifestyle, so, spreading the message through media influencer will more likely to develop impact. Conclusion & Significance: Emphasizing coffee as a lifestyle which is also an preventive measure from atherosclerosis-induced cardiovascular disease at the same time is strategic because it’s already known widely, so it’s likely to also be accepted widely.