Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd International Conference on Cardiovascular Medicine and Cardiac Surgery Golden Tulip Berlin – Hotel Hamburg.

Day 2 :

Keynote Forum

Alicja Jozkowicz

Jagiellonian University, Poland

Keynote: Nrf2 and Keap1: A quintessential duet in endothelial cells

Time : 09:00-09:30

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Alicja Jozkowicz photo
Biography:

Abstract:

Nrf2 is a transcription factor known to modulate blood vessel formation. Various experimental settings, however, attribute to Nrf2 either stimulatory or repressive effects on angiogenesis. Our findings unveil the mechanism of Nrf2-dependent vessel formation, which reaches beyond transactivation of gene expression and reconciles previous discrepancies. We evidence that GDF-15- and SDF-1-induced angiogenesis strongly depends on the presence of Nrf2 protein, but does not rely on its transcriptional activity. Instead, Nrf2 serves as a protein restraining Keap1, its known transcriptional repressor. Angiogenic response is abrogated in Nrf2-deficient endothelial cells but not in cells expressing dominant negative form or Keap1-binding fragment of Nrf2. Deficiency of Nrf2 protein available for Keap1 leads to the overabundance of RhoGAP1, the protein regulating Cdc42 activity. This impairs podosome assembly and disrupts actin rearrangements, thereby preventing angiogenesis. Effects of Nrf2 deficiency can be rescued by concomitant knock down of RhoGAP1 or Keap1. Importantly, in the established murine model of Nrf2 deficiency, the N-terminal fragment of Nrf2 containing Keap1 binding domain is preserved. Thus, this model can be used to characterize Nrf2 as a transcription factor, but not as a Keap1-sequestering protein. Up to date the significance of Nrf2 in cell function has been ascribed solely to regulation of transcription. We demonstrate that Nrf2 serves a protein tethering Keap1 to allow podosome assembly and angiogenesis.

Keynote Forum

Sekib Sokolovic

Sarajevo University, Bosnia and Herzegovina

Keynote: Cigarette smokers and arterial stiffness

Time : 09:30-10:00

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Sekib Sokolovic photo
Biography:

Sekib Sokolovic is a Professor of Internal Medicine at Medical Faculty of Sarajevo University and Cardiologist at Sarajevo University Clinical Center. He is a European Hypertension Specialist and Director of National Training in Cardiology and Director of the Excellence Center in Arterial Hypertension. His expertise is arterial stiffness, vitamin D, arterial hypertension, microcirculation and pulmonary arterial hypertension. He is an invited speaker worldwide and key speaker as well.

Abstract:

Introduction: The correlation between the arterial stiffness and tobacco users has been verified in a clinical study. Increased arterial stiffness contributes to increased vascular calcifications and atherosclerotic disease and all cardiovascular mortality. Cigarette smokers contribute to 6 million deaths per year globally. Measurement of the arterial stiffness has been recommended in the ESC/ESH guidelines for the arterial hypertension.
Material & Method: In order to evaluate the arterial stiffness, the measurement of aortic pulse wave velocity, (APWV),
augmentation index (AI), stroke volume, (SV), the reflection gradient (RC) was performed using Agedio Arteriograph. The estimation of cardiovascular risk factors was performed in all examined patients and two groups were formed. One group included smokers and the other one non-smoker healthy subjects. The open outpatient controlled prospective study has been designed. The cardiovascular others risk factors were evaluated in all.
Results: Preliminary results obtained have shown the significant increase in APWV, augmentation index and reflection index in smokers group compared to normal arterial stiffness values in non-smokers.
Conclusion: These preliminary results have shown that arterial stiffness has been significantly increased in a smoker group whereas the average vascular age has been increased. This finding is additional evidence for the cigarette smoking as risk factor for early vascular pathophysiological changes. The measurements of these parameters are necessary for the cardiovascular risk disease prevention.

Conference Series Cardiovascular 2018 International Conference Keynote Speaker Marco Picichè photo
Biography:

Marco Picichè (MD, Ph.D.) graduated with a degree in medicine from the University of Florence in 1995 and completed his cardiac surgery residency at the Tor Vergata University of Rome in 2000, both summa cum laude. He held regular teaching appointments at the university of Montpellier school of medicine, obtained certification by the French Board in cardiac surgery (Paris, 2007), earned his research master in surgical science (Paris, 2007), and received a university diploma in vascular surgery (Paris,2007). In May 2009 he had the honor of opening the 44th Congress of the European Society for Surgical Research with a lecture on ‘‘The history of surgical research.’’ In September 2011 he received a doctor of philosophy (Ph.D.) in therapeutic innovations from Paris-Sud University. He is the Editor in Chief of the book : « Dawn and evolution of cardiac procedures : research avenues in cardiac surgery and interventional cardiology » (Springer-Verlag publishing house, September 2012). He patented a new surgical instrument. Currently he is a cardiac surgeon in Italy.

Abstract:

No one knows the true incidence of refractory angina, but it is generally agreed that there are thousands new cases annually. The incidence will presumably increase with the increase of average age. Patients suffering from refractory angina are known as no-option, because they are not amenable to coronary artery bypass grafting or percutaneous coronary interventions. The main reason to be unamenable to conventional revascularization techniques is a diffuse coronary disease, and secondarily comorbidities.
Several alternative methods have been advocated, such as stem cell therapy, external counter-pulsation, laser transmyocardial revascularization sympathectomy, partial occlusion of the coronary sinus, shock wave myocardial revascularization. The internal mammary artery (IMAs) has the potential for developing collateral branches under some circumstances. This was the basis for an old operation performed in the 1940s, i.e. the tunnellization of the IMAs in to the left ventricle free wall.

  • Special Session
Location: Hall - Sylt 3
Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany. From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Abstract:

Objectives: Heart transplantation is the last surgical option for infants and young children with congenital heart failure after failed conventional repair or palliative procedures. We aim to present our results in a retrospective and descriptive analysis.
Methods: 18 heart transplantations on children (nine female, nine male) were performed from 1988 to 2015. The range of age was between 0 days and 3 years. Indications for a transplantation were hypoplastic left heart syndrome (n=14), non-compactionsyndrome (n=2), Bland-White-Garland-syndrome (n=1) and transposition of the great arteries (n=1). 14 children (78%) had had a previous cardiac surgery. Four patients (22%) required mechanical circulatory support for bridging: ECMO (n=2; 11%), or LVAD and ECMO (n=2; 11%). 15 (83%) underwent a biatrial method, three (17%) a bicaval one.
Results: The median waiting time after listing was 68 days (min: 0 days, max: 386 days, standard deviation (SD): 102.8 days). The overall survival was 61%, 13 children (72%) survived the first year. Two patients (11%) had a retransplantation. The median time patients spent at intensive care unit was 17 days (min: 1 day; max: 121 days). They were respirated for seven days (min: 1 day; max: 91 days). Perioperative factors we analyzed were: the median myocardial ischemia time was 236 minutes; the median aortic clamp time was 95 minutes and the median time of circulatory arrest was 60 minutes. Three children (17%) got a pericardial effusion. Two patients (11%) suffered each: bleeding, cardiac arrhythmias, diaphragmatic paresis and cerebral complications. Five (28%) got a lymphoproliferative disease. Seven children (39%) got a coronary graft vasculopathy. Two (11%) needed interventional therapy. Three (17%) got a cardiac pace maker. According to our data, six children had a rejection which called for treatment.
Conclusion: Heart transplantation is still the best therapeutic option after end-stage heart failure in children. Cumulative results suggest one additional year of life in more than 70% and a survival of more than 20 years are possible. These results were comparable to those of the ISHLT registry in pediatrics.

  • Cardiac Neurodevelopment | Case Reports on Cardiac Surgery | Arrhythmias | Heart Failure
Location: Hall - Sylt 3
Speaker

Chair

Marco Picichè

San Bortolo Hospital, Italy

Session Introduction

Prerana Banerjee

University Hospital Basel, Switzerland

Title: Off-pump aortic valve bypass to treat severe aortic stenosis
Biography:

Prerana Banerjee has gained her experience in Cardiac Surgery. Her interest and work in different hospitals in Switzerland allowed her to witness various operation techniques. During residency with PD Dr. O. Reuthebuch she learned about the alternative technique for treating severe aortic stenosis.

Abstract:

Majority of patients suffering from aortic valve stenosis are treated by aortic valve replacement or via transcatheter aortic valve implantation. However, a subset of patients having severe comorbidities, such as renal insufficiency, severely impaired ejection fraction, bicuspid aortic valve, large aortic annulus, ostial encroachment, redo-operation as well as severely calcified porcelain aorta, have a relevant periprocedural risk. For this patient cohort an alternative treatment, aortic valve bypass (AVB) with placement of a valved fabric graft between the left apex and descending aorta, is considered. Though already developed in the early 1960’s surgical acceptance was low due to the lack of appropriate instruments and the need for cardiopulmonary bypass (CPB). However, with the development of a coring device (Correx, Inc., Waltham, MA, USA) these impediments have been overcome. We report on a 72-year-old male patient suffering from severe low-flow-low-gradient aortic valve stenosis (left ventricular ejection fraction 20%, mean pressure gradient 26 mmHg, valve orifice area 0.7 cm2). Clinical symptoms were those of congestive heart failure. Previously the patient had undergone balloon valvuloplasty without major improvement. On the basis of concomitant mutilating diagnosis the patient was rejected for conventional surgery and transcatheter treatment. Thus AVB was suggested. The AVB consists of two components (a straight valve-containing conduit with a porcine valve and an angled left ventricular connector) and bypasses the blood flow via the left ventricular apex into the descending aorta. Perioperative course of our patient with implantation of the AVB without CPB was uneventful as was the
postoperative course. A magnetic resonance imaging of the heart on the fourteenth postoperative day demonstrated 55% of the cardiac output passing via the conduit (2.6 l/min was measured in the descending aorta, 2.1 l/min in the ascending aorta). We recommend off-pump AVB in patients with severe aortic stenosis when other therapy options are ruled out.

Eva Delmo Walter

Cardio Centrum Berlin, Germany

Title: VAD in children with heart failure
Biography:

Abstract:

Biography:

Maadarani Ossama is trained in both Cardiology and Intensive Care Medicine. He developed a major interest in the application of whole body ultrasound and echocardiography in the critically ill. He developed modern protocols in daily use of ultrasound and echocardiography in intensive care unit. He has published number of publications in field of ultrasound in Intensive Care Medicine.

Abstract:

Background: Echocardiography and lung ultrasound are important tests for assessing left ventricular function in patients presented to the emergency department with acute pulmonary edema. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema.

Aim: To investigate the relationship between the B profile on ultrasound chest and spectral tissue Doppler echocardiography (E/e’ ratio) in patients presented with the suspicion of acute pulmonary edema. Methods: This paper reports a prospective observational study of 61 consecutive patients, which was presented with symptoms and signs of pulmonary edema and B-profile detected by echocardiography with a 5 MHz curvilinear probe. Critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. Results: Sixty-one participants were included in the study. Forty-seven of the 61 patients had a B-profile and 14 patients had an A profile. The mean E/e’ level in the patients with B-profile was 20.8, compared with the mean level in the patients with an A-profile of 8.2 (CI=0.33–0.82). The distribution in the two groups differed significantly (p=0.003). Based on the value of E/e’, the sensitivity and specificity were determined; the sensitivity of B profile on ultrasound was 92% (95% confidence interval (CI)=0.812–0.968), and the specificity was 91% (CI=0.623–0.98). The positive predictive value of the B-profile was 97% (CI=0.889–0.996), and the negative predictive value was 71% (CI=0.454–0.883). The systolic function in the subjects with a B-profile was below 50% in 74.3% of the subjects and normal in 25.7% of the subjects. All the subjects with B profile and systolic function >50% had elevated ProBNP and E/e’ >15. An A-profile subjects had systolic function >55%. 

Conclusions: Detecting the B-profile in lung ultrasound is highly sensitive and specific for elevated left ventricular diastolic pressures, regardless of the systolic function of the left ventricle which may help in diagnosing pulmonary edema.

Bin Liu

The Second Hospital of Jilin University, China

Title: Comprehensive strategy to deal with chronic total occlusion
Biography:

Bin Liu is the Director of the Cardiovascular Department of the Second Hospital of Jilin University. He has his expertise in Interventional Cardiology, especially in Chronic Total Occlusion. He is the Fellow of European Society of Cardiology, the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions Foundation. He is also a Member of APHA, Director of Committee of Cardiology Section of the Jilin Province Medical Association.

Abstract:

Statement of the Problem: Coronary chronic total occlusions (CTOs) are common during diagnostic angiograms. Comprehensive application of various strategies can improve the success rate. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of left anterior descending artery (LAD) and right coronary artery (RCA) CTO that was successfully revascularized using complex strategy. Methodology & Theoretical Orientation: A 63-year-old man with two times of myocardial infarctions was presented with new onset angina and dyspnea at rest. Angiography showed that LAD and RCA CTO, proximal LCX had a serious stenosis. RCA PCI was attempted using an antegrade approach. This approach was unsuccessful due to branch vessel nearby the occlusion and the wire got into the branch repeatedly. As a result, we used a balloon to expand the entrance of the branch in order to extrude the CTO lesions, the wire gets through the occlusion and the RCA had a successful reperfusion. RCA supplied obvious retrograde vessels to LAD, but from the retrograde, the nub of CTO was flat and the wiring process failed. Then the strategy was changed from retrograde to antegrade. Retrograde wire showed a good milestone. Finally, LAD had a successful reperfusion. At follow-up, the patient was asymptomatic and returned to her usual activity. Conclusion & Significance: Side branch technique is an important method to antegrade strategy for CTO. Also, antegrade and retrograde should be used together to increase the success rate.

  • Pediatric Cardiology | Case Reports on Heart Devices | Cardiac Nursing and Healthcare
Location: Hall - Sylt 3
Speaker

Chair

Ihor Huk

Medical University of Vienna, Austria

Session Introduction

Muhammad Azam Shah

King Fahad Medical City, Saudi Arabia

Title: Left Atrial Appendage (LAA) Closure with Double WATCHMAN Devices; A case report
Biography:

Muhammad Azam Shah is working as Non-Invasive Cardiologist at King Fahad Medical City, Riyadh, Saudi Arabia. He has special interests in research and is currently working on multiple projects. Echocardiography is his area of specialty. He has presented abstracts and posters in multiple scientific meetings.

Abstract:

The risk of cardioembolic stroke is high in patients with atrial fibrillation. Antiplatelet agents, vitamin K antagonists and new oral anticoagulants (NOACS) are effectively used to reduce the risk of thromboembolism in high-risk patients. However, increased risks of life-threatening bleeding and narrow therapeutic indexes result in inadequate utilization of these therapies. There is growing practice and shreds of evidence in favor of closing left atrial appendage (LAA) percutaneously, using different devices in patients with either contraindicated or difficult anticoagulation. We are reporting a rare case of an old male with atrial fibrillation, high thromboembolic risk (CHADSVASc sore 4) and high bleeding risk score (HASBLED score 4). He underwent LAA closure using two LAA percutaneous closure devices (WATCHMAN) due to bi-lobed LAA. Considering a great variability in the shape and size of LAA, sometimes, a single device may not cover the whole ostium, leading to residual leaks, which can lead to nidus for thrombus formation. Although it technically sounds feasible but there are few challenges associated with double device implantation. Sealing of bi-lobed LAA is technically possible especially with favorable anatomy, which includes totally separated bodies of both lobes with adequate body sizes.

Biography:

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany.  From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Abstract:

Introduction: Due to an increasing waiting time for available donor organs in pediatric heart transplantation (pHTx) ABOincompatible HTx (HTxi) may be a satisfying option and probably an unpreventable one. There is an immunological window of tolerance during the human embryonic development which persists into the time of infancy. It has the potential of developing natural antibodies to ABO-antigens. This process plays a significant role in ABOi organ transplantation and could maintain long-term tolerance to a certain degree in the setting of HTxi.

Methods: This systematic review and meta-analyses aims at providing an overview of the reported outcome of infants and small children with end stage heart failure after undergoing an HTx. A systematic literature search for publications reporting the outcome after pHTx published between 2001 and 2017 was conducted. Studies written in English with a study size of more than 10 patients were included. The primary outcome was mortality at HTx-listing and one year after ABO-compatible HTx (HTxc) or HTxi. Exploratory data analysis of four studies was analyzed. Two types of model (fixed effect model and random effect model) were represented. Primary outcome measure was all cause mortality or delisting on the HTx list. Results: Total mortality on HTx list in all groups was: I2=89.9%, 95% CI=64%, 99.3%. Delisted from HTx list because of recovering or worsening of clinical status before HTx: I2 =72.6%, 95% CI=16.8%, 97.5%. HTxc: I2 =99%, 95% CI=97.3%, 99.8. 12 months survival after HTx was: I2= 87.5%, 95%CI =56.1%, 99.1%. 86% of the patients survived 12 months after HTx in average with a 95% confidence interval of 0.84, 0.88.

Conclusion: HTxi is a good option with similar results compared to HTxc in infants. It might avoid the long waiting time and minimizes the risk of death on the waiting list. However, long-term results are yet to be determined, as well as complications and risks. Aspects such as renal function, infections, graft vasculopathy, the risk for malignancy and chronic rejection after HTxi remain to be examined closely.

Biography:

Abstract:

Background: Neutrophil extracellular traps (NETs) have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs). NET formation involves histone modifications such as citrullination allowing for DNA decondensation and DNA release into extracellular space. NETs have been detected in the adventitia and intraluminal thrombus (ILT) of AAAs and the associated proteins have been proposed to promote the inflammatory reaction that drives aneurysm development. Purpose: Our study has addressed the notion that NET components might serve as AAA biomarkers or novel targets of AAA therapy.

Methods: Parameters of neutrophil activation as well as NET formation were determined in blood and tissue samples collected from 40 AAA patients (scheduled for surgical repair) and 40 healthy controls matched for age, sex, body mass index and smoking habit. Neutrophil and NET components were determined by ELISA in patient plasma or conditioned medium of resected tissue. NETs were visualised in aortic wall and ILT by immunofluorescence microscopy. In a model of AAA formation based on angiotensin II administration to ApoE null mice, inhibition of NET formation was tested by applying a citrullination blocker. Results: Among the tested parameters of neutrophil activation and NET formation, citrullinated histone H3 was found to be significantly increased in blood (median 362 vs. 309 ng/ml; p=0.004) and aortic tissue (50.9 vs. 3.7 ng/mg; p=0.001) of AAA patients compared to healthy controls. Furthermore, NETs were highly prevalent in the intraluminal thrombus (corresponding to 642.3 ng citrullinated histone H3 per mg ILT). Plasma levels of citrullinated histone H3 decreased significantly after surgical repair. In vivo application of a citrullination inhibitor significantly reduced the capacity of mouse neutrophils to undergo NET formation. Furthermore, when aneurysm formation was initiated by angiotensin II application, disease progression was prevented in mice treated with the NET inhibitor (N=5) as compared to controls (N=5; p=0.014).

Conclusions: Histone citrullination which occurs during the formation of neutrophil extracellular traps was revealed as a biomarker of AAA formation and a potential therapeutic target to control aneurysm progression in established disease (as would be required for clinical application).

Biography:

Rostislav Belobrov is Senior Nurse at Cardiology Intensive Care Unit of Wolfson Medical Center and a student for Magister of Public Health at Tel -Aviv University.
 

Abstract:

Statement of the Problem: Patients, which arrive to the hospital with ventricular arrhythmia due to the different causes, in most cases are getting loading dose of intravenous amiodarone. The most common side effect of intravenous amiodarone is thrombophlebitis of intravenous access. Central venous line causes much less thrombophlebitis, but complications of central venous line exceed the peripheral vein access. This pilot study is aimed to find association between the use of larger size peripheral vein cannula and decreased of thrombophlebitis. Second goal of this pilot study is to define the variables which are associated with incidence of thrombophlebitis.

Methodology: Observation prospective pilot study was conducted in Intensive cardiac care unit of single medical center during one year. 53 patients were prescribed to get intravenous amiodarone due to medical indication. Eight patients were excluded from the pilot study due to comatose state or use of central vein line. For 45 patients, information about peripheral I.V. cannula was obtained, including place, size (18 gauges or 20 gauges), and time of event of thrombophlebitis, if appeared. Additional clinical information was collected from medical records. Kaplan-Meier method and Breslow test were used to find significance between time to event of thrombophlebitis for two sizes of I.V. cannulas. Cox proportional hazard model was used to find the variables, which could be associated with the event of thrombophlebitis.

Findings: According to Breslow test, 18 gauge I.V. cannula has significant longer time without thrombophlebitis (χ²=4.717 p=0.03 18G median time to event 32.5 h CI 95%: 10.6-54.4, 20G median time to event 20.0 h CI 95%: 18.6-21.4). According to Cox proportional hazard model, adjusted for I.V. cannula size, each BMI unit and female gender were associated with more thrombophlebitis events.

Conclusion: In order to prevent thrombophlebitis, using large sized I.V. cannula is preferable for intravenous amiodarone administration, especially in overweighed and female patients.

Biography:

Mirela Anca Stoia has her expertise in cardiovascular investigation and diagnostics, based on Cardiology, Internal Medicine and European Fellow in Angiology specializations. She is working in an Emergency Clinical University County Hospital and promoting an integrative medicine, she is implicated in evaluation of atherosclerotic patients in order to assesses the screening and the hierarchs of the multisite arterial lesions for an adequate management in patients undergoing non-cardiac, particularly vascular surgery, in the cardiac patients with other comorbidities association care and in the emergencies cardiac assistance. As an Assistant Professor she teaches Cardiology, Echocardiography, Vascular Ultrasonography and Internal Medicine to medicine students and to residents. Her research interests are related to multidisciplinary cardiology, imaging exploration, biomarkers in cardiology. Her algorithm which identified significant coronary and cervical arterial lesion in patient with critical leg ischemia, from a long experience with many investigated patients, is practical, accessible and applicable.

Abstract:

Statement of the Problem: Patients with peripheral artery disease (PAD) have multisite arterial lesions especially in coronary and cervical arteries, often less symptomatic and diagnosed, which increase dramatically the mortality through myocardial infarction and stroke and the duration of hospitalization, especially after vascular surgery. The purpose of this study was to assess the role of an overall cardiac and arterial screening, including non-invasive and invasive investigation, revealing the role of more accessible examinations, in order to estimate the perioperative cardiovascular risk and to define the therapeutic strategy for revascularization.

Methodology & Theoretical Orientation: We studied 142 patients with critical leg ischemia (CLI) scheduled for vascular surgery. The history, clinical examination, cardiovascular risk factors (CVRF) profile and systematic ECG examination of these patients looked for suspected atherosclerotic lesions in coronary and cervical arteries beside the symptomatic peripheral arterial territory. In patient presented acute coronary syndrome in the last six months or Eagle score >2, the coronary angiography was performed systematically. In all patients cervical arterial ultrasonography and in selected patients, cervical arterial angiography was performed.

Findings: More of 50% of CLI patients had multiple CVRF. We find significant coronary and/or cervical arterial lesions in 44.4% of the investigated subjects. Hemodynamic significant coronary arteries stenosis >70% were diagnosed in 29.6% and hemodynamic significant cervical stenosis >70% or carotid thrombosis were diagnosed in 11.8% of patients with CLI. The clinical and imagistic non-invasive algorithm selecting patients with CLI and significant stenosis in the coronary and/or arterial cervical territories was confirmed through invasive angiography evaluation in 69.1% of cases.

Conclusion & Significance: Demonstrating the multisite arterial lesions profile in patients with CLI and with significant stenosis in coronary and/or cervical arteries changes the treatment strategy and management. In these cases, medical therapy should be more intensive and revascularization interventions in coronary and cervical arteries might precede peripheral arterial revascularization procedures. 

Biography:

Jong-Hau Hsu M.D. is a professor of Pediatrics in Kaohsiung Medical University in Kaohsiung, Taiwan. He is also the director of pediatric cardiology and pediatric intensive care unit in Kaohsiung Medical University Hospital, and the vice director of school of medicine of Kaohsiung Medical University. As a pediatric cardiologist and intensivist, his current research interests focus on biomarker of pediatric intensive care and novel pharmacologic targets on regulation of pulmonary circulation and ductus arteriosus patency.

Abstract:

The ductus arteriosus (DA) is an artery indispensable in fetal circulation. PDA is a major cause of morbidity and mortality in premature infants, whereas persistent PDA is life-saving in newborns with DA-dependent CHDs. Therefore, elucidating molecular mechanisms underlying regulation of DA patency is an important field of vascular biology and translational research of pediatric cardiology. DA closure is a complex process including two mechanisms: functional and anatomical closures. Functional closure is a transient response mediated mainly by vasoconstriction caused by abrupt increase of oxygen tension and postnatal withdrawal of vasodilatory PGE2. Anatomical closure is a constitutive process of luminal obliteration characterized by intimal thickening, resulting in progressive DA vascular remodeling and permanent DA closure. Current clinical approach for management of DA patency is mainly targeted on the PGE/cAMP pathway. However, recent studies have shown that PGE can promote DA remodeling through EP4 receptor while maintaining DA vasodilation. Therefore, novel pharmacologic strategy regulating vaso-reactivity and remodeling would be helpful for management of functional and anatomic closure of DA. The purposes of this talk are to review the complex mechanisms regulating DA patency, and share our translational research of novel pharmacologic targets, including BNP, cGMP pathway and Notch signaling. An improved understanding of the mechanistic pathways regulating DA patency may yield novel or additional therapeutic strategies for patients with PDA and DA-dependent CHDs.

Biography:

Volodymyr Isaienko was born on October 07, 1961, in the Kyiv, Ukraine.Education: higher, Kyiv Medical Institute named O.O. Bogomolets, medical faculty in 1984 Academic rank, scientific degree: associate professor (2013), PhD (2005). Total work experience - 33 years, in this institution - 17 years. Labor Path: After education in the Kiev Medical Institute named O.O. Bogomolets in 1984, worked as a surgeon in the Kyiv’s clinic № 1 until 1988. From 1988 to 2001 worked in the National Institute of Cardio-Vascular surgery named N.M. Amosov of the Academy of Medical Sciences of Ukraine as doctor-surgeon. V. Isaenko has a higher qualification category in the field of "Surgery of the heart and main vessels. He defended in 2005 his Ph.D. thesis on the topic: "Surgical correction of mitral valve lesions in infectious endocarditis". Since 2001, V. Isaenko works as an assistant, since 2012 to present - Associate Professor of the Department of Cardiac and main vessels surgery at the National Medical Academy of Postgraduate Education named P.L. Shupik, existing on the base of the National Institute of Cardiovascular Surgery named N.M. Amosov AMS of Ukraine. Associate professor received his academic title in 2013. V. Isaenko is the author of more than 125 scientific articles on various aspects of cardiac surgery, has 12 author's certificates for inventions. V. Isaenko is the member of the Association of Cardiovascular Surgeons of Ukraine.

Abstract:

Material & Methods: In the N M Amosov National Institute of Cardiovascular Surgery of the Academy of Medical Sciences of Ukraine for the period from 1.01.1969 to 1.01.2018. 916 interventions were performed in heart tumors. Heart myxomas were found in 818 (89.3%) cases, of which 718 (87.8%) are myxomas of the left atrium. The age of patients with myxomes was 3 to 78 years (on average 47.5±3.4 years). The embolic syndrome was detected in 44 (5.4%) cases with a heart myxomas, of which 35 (4.1%) patients were in the cerebral vessels. The most traditional access through the right atrium and the interatrial septum was used in 543 (75.6%) cases with a myxomas of the left atrium, tumor fragmentation was observed in 109 (20.1%) cases. At the same time, an important stage of the operation is an adequate dissection of the interatrial septum. Analysis of the attachment of the left atrial myxoma to the interatrial septum in 124 patients showed that 66 (53.2%) had the tumor base in its middle third. In 45 (36.3%) cases the place of tumor fixation is the lower third of the interatrial septum. And only in 13 (10.5%) patients the upper third of the septum was affected. This is the safest site of introduction through the interatrial septum, and for the subsequent visualization of the tumor's foundation, which became the basis of our methodology.

Results: In 91 of 93 patients, the use of the new technique allowed the safe detection and isolation of the leg of the myxoma. The frequency of fragmentation of the tumor upon its removal decreased to 2.2%. The need for emergency surgery is proved, which reduces the threat of hospital preoperative mortality. Over the past 17 years, 455 operations have been performed without fatalities. Survival in the period up to 20 years was 79.7%. Relapses of myxogma were found in 16 (2.1%) patients in the period from 2 to 12 years after the initial operation.

Conclusions: With the most frequent localization of the myxoma in the left atrium, it is expedient to eliminate the myxoma by accessing the right atrium and the interatrial septum with an improved method of manipulation on it, with the subsequent possibility of switching to alternate atrial access to prevent fragmentation of the tumor.