Middle East Heart Congress March 18-20, 2019 Barcelona, Spain

Samah Alasrawi is a Pediatric Cardiologist at Al Jalila Children’s Specialty Hospital since three years after graduating from Damascus University, Syria, followed by a Master’s degree in Pediatric Cardiology. Besides having worked in numerous private hospitals in Damascus as a Consultant Pediatric Cardiologist, she also had a private practice with clinical and research interests in congenital heart diseases, pulmonary hypertension, cardiomyopathies and arrhythmias in children. She has 7 articles published in 2018.

The diagnosis of cardiac disease is not always straightforward because physical examination, ECG, and CXR are oft en diffi cult to interpret in the newborn period compared to older infant or child. Although echocardiography is required to precisely defi ne the anatomical abnormality, it is usually possible to defi ne the functional abnormality on the basis of the clinical and radiographic fi ndings.

Th e timing of presentation and severity depends on:

• Nature and severity of defect

• Th e alteration in cardiovascular physiology secondary to the eff ect of the transitional circulation as

• Closure of ductus / restriction of patent foramen ovale (PFO)

• Fall in pulmonary vascular resistance (PVR)

Th e most important factors in narrowing down the diagnostic possibilities are:

1-Th e clinical presentation

• Shock (ductal dependent systemic circ.) (Grey baby)

• Cyanosis (ductal dependent pulmonary circ.) (Blue Baby) including severe Ebstein’s anomaly

Mohamed Al Zawam completed his Bachelors of medicine and surgery in 1998 from Alfath University In Tripoli which is now called as Tripoli University after

February revolution. He has completed his Diploma of cardio- pulmonary resuscitation from Egypt in 2006. After that he completed his Master of cardiology at Holland Academy of Science and Arts in 2007. Now he is working as a cardiologist in Al Fardous Clinic in cardiology ward, Tripoli, Libya.

Background: Recently high blood pressure has seen an increasing prevalence in Tripoli and the incidence of complication has increased, we also noticed a weak rate of control. Hypertension continues to increase in prevalence both in developed and developing countries, thereby expanding its role in cardiovascular and renal morbidity and mortality worldwide despite steadily increasing understanding of its pathophsiology, the control of hypertension in USA has improved minimally in the last decade.

Objectives: So we need to do study to explain the causes of hypertension, its complication, types, prevalence in society and types of drugs used to treat it.

Methods: Cross sectional study among hypertensive patients, we analyze the data has been packaged in special questioner for patient, with hypertension research in advance to number 1100 relay in cardiology clinics, with Direct measurement of blood pressure by collaborator in search and Check the patient's fi les, data was packaged and analyzed by the soft ware program, SPSS, case series study.

Results: Male 34.6% ,female 65.3% ,ISH 47.5% ,IDH 5.8% ,combined S+D HTN 46.8% ,home reading 6.8% ,clinic reading 60.4% ,dual reading 32.7% , 51.3% follow up in private , 20.8% in polyclinic , 9.6% secondary hospital , 16.2% tertiary hospital , 2.1% polyclinic + private , 73.6% with DBP<=90mmhg ,47% with SBP <=140 mmhg , 25.1% <140/90 mmhg , 27.4% have family history of HTN , 42.3% are diabetics - {25.9% pre HTN , 16.4% post HTN }, 2.1%unknown , 55.1% essential , 26% post diabetics , 11% PIH , 7.7% post renal disease , 2.5% post hypothyroid , .1% AVD , .1% Parkinson ,81.3% non smoker , 9.9% give- up smoker ,8.7% continue smoker ,71.1% decrease salt aft er HTN , 64.8% under life style modifi cation ,3.5% have H/O oral contraceptive ,10.9% have MI , 8.1% have CVA or TIA ,patients under one medicine 49.2% and controlled to less 140/90 by 22% ,two medicine 26.45% and controlled by26% ,three medicine 11.5% controlled by 33% ,four medicine 3% controlled by 33% ,the rate of participation of drugs in treatment was as follow , CCB-DHP 29.8% ,ARBs 28.5% ,BBs 27.5% ,ACEs 25.6% ,thiazid diuretics 18.8% ,loop diuretics 11.3% , alpha+B blocker 2.2% , aldosteron receptor blocker 2% ,central acting drugs 1.5% ,.09% K-sparing diuretics, resistant HTN >140/90 MMHG 1.9% , Resistant HTN >140 MMHG 2.9% , patients with BP <120/80 mmhg 4.6%.

Conclusion: Incidence of hypertension in female two times than in male. Prevalence in female increased exponentially by age. No age-specifi c associations in male, Prevalence of combined hypertension S+D more in male than female and vice versa in ISH , about 1/4 controlled to less 140/90 mmhg {25.1%}, Dual measurement {home + clinic} about 1/3 , White coat eff ect more in secondary HTN, And more in female than male , 28.4% in group of dual reading. Causes of hypertension, 55% essential, 26% DM, PIH 11%, Renal causes 7.7%, hypothyroid 2.5%, and Unknown 2.1%. Parkinson .1%, aortic valve .1%.Family history of hypertension playing role in pathogenesis of hypertension, and more in combined S+D HTN,ISH more in diabetics, Risk of MI and CVA&TIA in cases of ISH 3 times greater than that in combined S+D HT. Risk of MI in male more than that in female, CVA $ TIA equal both in male and female And CVA & TIA and MI incidence increased by widening of pulse pressure. When BP decreased below 120/80 risk of CVD increased. CCBs, ARBs, BBs, ACEIs, thiazide groups and loop diuretics are the most commonly used drugs as Antihypertensive as ordered in the list. Diabetics developed in CCBs, BBs, thiazide, ACEIs, ARBS, and Loop diuretics as ordered in list. Resistant hypertension, Constitute 4.8% of total sample, More in female, in renal disease patient and, Diabetics and family history playing role, 2/3 has no dual reading {home+ offi ce}.

 

Walid Mohamed Sabry Mohamed Khalil Eltahlawy is a Cardiologist in the Heart and Vascular Institute at Cleveland Clinic, Abu Dhabi. He has also served as Cardiology Specialist for more than 5 years in Cardiology Department, Dubai Hospital in Dubai Health Authority, Dubai. He has ESCVI accreditation in Trans Thoracic Echo (TTE) in 2012 and re-accreditation 2018. In addition he has ESCVI accreditation in trans-esophageal echo 2018 and also has Acute Cardiac Care Accreditation (ACCA), 2018. He is an Echo Course Director at Dubai Health Authority, Dubai, UAE and Egyptian General Medical Syndicate, Cairo, Egypt.

Cardiac echocardiography is becoming an essential diagnostic tool for a variety of cardiac pathology. Acquiring the necessary knowledge will help non cardiac and the cardiac specialist to understand the echocardiography images and reports and in return will improve the care of the patients. Th e aim of these of publication is to address the basic knowledge of cardiac echocardiography and the recent advances of its applications.

Th e work shop will discuss:

1. Historical background of echocardiography

2. Ultrasound production and detection

3. Th e Piezoelectric eff ect

4. Modes of image display

5. How the ultrasound image is created

6. Echocardiography topographic views

7. From 2D imaging to real-time 3D imaging

Manochihr Timorian is currently working as a Consultant Cardiothoracic Surgeon in the Department of Cardiothoracic Surgery in Amiri Medical Complex, Kabul, Afghanistan. He has completed his graduation from Kabul Medical University, Kabul, Afghanistan. He has also completed his Diploma in General and Minimally Invasive Surgery from Apollo Hospital Delhi, India.

The purpose of this study was to evaluate the early out come aft er total correction of tetralogy of Fallot in 180 consecutive patients with a mean age of 5-30 years underwent repair of surgery in a single center Amiri Medical Complex, Kabul, Afghanistan between August 2015 and October 2018. 8 patients had initial palliative operations (modifi ed BT shunt) in, outside centers and referred to us for total correction. Trans annular pericardial patch was inserted in 133 (73.8%) patients, 32 (17.7%) patients repaired trans-atrial total correction (ventricular septal defect, right ventricular out fl ow tract muscle band resection and pulmonary valvotomy through right atrium) for 15 (8.3%) patients with absent pulmonary valve mono cuspid and bicuspid pulmonary valve reconstructed with pericardial patch. Mean follow up was 1-3 months post operatively and mortality was 8.8%. Most of the patients whom repaired with trans-annular patch had free pulmonary valve regurgitation post operatively by trans-thoracic echocardiography, 26 patients had excellent function of monocuspid and bicuspid reconstructed pulmonary valve by pericardial patch, the mean gradient of right ventricular out fl ow tract was 15 to 35 mmHg post operatively. Twenty-two (22) patients had small residual ventricular septal defect and none of the patients had complete heart block (0%). Total correction of tetralogy of Fallot can have low operative mortality and provide excellent short and long term survival, this experience suggests that key factor in total correction of tetralogy Fallot is to correct the pathology completely.

Walid Mohamed Sabry Mohamed Khalil Eltahlawy is a Cardiologist in the Heart and Vascular Institute at Cleveland Clinic, Abu Dhabi. He has also served as Cardiology Specialist for more than 5 years in Cardiology Department, Dubai Hospital in Dubai Health Authority, Dubai. He has ESCVI accreditation in Trans Thoracic Echo (TTE) in 2012 and re-accreditation 2018. In addition he has ESCVI accreditation in trans-esophageal echo 2018 and also has Acute Cardiac Care Accreditation (ACCA), 2018. He is an Echo Course Director at Dubai ealth Authority, Dubai, UAE and Egyptian General Medical Syndicate, Cairo, Egypt.

Stress cardiomyopathy, also referred to as broken heart syndrome, Takotsubo cardiomyopathy and apical ballooning syndrome, is a condition in which intense emotional or physical stress can cause rapid and severe heart muscle weakness (cardiomyopathy). Th is potentially life-threatening condition can occur following a variety of emotional stressors such as grief (e.g. death of a loved one), fear, extreme anger and surprise. It can also occur following numerous physical stressors to the body such as stroke, seizure, diffi culty breathing (such as a fl are of asthma or emphysema) or signifi cant bleeding. Similar to a heart attack, patients with stress cardiomyopathy can present with low blood pressure, congestive heart failure and even shock. But unlike a heart attack, which kills heart cells, it is believed that stress cardiomyopathy uses adrenaline and other hormones to temporarily stun heart cells. Fortunately, this stunning gets better very quickly, oft en within just a few days to a few weeks. So even though a person with stress cardiomyopathy can have severe heart muscle weakness at the time of admission to the hospital, the heart completely recovers within a couple of weeks in most cases and there is no permanent damage.

Yasser Zaghloul is a Consultant of Anesthesia at Sheikh Khalifa Medical City, Abu Dhabi, UAE. He is the Director of Abu Dhabi Anesthesia Club and Anesthesia Refresher Course and also Lecturer and Instructor in the following international courses: FCCS, PFCCS, ENLS, airway management, critical care nephrology and mechanical ventilation courses. He had previously worked as a Consultant of Anesthesia & ICU in Ireland. He has completed graduation in 1986 from Faculty of Medicine, Alexandria University, Egypt. He has been trained in anesthesia and critical care medicine in both Egypt and Ireland.

Case Details: A 72 years old man was scheduled for live-related renal transplant, he has the following medical problems:

• End Stage Renal Disease on hemodialysis

• Hypertension

• Diabetes mellitus type II

• Dyslipidemia.

Medications: Linsinopril 5mg OD, Glipizide 10 mg OD, Atrovatatin 20 mg OD

Discussions:

• Preoperative preparation

• Anesthetic considerations

• Perioperative fl uids management

• Hemodynamic monitoring

Jennifer Maralit has completed her Bachelor’s Degree in Nursing from Southern Luzon Polytechnic College. She is certifi ed in Critical Care by American Association of Critical Care Nurses in 2007. She also has the certifi cation for Pediatric ICU and Neonatal ICU by Indiana University in 2009 and 2010, respectively. She has completed her Master’s Degree in Nursing from the University of the Philippines in 2016. She had her ECMO Specialist Training Course from Glenfi eld Hospital in Leicester in 2010, United Kingdom and ECMO training for Cardiohelp in Netherlands in 2013. She is currently working in Sheikh Khalifa Medical City (SKMC) since 2005 as a Charge Nurse Educator and ECMO Coordinator.

Extracorporeal Membrane Oxygenation (ECMO) is an established therapy in the management of patients with refractory cardiogenic shock or acute respiratory failure. Th e use of Extracorporeal Membrane Oxygenation (ECMO) for severe Acute Respiratory Failure (ARF) is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with suffi cient experience, volume and expertise to ensure it is used safely. We are oft en faced with institutions trying to determine if it is worth developing a formal ECMO program. Many institutions have been doing ECMO for many years but are now considering formalizing their program and processes. But the expense to do this could be signifi cant. The development of a successful Extracorporeal Membrane Oxygenation (ECMO) program requires an institutional commitment and the multidisciplinary cooperation of trained specialty personnel from nursing, internal medicine, anesthesiology, pulmonology, emergency medicine, critical care, and surgery and oft en pediatrics as well. Th e specialized training is necessary to cultivate an integrated team capable of providing life-saving ECMO cannot be underestimated. Th e development of a successful ECMO program is best suited to a tertiary medical center that is centrally/regionally located and capable of fi nancially supporting the level of expertise required as well as managing the program’s overall cost eff ectiveness.

What is telemedicine and how can it serve cardiology? Telemedicine is information and communication technology applied to medicine: a revolution changing the concept of medicine as we know it. In the smartphone era, new devices equipped with health applications are invading the market every day: billion dollar corporations, such as Apple Health and Google Fit, are investing to monitor their customers' health. But where do these data go? Th ey end in the hands of these giants and their customers, but not in those of the only people entitled to read and understand them completely: the physician’s ones.My name is Sergio d'Arpa and I founded my Company, Klinik Sankt Moritz AG, with the mission to integrate these data and make them available to physicians, anytime, anywhere.Our digital Clinic is the most advanced in the world and uses the ultimate in technology in the most innovative way.We monitor our patients, anywhere they are, by means of several devices. Our mission is to make active prevention. A clinical screening of the patient, to be performed at their domicile, is done fi rst, under our remote supervision. Only upon completion of these preventive screenings, they are provided with our bundle of devices, named ‘medical bubble’, like a protective bubble always around them. We designed a specifi c medical bubble for cadiological patients. Our aim is to free them from any concern about their health status, allowing them to live fully. They will be able to sail on their yacht, embracing the open sea without any concern. But also, we free cardiologists from emergency phone calls received while lacking of any clinical data of the patient. Our bubble includes even troponin test. Cardiologists will have a complete overview of the patient even thousands kilometers away. A cutting-edge system off ering serenity and freedom to physicians and patients. Physicians are not required anymore to stay in or near a hospital. And, foremost, we encourage prevention on the healthy patient.

Manochihr Timorian is currently working as a Consultant Cardiothoracic Surgeon in the Department of Cardiothoracic Surgery in Amiri Medical Complex, Kabul, Afghanistan. He has completed his graduation from Kabul Medical University, Kabul, Afghanistan. He has also completed his Diploma in General and Minimally Invasive Surgery from Apollo Hospital Delhi, India.

The diff usely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diff usely diseased vessel. Coronary endarterectomy assures complete revascularization of myocardium in case of diff usely diseased vessels and prevents residual ischemia but it has not been widely used. Recently cardiac surgeons are performing and increasing number of coronary artery endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass graft ing surgery. We assessed the early clinical and echocardiographic outcomes of 22 patients undergoing coronary artery endarterectomy of Left Anterior Descending (LAD) diagonal (D1or D2) and Right Coronary Artery (RCA) with patch plasty method using Left Internal Th oracic Artery (LITA) and Saphenous Vein Graft (SVG) between January 2017 and June 2018.

Jennifer Maralit has completed her Bachelor’s Degree in Nursing from Southern Luzon Polytechnic College. She is certifi ed in Critical Care by American Association of Critical Care Nurses in 2007. She also has the certifi cation for Pediatric ICU and Neonatal ICU by Indiana University in 2009 and 2010, respectively. She has completed her Master’s Degree in Nursing from the University of the Philippines in 2016. She had her ECMO Specialist Training Course from Glenfi eld Hospital in Leicester in 2010, United Kingdom and ECMO training for Cardiohelp in Netherlands in 2013. She is currently working in Sheikh Khalifa Medical City (SKMC) since 2005 as a Charge Nurse Educator and ECMO Coordinator.

Extracorporeal Membrane Oxygenation (ECMO) is an established therapy in the management of patients with refractory cardiogenic shock or acute respiratory failure. Th e use of Extracorporeal Membrane Oxygenation (ECMO) for severe Acute Respiratory Failure (ARF) is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with suffi cient experience, volume and expertise to ensure it is used safely. We are oft en faced with institutions trying to determine if it is worth developing a formal ECMO program. Many institutions have been doing ECMO for many years but are now considering formalizing their program and processes. But the expense to do this could be signifi cant. Th e development of a successful Extracorporeal Membrane Oxygenation (ECMO) program requires an institutional commitment and the multidisciplinary cooperation of trained specialty personnel from nursing, internal medicine, anesthesiology, pulmonology, emergency medicine, critical care, and surgery and oft en pediatrics as well. Th e specialized training is necessary to cultivate an integrated team capable of providing life-saving ECMO cannot be underestimated. Th e development of a successful ECMO program is best suited to a tertiary medical center that is centrally/regionally located and capable of fi nancially supporting the level of expertise required as well as managing the program’s overall cost eff ectiveness.