Day 1 :
Keynote Forum
Zabrina Kay L. Rodriguez
Medical degree from the Manila Central University
Keynote: Coronary Arteriovenous Fistula with Congenital Peripheral Arteriovenous Malformation in a 20-year-old: A Rare Case
Time : 14:00
Biography:
The author has obtained her medical degree from the Manila Central University Filemon D. Tanchoco College of Medicine at age 25. She had her residency training in Internal Medicine at the St. Luke’s Medical Center Quezon City, and is currently a 1st year Cardiology fellow at the Henry B. Calleja, Heart and Vascular Institute, St. Luke’s Medical Center Quezon City
Abstract:
BACKGROUND: Arteriovenous malformations (AVM) are pathologic connections between arteries and veins. They may occur as an isolated lesion or in combination with other lesions, which may be part of a syndrome. Data on congenital peripheral AVM occurring concomitantly with a coronary arteriovenous fistula (CAVF) is limited.
CASE: A 20-year-old female presented with a 3 year-history of easy fatigability and recurrent exertional chest pain not relieved with analgesics and nitrates. Her previous medical history included recurrent AVM of the right leg despite percutaneous gel foam embolization six years ago. Her physical examination was unremarkable. Apart from a chest X-ray that showed cardiomegaly, preliminary work-up was essentially normal (Troponin, 12-L ECG, 24-hour Holter monitor, 2DEchocardiogram, Stress Echocardiography, Myocardial Perfusion Imaging). CT coronary angiography (CTA) showed a CAVF of the left circumflex artery and great cardiac vein. The patient is now referred to TCVS for surgical intervention.
DISCUSSION: Despite extensive work-up for the patient that showed unremarkable results, we pursued a CTA due to a clinical suspicion of a CAVF in a background of congenital AVM. This resulted to a definitive diagnosis, which may otherwise be dismissed as a non-cardiac cause of chest pain.
CONCLUSION: We highlight the importance of increased clinical suspicion for CAVF for young patients with persistent chest pain, especially in the setting of previous congenital lesions. Further investigation is needed to determine whether an anomalous arteriovenous connection at one site predisposes an individual to having an arteriovenous connection at another. This is an underreported phenomenon that could be a part of a rare syndromic condition.c
- Pediatric Cardiology
Session Introduction
Abimbola K. Saka
ECFMG certified medical doctor, University of Toronto
Title: Improving The Uptake of TAVR In Ontario
Biography:
Abimbola Saka is ECFMG certified medical doctor enrolled in the MHSc- Translational Research Program at the University of Toronto’s Faculty of Medicine. Abimbola is passionate about enhancing care through a patient-centered approach— by involving patients in the decision making processes about their health. Abimbola is an aspiring cardiologist with a research interest in cardiovascular health.
Abstract:
Despite an increased rate of TAVR since 2011, with 28 TAVR centers in Canada, except for two provinces (Saskatchewan and Newfoundland), there is yet an observed asymmetry in the uptake of TAVR across Canada institutions when compared to other developed countries (Asgar et al., 2018). Our aims are:
- To understand the principle reasons why SAVR is chosen over TAVR; and
- To develop an evidence-based intervention to promote TAVR as the preferred alternative in patients deemed intermediate to high risk for surgery.
This research is a three-phase mixed-method design that consists of;
an online survey, a virtual co-design session to explore the decision-making behind performing either SAVR or TAVR therapies, and a pilot phase to test the intervention developed to improve the evidence-based update of TAVR. We developed a survey to understand the characteristics of the decision-makers and the reasons why one therapy is preferred over another. The survey will be administered in an electronic format to a maximum of 385 identified decision-makers (interventional cardiologists, surgeons, nurses, and organization’s heart team) for TAVR and SAVR across hospitals in Toronto. The second phase will include a virtual co-design session with a group of respondents. The third phase will involve a low fidelity testing of the intervention through an electronic survey of five decision-makers to identify if the intervention works and if this will change or impact their decision making.
We hope that this project will contribute to the understanding of the dissemination, implementation, and adoption of new standards of care.
- Clinical Cardiology
Session Introduction
Sourav Taru Saha
PhD. student,University of the Witwatersrand, Johannesburg, South Africa
Title: Delving KS-01 as a novel therapeutic strategy in treating breast cancer
Biography:
Mr. Sourav Taru Saha is a PhD. student working on Breast cancer at the University of the Witwatersrand. The research group’s main focus is the link between Cholesterol and Breast cancer. Till now, his research has shown promising results and in 2018 the concept would be tested in vivo. Based on the results, this research might lead to a novel drug in treating Breast cancer
Abstract:
Cancer cells have an increased need for cholesterol, which is required for cell membrane integrity. Cholesterol accumulation has been described in various malignancies including breast cancer. Cholesterol has also been known to be the precursor of estrogen and vitamin D, both of which play a key role in the histology of breast cancer. Thus, depleting the cholesterol levels in cancer cells is a proposed innovative strategy to treat cancer. Therefore, novel cholesterol-depleting compounds are currently being investigated. KS-01 is a cyclic amylose oligomer composed of glucose units. It solubilizes the cholesterol and is proven to be toxicologically benign in humans. This led us to hypothesize that it might deplete cholesterol from cancer cells and may prove to be a clinically useful compound. Our work provides preliminary experimental evidences to support this hypothesis. We identified the potency of KS-01 in vitro against two breast cancer cell lines: MCF-7 (Estrogen positive, ER+), MDA-MB-231(Estrogen negative, ER-) and compared the results against two normal cell lines: MRC-5 (Normal Human Lung Fibroblasts) and HEK-293 (Normal human embryonic kidney cells) using cytotoxic, apoptosis and cholesterol based assays. KS-01 treatment reduced intracellular cholesterol resulting in significant breast cancer cell growth inhibition through apoptosis. The results hold true for both ER+ and ER-. These data suggest that KS-01 can prevent cholesterol accumulation in breast cancer cells and is a promising new anticancer agent
- Cardiovascular Diseases
Session Introduction
Camille-Marie Go-Cacanindin
Medical Degree, Philippine Heart Center, East Avenue, Quezon City, Philippines
Title: Anomalous Left Coronary Artery from the Right Pulmonary Artery
Biography:
Camille-Marie Go-Cacanindin has obtained her Medical Degree at the age of 25 years from University of Santo Tomas Faculty of Medicine and Surgery and Pediatric Residency Training from Philippine Children’s Medical Center. She is currently a Pediatric Cardiology Fellow in training at Philippine Heart Center, a tertiary cardiovascular referral center
Abstract:
Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) occur in 1 in 300 000 live births. The most common origin of the abnormal LCA is from the pulmonary truncal sinuses. The rarest form of ALCAPA presents with anomalous left coronary artery arising from the right pulmonary artery. This is a case of 1 month old female presenting with Dyspnea , 2D echocardiography revealed ALCAPA. Intraoperativley, the Left Coronary Artery was found to be originating from the Right Pulmonary Artery. The patient underwent coronary implantation and LeCompte procedure.
In the most common form of ALCAPA, the abnormal coronary artery arises from the adjacent pulmonary valvar sinus, rather than the pulmonary trunk. In this case, the Anomalous Left Coronary Artery originated the Right Pulmonary Artery. Such case has an incident of 1 in 2,000,000 live births. This is the first reported case in a tertiary cardiovascular referral center. In fetal life, this has no detrimental effect since pressures and saturations are similar in the aorta and pulmonary artery. After birth, however, the pulmonary artery contains desaturated blood at pressures that rapidly fall below systemic pressures. The left ventricle is perfused with desaturated blood at low pressures leading to infarction with ventricular dysfunction. Coronary translocation and Lecompte maneuver was done which provided relief for the patient’s condition.
- Hypertension & Stroke
Session Introduction
Sarah Watson
MSc, University College London, London, UK
Title: TROPONIN I AND ITS RELATION TO DISEASE SEVERITY IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY
Biography:
Sarah has completed an MSc in Cardiovascular Sciences (with distinction) from University College London at age 22. She is now entering her 4th year of medical school at Queen’s University Belfast. Sarah is committed to pursuing a a clinical career in cardiology alongside research activities.
Abstract:
Troponin is associated with increased risk of adverse outcomes and correlates with multiple parameters of disease severity in adults with hypertrophic cardiomyopathy (HCM). However, prognostic and staging markers in adults are not always of value in children with HCM. This study assessed the ability of troponin I (TnI) to predict clinical variables in a paediatric cohort of HCM and compare this to well-established biomarker, NT-proBNP. TnI and NT-proBNP were measured in forty-nine patients with HCM [10.69±5.34 years old, 32 (65.31%) male] and elevated TnI is defined as ≥34ng/L (99th percentile reference limit). Evaluation included ECG, echocardiography, ambulatory ECG [19 (38.78%)], ICD interrogation [9 (18.37%)], exercise testing [19 (38.78%)], and cardiac magnetic resonance (CMR) imaging [16 (32.65%)]. TnI was detected in 19 (38.78%) and ≥34 ng/L in 14 (28.57%). There were significant differences in maximum wall thickness (MWT) z-score, E/E’, mitral E-wave deceleration time, and CMR-assessed LV mass index between patients with TnI<34ng/L and TnI≥34ng/L. Continuous TnI, but not NT-proBNP, correlated with global longitudinal strain (rs=0.62, p<0.001), and there were significant differences in TnI levels in patients with ST-segment changes, and late gadolinium enhancement. Both biomarkers correlated with MWT z-score and E/E’, although correlations were stronger for NT-proBNP. Multivariate analysis revealed TnI was an independent predictor of MWT and LV mass index. Troponin is a reliable biomarker to identify features of HCM (extreme hypertrophy and diastolic dysfunction) and may be an additive monitoring parameter in children. However, the utility beyond NT-proBNP, and the ability to identify subclinical ischaemia and fibrosis is uncertain