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Plenary Talks

Abstract

Using the above methods, we can not only detect cardiovascular disease or cancer, but we can also evaluate any therapeutic effect. For non-ivasive quck screening of cardiovascular disease we try to detect visible changes appearing at eyebrows nearest to the nose which become more white and eventually hair disappears when disease advances. Invisible changes of cardiovascular representation area of left upper lip near midline can be detected using Bi-Digital O-Ring Test. For the detection of Lyme disease which we found to be one of the major causes for atrial fibrillation and it can be one of the major causes for stroke. When Borrelia Burgdorferi spirochete (B.B.S.) infection exists at SA-node area or atrium of heart, we can detect the infection from ECG’s. When there is a significant Lyme disease infection we can detect it non-invasively from recorded SA-node or P-wave area of the ECG using electromagnetic field resonance phenomenonan between the B.B.S. on the heart and the standard known amount on the B.B.S. slide in less than 10~15 min. Also, when the Lyme disease infection is more than a few hundred ng often atrial natriuretic peptide are often increased significantly. When we examine the ECG example of atrial fibrilation, we often detect B.B.S. infection. If atrial fibrilation is due to B.B.S. infection, most effective treatment should be reducing or eliminating B.B.S. infection. If the patient has cancer, the author found most of the cancers can be detected using rapidly changin QRS-complex of ECG’s, particularly when the amplitude of the QRS-complex is more than 1.2 mV we can also detect not only cancer but the stage of the cancer as well. Some of these examples will be shown. Optimal concentration of zinc up to 25 mg is highly beneficial as it makes DNA very stable. However, even additional 2.5 mg or higher amount of zinc produce unstability of DNA and produce DNA mutation including development of cancer. For example, optimal dose of banana is a very small amount & the optimal dose of Marijuanna is very little. Both of them have about 40 mg zinc concentration, which makes DNA very unstable & becomes a very significant carcinogenic factor.

Biography

Dr. Yoshiaki Omura received Oncological Residency training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco- Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia Uni.. He researched EMF Resonance phenomenon between 2 identical molecules for non-invasive detection of molecules, at Graduate Experimental Physics Dept., Columbia Uni., for which he received U.S. patent. He is also the creator of Bi-Digital O-Ring Test. He published over 270 original research articles, many chapters, & 9 books. He is currently Adjunct Prof. of Family & Community Medicine, New York Medical College; President & Prof. of Int’l College of Acupuncture & Electro-Therapeutics, NY; Editor in Chief, Acupuncture & Electro-Therapeutics Research, Int’l Journal of Integrative Medicine, (indexed by 17 major int’l Indexing Periodicals); Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan, Korea, & China.

Speaker
Yoshiaki Omura / New York Medical College, USA

Abstract

Cardiac Allograft Vasculopathy (CAV) is a frequent complication of heart transplantation (HTx). To help identify patients destined for cardiac graft failure, early determination of layer-specific coronary wall thickening is of major importance. For patients destined for CAV complications of HTx, therapy must be initiated early to be effective. Therefore, early diagnosis of CAV is paramount to minimize CAV-related graft failures. Once CAV causes allograft dysfunction, the only long-term therapeutic solution is a re-transplantation.

Our work reports methods for and validation results of quantitative analysis of coronary OCT images in HTx patients that will facilitate creating predictive models identifying which individual HTx patient is pre-destined for cardiac allograft vasculopathy and thus a candidate for aggressive therapy early after the heart transplant surgery. Performance of quantitative analysis of coronary morphology in HTx patients was assessed in 38 OCT pullbacks from 20 HTx patients (538±1 image frames each, 10,760 frames total). Intimal and intimal-medial layer thicknesses of computer analysis correlated well with expert-defined independent standards (y=1.04x+5.2, R2=0.97; y=0.91x+16.9, R2=0.97 respectively).

Our new quantitative analysis of coronary wall morphology offers performance statistically indistinguishable (p=NS) from that of expert tracing. The reported approach is fast, efficient, and facilitates accurate layer-specific quantification of coronary wall thickness changes after HTx and serves as the validated pre-requisite to precision medicine approaches to CAV failure prediction.

Biography

Dr. Milan Sonka received his Ph.D. degree in 1983 from the Czech Technical University in Prague, Czech Republic. He is Associate Dean for Graduate Programs and Research of the College of Engineering at the University of Iowa, Professor of Electrical & Computer Engineering, Professor of Ophthalmology & Visual Sciences, and Radiation Oncology, Co-director of the Iowa Institute for Biomedical Imaging, IEEE Fellow, AIMBE Fellow, and MICCAI Fellow. His research interests include medical imaging and knowledge-based image analysis with emphasis on cardiovascular, pulmonary, orthopedic, cancer, and ophthalmic image analysis. He is the first author of 4 editions of Image Processing, Analysis and Machine Vision book (1993, 1998, 2008, 2014) and co-authored or co-edited 20 books/proceedings. He has published more than 180 journal papers and over 430 other publications. He is past Editor in Chief of the IEEE Transactions on Medical Imaging and member of the Editorial Board of the Medical Image Analysis journal. To bring results of his research work to clinical practice, he has co-founded two medical imaging companies -- Medical Imaging Applications LLC, and VIDA Diagnostics Inc.

Speaker
Milan Sonka / University of Iowa, USA

Abstract

The cardiovascular disease (CVD) is the global leading cause of human death. The blood biomarkers, as targets of treatment, will help to prevent and cure CVD. The abnormal metabolizing of lipids and glucose have been extensively studied in early prognosis and diagnosis of CVD and effectively reduce the morbidity and mortality, but there were little information on the protein and amino acids in CVD. This study aimed on the variation of blood amino acids profile in different stages of CVD.

We have detected 11 amino acids and SA in health control and patients with MS, ACS and HF. GLY and PRO were significant difference between the AMI and the UAP. The ROC curve area of them in multivariate analysis was 0.681 (0.600-0.754) (p<0.001). ARG, GLY, MET, TYR and SA were significant difference between the AMI and the MS. The ROC curve area of GLY and ARG in multivariate analysis was 0.953 (0.911-0.979) (p<0.001). There were significant differences in 9 amino acids and SA between the AMI and the HC. The ROC curve area of GLY, ORN and PHE in multivariate analysis was 0.991 (0.962-0.999) (p<0.001). There were significant differences in 3 parameters between the CHF and the UAP. The ROC curve area of CIT and L-I-P in multivariate analysis was 0.839 (0.742-0.910) (p<0.001).

Eleven blood amino acids and SA in patients with MS, ACS and CHF and in HC have been analyzed and the variation between different groups have been found, the results suggested that branched chain amino acids and aromatic amino acids might be a new group of biomarkers for CVD which needed for further attention.

Biography

Dr. Yaping Tian was the Professor and Director of translational medicine laboratory, Chinese PLA General Hospital. Dr Tian received his Master Degree in Medicine from Chinese PLA Postgraduate Medical School in 1989 and PhD from Academy of Military Medical Sciences in 1993. He had been trained as Postdoctoral Fellow for 2 years(1995-1997) in The Queen Elizabeth Hospital, Australia. Dr. Tian has been focusing on the study of the specific serum proteomic profiles and genetic signatures in different diseases, especially on cancer and cardiovascular diseases. Dr. Tian has received more than 20 grants and published more than 400 scientific papers in peer-reviewed journals.

Speaker
Yaping Tian / Chinese People's Liberation Army General Hospital, China

Keynote Talks

Abstract

Background: While the maternal risk factors on congenital heart defects (CHD) have often been assessed, paternal contribution to CHD, especially the joint effects of paternal behavior, demographic and environmental exposures on CHD remain unknown. This study examined the major impacts of paternal alcohol consumption and its interaction with paternal social-demographics and environmental exposures on CHDs in China.

Methods:A population-based case-control study involving 4726 singleton CHD cases and 4726 controls (singleton newborns without any malformation and matched on hospital, gender and gestational age) was conducted using the Guangdong CHD study(2004-2014). Information on parental demographics, behavioral patterns, disease/medication, and environmental exposures (three months before pregnancy) were collected through face-to-face interviews.

Results: Paternal alcohol consumption was associated with an increased odds ratio (OR) of CHDs [adjusted OR=2.87, 95% confidence interval(CI): 2.25-3.65]. Additionally, paternal smoking, industry occupation, organic solvent contact, virus infection and antibiotic use, living in rural areas, low household income, and migrant status were significantly associated with CHD (OR ranged:1.42-4.44).We found that more paternal risk factors the higher risks of CHDs. Significant additive or multiplicative interactions were observed between paternal consumption and smokingon any CHD [interaction contrast ratio (ICR)=4.72, 95%CI: 0.96-8.47] and septal defects (ICR=2.91, 95%CI=1.39-6.09). We also found significant additive interactions between paternal alcohol consumption and paternal industrial occupation(ICR=2.79, 95%CI=0.23-5.35), orlow income (ICR=2.04, 95%CI=0.25-3.82) on septal defects.

Conclusions:Paternal alcohol consumption and multiple paternal factors were significantly associated with CHDs. Paternal smoking, industrial occupation and low income modified paternal alcohol consumption–CHD relationship.

Biography

Dr. Shao Lin has completed her PhD from University of North Carolina at Chapel Hill, USA. She is a professor at the Department of Environmental Health Sciences and an associate director of Global Health Research, State University of New York at Albany. She has been awarded multiple grants from NIH and published more than 130 peer-reviewed papers in reputed journals. Her postdoctoral fellow, Dr. Wangjian Zhang, obtained his PhD from Sun Yat-sen University, China, and has published more than 50 peer-reviewed papers in reputed journals.

Speaker
Shao Lin / University at Albany, SUNY, USA

Abstract

Background:Comprehensive fetus management for congenital heart defects (CHD) is universally lacking in developing countries. We developed a multidisciplinary team approach (MTA) during prenatal and postnatal period in southern China in order to improve health outcomes of CHD fetuses.

Methods:In this prospective cohort study, confirmed CHD fetuses diagnosed in a large tertiary cardiac care center’s from 2011 to 2015 were included. Structured clinical pathways through MTA was evaluated.Perinatal outcomes (live birth, elective terminations, spontaneous fetal death and stillbirths) and early survival status were compared pre-MTA (2011-2013) and post-MTA (2014-2015) women. Risk factors for termination were also assessed.

Results: Overall, 1032 CHD fetuses were included. After MTA was introduced,the live birth rate significantly improved (56.6% VS. 46.5%, OR adjusted=1.59, 95%CI: 1.10-2.29), and the termination rate significantly? reduced in isolated-lesion CHD fetuses. No significant differences in the postnatal survival rates were observed.Multiple-lesion CHD, critical CHD, gestational age<28 weeks at prenatal diagnosis, andreferral from district hospitals was a new-found independent risk factor for termination compared to live births.

Conclusion:This comprehensive MTA program providing to Prenatally diagnosed CHD fetusescan improve the fetuses’ perinatal outcomes, especially in isolated-lesion CHD cases. Education for district hospitals of standardizing consultation and timey transferring are crucial to improve the CHD outcomes.

Biography

Xiaoqing LIU is a Chief cardiologist and epidemiologist, director of epidemiology department, director of WHO collaborative center for research and training in cardiovascular disease. She has completed her doctor degree from Guangdong university of Pharmaceutical in-1985. She is a trained epidemiologist and has a major interest in disease risk factor, evaluation of post intervention and community control of cardiovascular disease. Since 2010 she begins focus her research on congenital heart disease(CHD) both in neonate and adult. Including risk factors, post intervention evaluation, multi-center registration, setting up database, patient’s management and education.

Speaker
Xiaoqing Liu / Guangdong Cardiovascular Institute, China

Abstract

Atrial fibrillation (AF) is a cardiac arrhythmia characterized by a rapid and irregular heart rhythm. It is associated with increased risk of stroke, cardiac failure, and mortality.
Limitation of known meaningful markers and tissue heterogeneity often hinder successful assessment and classification of the paroxysmal (PX), persistent (PE), and long-lasting persistent (LSP) AF subtypes. A significant proportion of AF patients are therefore clinically misclassified. Label-free and multiplex in situ analysis techniques have the potential to overcome these limitations. Thus, we conducted the first matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MALDI IMS) to determine differences in the spatial molecular characteristics of AF subtypes.
By using an unsupervised component analysis, characteristic peptide signatures and values were observed that enabled the discrimination of the myocardial regions of different AF subtypes. In particular, peptide values from alpha 1 type I collagen were identified that were significantly higher in LSP and PE tissue but not in PX myocardial AF tissue. These findings were confirmed by immunohistochemistry and through the determination of potential interstitial fibrosis via histopathology. Our study underscores the translational potential of imaging mass spectrometry to classify AF subtypes in myocardial tissue from patients with AF.

Biography

Dr. Salah A. Mohamed is an Associate professor of Experimental Cardiac Surgery. The academic journey leads to PHD and Training, at the Institute of Legal Medicine and Laboratory/Group Leader in the Department of Cardiac and Thoracic Vascular Surgery. He has published in different reputed scientific journals in the topics of aortic and aortic valve disease, Genetics, and biomarker discovery. His laboratory also focuses on understanding the causes of atrial fibrillation. He sits on the editorial boards of many scientific and medical journals.

Speaker
Salah A. Mohamed / University of Luebeck, Germany

Abstract

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease in live infants. The abnormality of TOF is characterized by a gross structural abnormality of the heart development and with ~ 1 in 3,000 live newborns. 70% of TOF cases also occur with unknown causes. To date, few causative genes of TOF have been identified for TOF. The POPDC family with highly conserved popeye domain and three transmembrane domain consists of three members, POPDC1 (bves), POPDC2 and POPDC3. The POPDC genes are strongly expressed in the embryonic heart, suggesting their potential function in heart development and cardiac diseases. Indeed, it has been found that the expression of POPDC1 is altered in patients with congenital septal defects, and missense mutations of POPDC1 and microdeletions of POPDC3 locus have been found in TOF. Also in our preliminary test, a missense mutation of POPDC3 was detected in sporadic TOF patients via exon sequencing. TOF is often caused by dysfunction of secondary heart field cardiac progenitor cells during early development stages or perturbation of morphogenesis of OFT, a SHF derived structure. Though POPDC family has been indicated in TOF, it is an intriguing question how the POPDC transmembrane protein regulates the important transcription factor in nucleus to play a pivotal role in the early regulation of cardiac progenitor cells. Here we will present a working model for TOF beginning with the POPDC family.

Keywords: Tetralogy of Fallot, POPDC family, cardiac progenitor, genetic regulation.

Biography

Dr. Xiushan Wu completed his PhD from Stockholm University in 1986-1990, postdoctoral studies from Michegan University and etc in 1990-1994 and Scientist in Karolinska Institute in 1994-2000. He is the Director and Professor of The Center for Heart Development, Hunan Normal University. His research focuses on understanding the mechanisms by which embryonic heart is developed using Drosophila, zebrafish and mice as models. He has published more than 350 papers including over 110 SCI papers.

Speaker
Xiushan Wu / Hunan Normal University, China

Abstract

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries causing vessel occlusion, leading to myocardial ischemia and infarction. Smoking, age and high-sensitivity C-reactive protein (hs-CRP) are risk factors for CAS. In the mid 2000s, inflammation was shown to be associated with CAS, as evidenced by elevated peripheral white blood cell and monocyte counts, hs-CRP, and interleukin-6 (IL-6). In healthy people, rather than CRP, IL-6 is correlated with endothelial dysfunction, predisposing to CAS.

Recently, nicotinic acetylcholine receptors (nAChRs) have gained focus in cardiovascular studies because they mediate the effects of nicotine on the vasculature. Among nAChRs, α7-nAChRs (encoded by gene CHRNA7) are identified in inflammatory cells, such as monocytes and monocyte-derived macrophages, and constitute part of the immunomodulatory circuit termed as the cholinergic antiinflammatory pathway (CAP) upon stimulation. We present a novel evidence for the proinflammatory role of α7-nAChRs in human CAS, and demonstrates that the activation of monocytic α7-nAChRs might modulate the development of CAS.

Furthermore, in inflammatory response to oxidative stress, >85% of oxidizing phospholipids are present on Lipoprotein(a) (Lp[a]). We studied the role of human CHRNA7-p38MAPK inflammatory signaling pathway on Lp(a)-induced macrophage polarization and CAS development. Lp(a) significantly enhanced CHRNA7 expression in macrophages with increased inflammatory cytokine production and M1 surface marker, CD86. In CHRNA7-silenced macrophages, Lp(a)-induced pro-inflammatory cytokine production was remarkably decreased, and CD86 expression suppressed, while M2 marker CD206 expression was not. Collectively, these data suggest an essential role of CHRNA7-p38MAPK inflammatory signaling axis in macrophages in the pathogenesis of CAS.

Biography

Ming-Yow Hung as an associate professor of medicine, and director of cardiac catheterization laboratory, shuang ho hospital, Taipei medical university, he has studied CAS and aortic stenosis for >10 years, during which time he has authored more than 40 peer-reviewed reports. Recent published papers include Oxidized phospholipids are proinflammatory and proatherogenic in hypercholesterolaemic mice. Nature 2018;558(7709):301-306, Activation of the Monocytic α7 Nicotinic Acetylcholine Receptor Modulates Oxidative Stress and Inflammation-associated Development of CAS via a p38 MAP-Kinase signaling-dependent pathway. Free Radical Biology & Medicine 2018;120:266-276, and CAS as Related to Anxiety and Depression: a Nationwide Population-Based Study. Psychosomatic Medicine 2019 Jan 15.

Speaker
Ming-Yow Hung / Shuang Ho Hospital, Taipei Medical University, Taiwan

Sessions:

Scientific Session 01

Abstract

Abnormal proliferation of pulmonary artery smooth muscle cells (PASMCs) plays a dominant role in the development of pulmonary arterial hypertension (PAH). Some studies and our previous work found that disturbance of fatty acid metabolism existed in PAH. However, the mechanistic link between fatty acid catabolism and cell proliferation remains elusive. Here, we identified an essential role and signal pathway for the key rate-limiting enzyme of mitochondrial fatty acid β-oxidation, carnitine palmitoyltransferase (CPT) 1, in regulating PASMC proliferation in PAH. We found that CPT1 was highly expressed in rat lungs and pulmonary arteries in monocrotaline-induced PAH, accompanied by decreased adenosine triphosphate (ATP) production and downregulation of the AMPK-p53-p21 pathway. Platelet-derived growth factor (PDGF)-BB upregulated the expression of CPT1 in a dose- and time-dependent manner. PASMC proliferation and ATP production induced by PDGFBB were partly reversed by the CPT1 inhibitor etomoxir (ETO). The overexpression of CPT1 in PASMCs also promoted proliferation and ATP production and subsequently inhibited the phosphorylation of AMPK, p53, as well as p21 in PASMCs. Furthermore, AMPK was activated by ETO, which increased the expression of p53 and p21, and the proportion of cells in the cell cycle G2 / M phase in response to PDGF-BB stimulation in PASMCs. Our work reveals a novel mechanism of CPT1 regulating PASMC proliferation in PAH, and regulation of CPT1 may be a potential target for therapeutic intervention in PAH.

Biography

Dr. Liangdi Xie has completed his PhD from Xiangya School of Medicine, Central South University, China. He is working in the First Affiliated Hospital of Fujian Medical University, and working as the director of Fujian Hypertension Research Institute and the vice editor-in-chief of Chinese Journal of Hypertension. He has published more than 100 papers (Chinese and English) as the first author or corresponding author in the field of cardiology, as well as a book of hypertension. Dr. Xie is also the fellow of American College of Cardiology (FACC) and the vice chairman of Hypertensionist of Chinese Medical Doctor Association (CMDA).

Speaker
Liangdi Xie / The First Affiliated Hospital of Fujian Medical University, China

Abstract

OBJECTIVES: Substantial controversy surrounds the choice between a mechanical versus bioprosthetic prosthesis for aortic valve replacement (AVR), based on age. This study aims to investigate national trends and in hospital outcomes of the 2 prosthesis choices.

METHODS: All patients aged >18 years in the National Inpatient Sample who received an AVR between 1998 and 2011 were considered. Valve-type use was examined by patient, procedural, and hospital characteristics, after which we matched patients based on their propensity score for receiving a bioprosthetic valve and compared their in-hospital outcomes. RESULTS: Bioprosthetic valves comprised 53.3% of 767,375 implanted valves, an increase in use from 37.7% in the period 1998 to 2001 to 63.6% in the period 2007 to 2011. The median age was 74 years for patients receiving bioprosthetic valves, and 67 years for those receiving mechanical valves. Use of bioprosthetic valves increased across all age groups, most markedly in patients age 55 to 64 years. Compared with patients receiving mechanical valves, these patients had a higher incidence of renal disease (8.0% vs 4.2%), coronary artery disease (58.5% vs 50.5%), concomitant coronary artery bypass grafting (46.7% vs 41.9%), and having surgery in a high-volume (>250 cases per year) center (31.3% vs 18.5%). Patients receiving bioprosthetic valves had a higher occurrence of in-hospital complications (55.9% vs 48.6%), but lower in-hospital mortality (4.4% vs 4.9%) than patients receiving mechanical valves. This difference was confirmed in propensity-matched analyses (complications: 52.7% vs 51.5%; mortality: 4.3% vs 5.2%).

CONCLUSIONS: Use of bioprosthetic valves in AVR increased dramatically from 1998 to 2011, particularly in patients age 55 to 64 years. Prosthesis selection varied significantly by facility, with low-volume facilities favoring mechanical valves. Aortic valve replacement with a bioprosthetic valve, compared with a mechanical valve, was associated with lower in-hospital mortality.

Biography

Dr. Jeffery Shuhaiber has broad training and expertise in various cardiovascular disorders. He completed his medical school training in England at Kings College London and undertook fellowships in USA and England. His research goal is to orderly adjust risk outcomes following cardiac surgery both in children and adults. Study endpoints have included mortality, morbidity and qualitative improvement initiatives. His interests include prevention of complications after surgery. Results of these clinical research studies have led to controlled studies of which have had important impacts on outcomes following open heart surgery. He is member of a number of professional societies and editorial boards and has more than 75 original publications as well as several book chapters.

Speaker
Jeffrey Shuhaiber / Baystate Health & Medical Center, USA

Abstract

According to the World Health Organization (WHO) cardiovascular diseases (CVD) continue to be the major cause of death around the world, in an analysis concerning the evolution of CVD, the entity points out that in the last two decades high income countries have observed a reduction in prevalence of CVD, while a rapid and astonishing increase in these diseases occurs in low and middle income countries.
The Brazilian Society of Cardiology emphasizes the pandemic scenario of cardiovascular morbidity and mortality as greatest health challenge of the country, “a dramatic scenario and far from minimally acceptablecontrol.”
The socioeconomic burden related to early mortality, the aftermath and damages to society shows the need of intensify CVD prevention among these countries, manly when considering the cost-benefit of preventive actions to curative actions. The scarcity of resources in the poorest countries, secondary social damages to morbidity and mortality of people in working age.
The Brazilian Ministry of Health recommends “health promotion with emphasis on school”, current Brazilian studies ratify the effectiveness of the method for reducing the risk of cardiovascular disease in parents from public and private school children, following line of studies with positive results observed in developed countries like England and German.
The WHO and other important researches corroborate the need to engage the entire family, considering the genetics and lifestyle issues that affect the family’s cardiovascular health.
Doctoral Thesis held at the University of São Paulo reinforce the lack of studies about the subject in public school in developing countries, such as Brazil, and with lower income families. The dissertation highlighted the need to expand the work in the area, particularly when it is considered that “large investments and improvement in the diagnostic and treatment area of CVD were not followed by the development of strategies to reinforce prevention, the main way to combat the problem”.
The USP group of study developed a program to prevent CVD in public schools, the actions occurred weekly, during a year, in the classroom hours with children between 6 and 10 years of age, with play activities, theaters, games and practices with focus on promoting physical activities and adoption health lifestyle habits. The children were guided to apply these concepts of health in their daily life of family togetherness.
At the end of the study, the analysis of cardiovascular risk factors showed significant improvement among parents of the intervention group compared to the control group, especially among parents with high or intermediate risk of cardiovascular illnesses.
The study in public schools, used the same method of previous research group study carried out in private schools that also observed significant decrease of cardiovascular risk from parents.
The Brazilian experiences highlight that this education program could transform the child in a multiplier agent of CVD prevention practices next to parents and other family members, provide condition for the child to develop and live a healthy lifestyle.
The study highlight the very low cost of the program, as only a health professional , working two days a week is able to develop the project in a school with more than five hundred students.
The cost-effectiveness of the method should be spotlighted, considering that the financing costs of the program depends on public health system, which in Brazil, as in many other countries is a sector with dearth of funding and lack investments in the preventive area.
Latest development in information and communication technology (TICs), especially the reduction in the price of these services and the electronic devices, could greatly contribute to the use of internet and mobile telephony in this preventive strategy.
The program will be extended to other cities, the USP research group intends plan to test the use of TICs and other adaptations to the method in order to further reduce the investment needed to implement the educational actions.
The challenge to minimize program cost, will allow increase the number of assisted people in the health cardiovascular education project in the schools, this will be the goal of the researchers for the next years.

Biography

Renata Balbino is a Registered Nurse specialized in Primary Care Education and coaching to Home Health Care professionals. As a Primary Care Nurse and CEO of Dedicare Cuidados Integrais I`m always looking for ways to prevent and care for health including cardiovascular diseases. I will present a case report on how to use children to help their families on preventing cardiovascular illness.

Speaker
Renata Balbino Nivoloni / Dedicare, Brazil

Abstract

Coronary artery disease (CAD) represents one of the leading causes of morbidity and mortality worldwide. Risk factors changes and pharmacological treatments have been associated with a reduction in the incidence of these conditions and nowdays both strategies represent a well recognized health public policy in most countries. Aspirin has been demonstrated to be useful for secondary prevention of CAD and current guidelines recommed its use as a first line for treating patients with a previous known CAD. Regarding the use of aspirin for primary prevention of CAD, there are many articles suggesting a possible benefits of this drug, but latest works have failed to found a clinical benefits. Ischemic and bleeding risks should be taken into account before start a new treatment with aspirin. There are many patients who could obtain higher benefits with aspirin use such as diabetic patients or high risk patients based on multiple risk scores. This issue needs more investigation to achieve definitive conclusions, but several points should be evaluated for possible implementation of aspirin for primary prevention of CAD such as risk/benefits ratio, aspirin doses, adverse side effects and patients´adherence.

Biography

Dr. Yaniel Castro-Torres was graduated as a Medical Doctor from Universidad de Ciencias Médicas de Villa Clara, Cuba. He gained a Medical Degree as Specialist in Cardiology from the same university. He has published 27 medical papers in reputed journals and participated in 19 scientific congresses. He has been awarded with the best Oral Presentation at two international medical meetings and has received recognition from several health organizations.

Speaker
Yaniel Castro-Torres / Hospital Universitario Celestino Hernández Robau, Cuba

Abstract

While previous studies uncovered individual vulnerabilities to cardiovascular diseases during catastrophic storms, few evaluated population vulnerability which is more important for identifying areas in greatest need of intervention. We assessed associations between community factors and cardiovascular diseases, and developed a community vulnerability index. We retained New York statewide emergency department visits for cardiovascular diseases from 2001-2014, and conducted time-series analyses at each spatial cluster to evaluate the cardiovascular risk associated with Superstorm Sandy (10/28/2012-11/9/2012) compared to the same period in other years. We defined census tracts in clusters with an elevated risk as “risk-elevated communities”, and all others as “unelevated”, then used machine-learning techniques to regress the risk elevation status against community factors to determine the contribution of each factor on population vulnerability, and developed a community vulnerability index (CVI). Overall, community factors had a positive contribution to the increased community vulnerability to Sandy-related cardiovascular diseases (8.18%). The contribution of the percentage of areas prone to flooding (40.34%), the percentage of residents living in group quarters (13.24%) and multi-unit structures (12.34%) tended to be larger than other factors. The CVI based on these factors achieved an accuracy of 0.77 (0.74, 0.79) in contrast to 0.55 (0.52, 0.57) of the existing index. High CVI communities were generally located in the southmost areas of the study region. Our findings suggested higher population vulnerability in less optimal communities. The percentage of areas prone to flooding was the dominant predictor for cardiovascular vulnerability. The CVI based on these factors has an appropriate predictive performance.

Biography

Wangjian Zhang obtained his PhD from Sun Yat-sen University, China, and has published more than 50 peer-reviewed papers in reputed journals.

Speaker
Wangjian Zhang / University of Albany, SUNY, USA

Abstract

Introduction : define what is Quality? what is Saftey? what is the methoed we will use in this presentation? i will Speak about the STEEEP , and the describtion of each part of alone plus the Quality Prinicple that we describe the ESR from them.

Methods: Being conducted in 2017, this qualitative study was the first of its type in KSA. Data were collected through in-depth semi-structured interviews with 45 Multidisplanary Cargivers working in different departments & Hospitals across the Kingdom . The participants were selected using a Random sampling method.Interviews were transcribed and analyzed following a qualitative content analysis approach. Written text was then coded, and themes were extracted from the data. Ethical considerations: The study was conducted with multidisplanary free informed consent and was approved by Ethics Committee of Enaya Hospital/ Enaya Medical group.

Findings: By analyzing the data, we found that disribuation for the multidispalnary over a diffrent commities over 1 year and 2 month has improved the outcome of the acheivment of the ESR by 38% as a results from the CPAHI Rounds on july 2017.

Conclusion: the distrubuation for the multidisplanary over all hospital comitties can improve significantly the percentage of ESR when being changed in yearly basies with taking the consedration of the active work for this Comitties and number of members.

Biography

Saed Al Nobani still as student in his DNP at the age of 35 years i completed my MSN from Liverpol University and Bachelor degree in Nursing from jordan university . He is the Manager of Education & life support in Enaya Hospital/ Enaya medical group In KSA-Dammam, he is certified as Patient safety officer from American institution of healthcare Management , He has published more than 3 papers in jordan about quality, patient saftey & waste managment

Speaker
Saed Misbah Al Nobani / Cleveland Clinic Abu Dhabi, UAE

Plenary Talks

Abstract

Background: Fulminant myocarditis (FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen (LSBCTR), a completely novel treatment regimen, for FM.

Methods: A total of 165 FM patients recruited from January 2008 to October 2018 were divided into two groups: patients receiving LSBCTR (84 cases), which includes (1) mechanical life support (positive pressure respiration, intra-aortic balloon pump with or without extracorporeal membrane oxygenation), (2) immunomodulation therapy using sufficient doses of glucocorticoids and immunoglobulins, and (3) application of neuraminidase inhibitors, and those receiving conventional treatment (74 cases). The endpoints were in-hospital death and heart-transplantation.

Results: Of all the population, 44 patients (26.0%) died in hospitals. In-hospital mortality were 3.6% (3/84) for LSBCTR group and 50.7% (41/81) for traditional treatment (P<0.001). Early application of LSBCTR, mechanical life support, neuraminidase inhibitors, and immunomodulation therapy significantly contributed to reduction in in-hospital mortality.

Conclusions: Our study describes a novel treatment regimen for FM patients that dramatically reduces in-hospital mortality. Its generalization and clinical application will efficiently save lives although further optimization is needed. This study offers an insight that virus infection induced inflammatory waterfall results in cardiac injury and cardiogenic shock and is therapeutic target.

Biography

Dr. Dao Wen Wang has received his PhD from Tongji Medical University during the period of 1992. Currently, he is working as Professor in Huazhong University of Science & Technology.

Speaker
Dao Wen Wang / Huazhong University of Science & Technology, China

Keynote Talks

Abstract

High intensity interval training (HIIT) is an exciting and increasingly popular mode of training for reducing risk factors associated with coronary heart disease, type 2 diabetes, the metabolic syndrome (MetS), and stroke. HIIT consists of short, intense bouts of exercise conducted at > 80% of maximum heart rate alternated with bouts of lower intensity, relief exercise. Although interval training has been around for years, new studies show better improvements in inflammatory markers, mitochondrial biogenesis, free fatty acid oxidation, and risk factors above that of traditional continuous aerobic programs which typically last much longer in duration. Furthermore, research now shows cardiometabolic benefits of HIIT in those already possessing heart disease, MetS, and type 2 diabetes. A recent study from the University of Miami showed that when resistance exercise was used in a HIIT program for at risk, overweight/obese women, fasting insulin levels decreased, -5.99 mI/L (p<.0.05), HOMA-IR decreased, -0.74 (p< 0.05), and HOMA2-beta decreased -40.28 (p< 0.05) compared to controls. Our findings confirm that resistance HIIT can effectively improve glucose homeostasis in women at risk for or possessing MetS. Future research should focus on the different types of HIIT using resistance and/or aerobic exercise to examine changes in cardiometabolic health in the long term.

Biography

Arlette Perry, Director, Laboratory of Clinical and Applied Physiology, University of Miami. Dr. Perry’s research has focused on cardiometabolic health in women with an emphasis on the role of exercise in the reduction of cardiovascular risk factors. Recent studies have focused more on the impact of visceral adipose tissue on cardiometabolic health, how that may differ by race, and it’s relationship to the sex steroid milieu in premenopausal women. Currently she is examining how a translational health program can increase physical fitness and physical literacy while reducing adiposity in minority children.

Speaker
Arlette C. Perry / University of Miami, USA

Abstract

Background: Although mutations and dysfunction of mtDNA are related to a variety of diseases, few studies have focused on the relationship between mtDNA and coronary heart disease (CHD), especially the relationship between rare variants and CHD.

Methods: Two-stage high-throughput sequencing were adopted to detect mtDNA variants or heteroplasmy and the relationship between them and CHD. In the discovery stage, 85 CHD patients and 80 demographically matched controls were recruited at Chinese PLA General Hospital. The whole mitochondrial genome was analyzed by high-throughput sequencing of long-range PCR products generated from peripheral blood. In the validation stage, high-throughput sequencing for mitochondrial target regions captured by GenCap Kit was carried out on 100 CHD and 100 controls. At last, tRNA fine mapping was performed between our study and the reported Chinese CHD study.

Results: Among tRNA genes, we confirmed a highly conserved rare variant A5592G previously reported in the Chinese CHD study. And a novel rare mutation T5628C (the combined p-value=7.39E-04) which disrupted an extremely conservative base-pairing at AC-stem of tRNA-Ala and meanwhile was predicted to be pathological, was found. Besides, two rare variants that affected rRNA structure (the combined p-value is 3.2E-02, 3.62E-03 for A735G, A2412G, respectively) and two rare pathological missense variants (the combined p-value is 1.04E-02, 1.97E-03 for T5095C, C15402T, respectively) were also found.

Conclusions: Our study confirmed the contribution of rare variants in CHD and found CHD patients had more nonsynonymous heterogeneity mutations, which may assist in identifying the genetic basis of CHD.

Biography

Dr. Kunlun He from Chinese People's Liberation Army General Hospital, is dedicated to basic and clinical research of cardiovascular diseases, especially genomics of heart failure and drug research on pulmonary hypertension. Currently engaged in artificial intelligence research of cardiovascular imaging.

Speaker
Kunlun He / Chinese People's Liberation Army General Hospital, China

Abstract

Influenza is a major cause of hospitalization in all age group and is one of the leading causes of morbidity and mortality in the USA. Influenza is an acute respiratory syndrome characterized by fever, respiratory and other systemic symptoms. It is caused by influenza A, B or less commonly by Influenza C viruses. Clinically most encounters are self-limited, but complications are not uncommon especially in patients with co-morbidities e.g. pregnancy, extremes of age, etc. Cardiovascular and respiratory and complications are the most common cause of mortality after influenza virus infection.There are many articles mentioning the association of influenza infection with pericarditis, myocarditis and acute myocardial infarction. Myocarditis is a known lethal complication associated with Influenza virus infection. Also, Influenza infection is known to be associated with acute exacerbation of heart failure, cardiogenic shock, fatal arrhythmias, and death. Due to the difficulty of diagnosis of viral myocarditis with non-invasive tests and lack of enough studies on the association of influenza virus and myocarditis, not much is known about influenza-associated myocarditis. Through this detailed review of literature and analysis, we have summarized the association between the influenza virus and myocarditis. Electrocardiographic findings, cardiac markers, echo findings and other clinical details have been summarized in this study.

Biography

Dr. Amit Bansal has completed his medical education from Delhi Universty, India and Internal Medicine residency from Johns Hopkins University, Baltimore, MD. He is currently working as Senior Hospitalist attending and Director of Quality for Rochester General Hospitalist Group at Rochester Regional Health, Rochester, NY.

Speaker
Amit Bansal / Rochester Regional Health, USA

Sessions:

Scientific Session 02

Abstract

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. About 1-2% of the populations have BAV, although the condition is at least twice as common in males. In approximately more than 50% of BAV cases, dilatation or aneurysms of any or all segments of the aorta can be found. Comprehensive genetic, molecular and proteomic analyses have increased our understanding of the complex cellular processes and signaling involved in the pathophysiology of ascending aortic aneurysms. In this talk, we report on the extrinsic factors involved in hemodynamic alterations associated with increased wall shear stress due to a modified flow profile and discuss the factors intrinsic to congenital aortic fragility, which is responsible for medial degeneration in the vessel wall. We also discuss the underlying genetic basis and basic pathology of BAV and ascending thoracic aortic aneurysms and compare these with mechanisms known to underly syndromic Marfan syndrome.

Biography

Dr. Salah A. Mohamed is an Associate professor of Experimental Cardiac Surgery. The academic journey leads to PHD and Training, at the Institute of Legal Medicine and Laboratory/Group Leader in the Department of Cardiac and Thoracic Vascular Surgery. He has published in different reputed scientific journals in the topics of aortic and aortic valve disease, Genetics, and biomarker discovery. His laboratory also focuses on understanding the causes of atrial fibrillation. He sits on the editorial boards of many scientific and medical journals.

Speaker
Salah A. Mohamed / University of Luebeck, Germany

Abstract

Abstract will be Updated soon....

Biography

Biography Will be Updated Soon.......

Speaker
S. Lawson Derby / Beverly Hospital, USA

Abstract

Background: Genetic testing is positive in only about 50% patients with ARVC. Exposure to toxic chemicals is very well known to cause injury to various organ systems.

Objective: We propose novel hypothesis of “acquired variant” of ARVC secondary to chemical exposure.

Results: A 57-year-old man presented with syncopal event and ventricular fibrillation requiring defibrillation by EMS. EKG revealed epsilon waves in leads V1–V3, II, III and aVF. Transthoracic echocardiogram (TTE) showed dilated right ventricle (RV). Left ventricular ejection fraction (EF) was 55%. Cardiac magnetic resonance (CMR) revealed diffuse right ventricular myocardial enhancement. RV was dilated with dyskinetic inferior and anterolateral free walls. RVEF was 31% and end-diastolic volume to body surface area (BSA) ratio was 113 mL/m2, which met the revised task force criteria for ARVC. Dual-chamber implantable cardioverter defibrillator (ICD) was placed. Genetic testing was negative for known ARVC mutations. There was no family history of ARVC or sudden cardiac death (SCD). 18F-FDG PET study showed uptake in the RV, septum, inferior, apical and anterior walls. Computerized tomographic (CT) scan of the chest did not reveal any definite adenopathy except some borderline mediastinal lymph nodes. Transbronchial lymph node aspiration and biopsy revealed minute fragments of anthracotic lymph node with granulomas secondary to anthracosis. Acid-fast stain, QuantiFERON Gold TB test and fungal stains were negative.
Patient had more than 35 years of occupational exposure to Phosphorus compounds, Barium salts and organic solvents like acetone and methyl ethyl ketone (MEK). This very well explains the anthracosis in lymph nodes and the hypothesis of “acquired” ARVD secondary to prolonged exposure to toxic chemicals. Phosphide toxicity is very well known to cause cardiac toxicity and arrhythmias. Chronic exposure to organic solvents like acetone and MEK can lead to genotoxicity and DNA mutations.

Conclusion: Our patient with negative genetic testing for ARVC and negative workup for differentials leads us to propose novel hypothesis of “acquired” ARVC secondary to prolonged exposure to cardiotoxic chemicals. Alternatively, etiology can be a rare genetic mutation, yet to be discovered.

Biography

Dr Amit Bansal has completed his medical education from Delhi Universty, India and Internal Medicine residency from Johns Hopkins University, Baltimore, MD. He is currently working as Senior Hospitalist attending and Director of Quality for Rochester General Hospitalist Group at Rochester Regional Health, Rochester, NY.

Speaker
Amit Bansal / Rochester Regional Health, USA

Abstract

Fear of losing one’s health is one of the primary concerns of all humans. Heart disease is the leading cause of death for both men and women. This is the case in the U.S. and worldwide. More than half of all people who die due to heart disease are men. The totaldeaths attributed in the US along in 2017 to cardiology related ailments was 647,457 which was23.5% of the total number of deaths. As the plaque develops, the arteries narrow. This makes it difficult for blood to flow around the body and increases the risk of heart attack or stroke. It can also give rise to angina, arrythmias, and heart failure.As the plaque develops, the arteries narrow. This makes it difficult for blood to flow around the body and increases the risk of heart attack or stroke. It can also give rise to angina, arrhythmias, and heart failure. Unlike most other diseases heart attacks come suddenly and have a statistically known to incur sudden and immediate death or irreparable damages. There is a new technology on the horizon which is going to change the way preventative cardiological health maintenance is delivered to millions of people around the world. The ability of SPEs to provide statistically referable presence of bio markers that indicate long term impact on cardiological health could mitigate and stop fatal conditions years before their slow build up. Unlike all the alternatives of healthy living and exercising regularly, the use of cloud-based diagnostics, patient sensor reading database and emergent patterns are now traceable with at an affordable cost in comparison to having physician visitation. As proof of this move towards embracing the NFC technology like never before in history, Apple finally decided to allow NFC transactions in iPhones, and other devices using iOS13 and retroactively to most devices produced since 2016 making the leap from zero to over a million overnight and for all future devices.

Android based phones already allow this, and this has major implications for NFC based sensor monitoring and ability for every day humans to test and record complex health markers pertaining to cardiological health. Using SPEs and other sensor e.g. CNT (Carbon Nano tubes) etc., there field is wide open for implementing and delivering this next millennium health care technology to the market with distributed costs already incurred by society such as mobile cellular data, devices, and the learning curve. Using a potentiostate interface a microchip can now be electrically connected to a sensor directly, and emit the reading wirelessly to a mobile phone which is able to sense the data and transfer it safely to a mobile app and from there to a cloud. This flow of information can then lead to patient getting live advise, interpretation and medical guidance way early on. Though such system are yet to be built, but we have all the essential components to build it. This presentation will explain the framework and various elements in detail for the notes and collaborations that are possible to deliver such a system.

Biography

Mr. Shan Sharma, BCA, MBA, Associates of BS has over the past 17 year participated in numerous global efforts to introduce and induce new transformative technology breakthroughs in a myriad of agricultural, automation and electronic applications of technology worldwide. He was awarded the International Business development leadership award in 2007 for his leadership in deploying animal identification radio frequency technology across Asia pacific and beyond. He has contributed to numerous organizations, public private partnerships and numerous national programs through software and technology including specialized semiconductor technology across the world since 2005 including the USA since 2012. He is the Business Development Principal and NFC evangelist, at Silicon Craft Technology PLC a publicly listed company with a global foot print in pioneering transformative technologies as a Semiconductor product and service organization with which he has been associated for over 14 years.

Speaker
Shan Sharma / Silicon Craft Technology PLC., Thailand

Abstract

Activation of the nuclear factor of activated T-cell (NFAT) signaling pathway contributes to atrial remodeling associated with AF progression. Our aim was to determine the role of NFATc2 in AF in humans and mouse models. Expression levels of NFATc1-c4 isoforms were assessed by qPCR in right atrial appendages from patients with chronic AF. NFATc1 and NFATc2 mRNA levels were elevated in cAF patients compared with patients in sinus rhythm (SR). Western blotting revealed increased cytosolic and nuclear levels of NFATc2 in atria of AF patients. Similar findings were obtained in CREM-IbΔC-X transgenic (CREM) mice, a model of progressive AF. Telemetry ECG recordings revealed spontaneous AF in CREM mice, which was prevented by NFATc2 knockout in CREM:NFATc2-/- mice. Programmed electrical stimulation revealed that the substrate for AF observed in CREM mice was absent in CREM:NFATc2-/- mice. Morphometric analysis and histology revealed greatly increase atrial weight and enhanced atrial fibrosis in CREM mice compared with WT controls, which was reversed in CREM:NFATc2-/- mice. Confocal microscopy showed an increased Ca2+ spark frequency despite a reduced sarcoplasmic reticulum (SR) Ca2+ load in CREM mice compared with WT, whereas these abnormalities were normalized in CREM:NFATc2-/- mice. Finally, genetic inhibition of Ca2+/calmodulin-dependent protein kinase II-mediated phosphorylation of S2814 on RyR2 in CREM:RyR2-S2814A mice suppressed NFATc2 activation observed in CREM mice, suggesting that NFATc2 is activated by excessive SR Ca2+ leak via RyR2. Our findings reveal activation of the NFAT signaling pathway in AF patients. NFATc2 knockout prevents the progression of AF in the CREM mouse model.

Biography

Dr Li Ni earned her MD (2004) and PhD (2009) degrees from Tongji Medical College, Huazhong University of Science and Technology, in China. She practices cardiology in Tongji Hospital, one of the leading teaching hospitals in China. She has been a visiting scientist in Dr Xander Wehrens’s lab (2016-2018). She published several papers as first author in high impact journals such as Circulation Research, Stroke and Molecular Pharmacology. She has got two grants from the National Natural Science Foundation of China as the principle investigator.

Speaker
Li Ni / Tongji Medical College, China

Abstract

A 72-year-old woman was admitted in the cardiac surgery department at the "Heart and brain" Hospital, Pleven, Bulgaria for surgical treatment of an intramural hematoma of the ascending aorta, diagnosed with a CT scan in the emergency room. In the morning before the admittion, she suddenly felt strong, "ruptiring" chest pain in the substernal area that lasted for more than 30 minutes, and she measured blood pressure of 180/100. Patient had medical history of hypertension with poor drug control, bronchial asthma, gastroesophageal reflux disease and gastritis. Initial vital signs at the admittion were: Respiratory system – tachypnea, respiratory rate 24/min, vesicular breathing without wheezing on both sides. Saturation 94%. Cardiovascular system - regular heart rhythm, pulse rate 66 bpm. Arterial blood pressure - 150/80 mmHg on both hands. Short systolic sound in the aortic area. Limbs - no edema, reserved pulsations of the peripheral arteries. Electrocardiogram (EKG) was immediately taken which showed normal sinus rhythm with left anterior fascicular block, with no pathological ST-segmet deviation. Nothing specific was found on the laboratory tests except a mild increase in glucose and creatine kinase (other cardiac enzymes were in normal range). An additional computed tomography (CT) with contrast was performed, which showed an ascending aorta aneurism with an intramural hematoma (IMH) type Stanford A, which spans from the left main coronary artery up until the brachipcephalic trunk (s. Innominate artery). An echocardiography was performed which revealed: minor aortic and mitral regurgitation. Dilatated ascending aorta - 56mm, aortic root - 34mm, Sino-tubolar junction - 29mm, double-stranded medial wall with 14-15mm seperation with hypoechogenic structure. Haematoma that starts from the non-coronary sinus and continues in the ascending aorta, aortic arch and the thoracic aorta.

Biography

Dr. Nikolay Dimitrov currently working as a Professor for the Department of Cardiology at UMHAT Heart and brain, Bulgaria.

Speaker
Nikolay Dimitrov / UMHAT “Heart and brain”, Bulgaria

Abstract

An increasing burden of cardiovascular diseases remains a vanishing mystery in its epidemiological aspects, affecting most of the population and carries a grim prognosis throughout the world. The tropical febrile disorders such as Endomyocardial fibrosis and rheumatic fever affecting the heart valves, endocardium and coronary arteries, leading to valvular deformities, infective vegetations, plaque formation in endocardium and coronary arteries which can produce arrhythmogenic, ischemic and embolic episodes suddenly as a devastating pattern. An etiological analysis is mandatory to reduce this burden by focusing on alternative routes of understanding its pathogenesis to control these enigmatic diseases. The role of antibiotics in coronary artery disease, penicillin prophylaxis in valvular heart disease, vaccination such as streptococcal vaccine, Ras vaccine and antifibrotic agents play an important research focus in its prevention and treatment. Survey of epidemiological measures, especially in tropical nations may bring new insights to control this global epidemic diseases.

Biography

Dr. Ramachandran Muthiah was the Consultant Physician & Cardiologist. He Published many papers in Cardio-source, American College of Cardiology Foundation, Case Reports in Clinical Medicine (SCIRP) and Journal of Saudi Heart Association. Special research on Rheumatic fever and Endomyocardial fibrosis in tropical belts, Myxomas, Infective endocarditis, apical hypertrophic cardiomyopathy, Ebstein’s anomaly, Rheumatic Taussig-Bing Heart, Costello syndrome and Tetralogy of Fallot.

Speaker
Ramachandran Muthiah / Zion hospital, India

Will be updated soon...