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985th Conference
18th Annual Cardiologists Conference June 19-21, 2017
Paris, France
Posters
Cardiologists 2017 Page 80
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Amjed Eljaili et al., J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Extra-cardiac compression and pericardial effusion secondary to primary mediastinal large B cell lymphoma Amjed Eljaili1, Abdalazeem Ibrahem1, Abdul Azzu2 and Ezeldin Ibrahim2 1 Betsi Cadwalader University Health Board, UK 2 Prince Salman Hospital, Riyadh, Saudi Arabia
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rimary mediastinal large B cell lymphoma (PMBL) accounting for 7% of diffuse large B cell lymphomas and represent 2.4% of all non-Hodgkin lymphomas. Median age at diagnosis in the third to fourth decade. In some cases the initial presentation can be an oncological emergency with locally invasive anterior mediastinal mass arising from thymus causing external pressure on the heart and the surrounding structures. Further pressure on the trachea and the lungs can also compromise the airway or lead to superior vena cava (SVC) syndrome. Background: PMLBL is classified as type of aggressive NHL which originating from the mediastinal thymic (medullary) B-cells, remarkably PMLBL has a discrete clinical features as well as categorically sharing some clinical and pathological features with other types of B cell lymphoma. From the most recent published studies, It was found that PMLBL has more benign outcome and excellent response to chemotherapy especially if dealt with at earlier stage. Case presentation: A 27 years old male who admitted with pleuritic chest pain, shortness of breath and palpitations, no remarkable past medical history, Clinically he was tachycardic of heart rate 117 bpm, BP 106/60, Temp 37.4 oxygen saturation of 100% on air, No other abnormality detected on other systemic examination. The initial investigation including, FBC, renal function, LFT, TFT, clotting profile, CRP and cardiac troponin were all within the normal parameters, negative virology screening tests. ECG showed sinus tachycardia, CXR revealed widened mediastinum. Chest abdo-pelvis CT scan confirmed the presence of a large anterior mediastinal mass of 9.6cm with moderate pericardial effusion. The mass infiltrates into the mediastinum and encasing the aorta, which is causing extrinsic compression on the mediastinal structures with appearances suggestive of right sided heart strain. There was 12 mm left hilar lymph node with no evidence of pleural effusion or pleural-based disease. Echocardiography has shown extra cardiac mass interiorly size 2.6 cm, pericardial effusion posteriorly 0.8 cm and laterally 1.3 cm, persevered LV systolic function and late systolic septal flattening, without evidence of cardiac tamponade. The patient was transferred to the local tertiary centre for pericardial effusion drainage and tissue biopsy that has confirmed the diagnosis of primary mediastinal diffuse large B Cell Lymphoma, as a result, the patient subsequently started on chemotherapy treatment (R-CHOP) under the care of haematology with excellent an outcome. Few weeks later, patient was readmitted with neurtropenic sepsis and large left pleural effusion as consequences of chemotherapy treatment for which he was treated aggressively with intravenous antibiotics and made a good recovery. Discussion: PMLBL is vigorous tumour arising in the mediastinum from the thymic (medullary) B cell. It has unique clinical and pathophysiological features In contrast with systemic diffuse large B cell lymphoma, however identifying the gray-zone lymphoma is of paramount importance as highlighted by the WHO for diagnostic and therapeutic purposes. Symptoms of cough, dyspnoea, hoarseness of voice, and dysphagia can be presentative feature of SVC syndrome and local invasion of the tumour. An adequate biopsy specimen with using immunophenotyping is the key to the diagnosis, There is disparity in clinical practice for treating PMLBL, the treatment options hugely depend on the patient and tumour characteristics. In this case the possibility of clinical SVC syndrome was excluded based on the facts that there were no characteristic signs of central venous obstruction, facial swelling or head fullness, although reported that the CT scan has shown a degree of compression on the mediastinal structures. Others potential emergencies that described in the literatures that some patients have presented with have included, cardiac tamponade, thrombosis of major neck or superior thoracic veins also hyperuricemia and tumor lysis syndrome. Patient with large mediastinal mass they may present also with cardiac or respiratory arrest at initial or during anaesthesia. Biography
Amjed Eljaili completed MBBS on October 2010 from University of Al-Zaiem Al-Azhari, Sudan, currently practicing in UK, Wales Deanery, foundation year-2 trainee, BCUHB, emergency department. He attended several academic meetings, regionally and nationally, He has participated in various national work-shops, congress participation and membership with British Institute of Radiology, UK.
[email protected] J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 81
conferenceseries.com
Amjed Eljaili et al., J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Case report: Prosthetic aortic valve endocarditis with aortic root abscess secondary to nontuberculous mycobacterium Amjed Eljaili1, Abdalazeem Ibrahem1, Abdul Azzu2, Ezeldin Ibrahim2 1 Betsi Cadwalader University Health Board, UK 2 Prince Salman Hospital, Riyadh, Saudi Arabia
N
on-tuberculous mycobacterium is uncommon causative organism of prosthetic infective endocarditis, but over the course of the recent years, the incidence of mycobacterial endocarditis significantly increased with often poor response to antimicrobial therapy as a result many patients have had a surgical intervention, therefore it is considered to be a serious cardiovascular condition that factually associated with high morbidity and mortality. The aortic, mitral and tricuspid valves were the most commonly affected sites of mycobacterial endocarditis. There are many risk factors that can predispose to infective endocarditis, the common observed risk factors include, congenital heart diseases, implanted medical devices insertion, various cardiothoracic operations as well as immune-compromised patient. The incidence of infective endocarditis is 2 to 10 episodes per 100,000 person-years in most population-based studies, and the incidence is higher in elderly population of up to 20 episodes per 100,000 person-year in the elderly. Non-tuberculous Mycobacterium considered to be an opportunistic pathogen and the most slowly growing species are the M. avium-intracellular complex. Rapidly growing non-tuberculous mycobacteria are more sensitive to antibiotics than slowly growing mycobacterium. CDR-IE is defined as infection extending to the electrode leads, cardiac valve leaflets or endocardial surface3. The isolated pocket infection is clinically suspected in the presence of local signs of inflammation at the site of the device; these signs are including warm site, redness, wound dehiscence, tenderness, erosion or purulent drainage. Generally speaking, the infection of the cardiac implantable devices is a dreadful. The incidence of CIEDs infection in a population-based study is 1.9 per 1000 device-year with a higher probability of infection after implantable cardioverter defibrillator (ICD) compared with permanent pacemaker (PPM) implantation. Case Presentation: A 58 years old female with recurrent history of infective endocarditis, first episode manifested two months following a metallic aortic valve replacement that she had undergone due to congenital bicuspid aortic valve. Patient presented with one-month history of exertional dyspnoea, chest tightness, fever, rigors, night sweat and general malaise, during the course of her hospital admission she has spiked high grade temperature several times whilst on the empirical antimicrobial therapy for infective endocarditis. On clinical examination of cardiovascular system there were no signs of heart failure, normal first heart sounds with ESM and metallic click on the second heart sounds. Other systemic examination findings were unremarkable. ECG showed first degree heart with LBBB. Her blood result on admission have shown raised inflammatory markers and serial of consecutive blood culture were negative, CXR showed no abnormality. Transoesophageal echocardiography infective confirmed abnormal looking aortic valve with typical appearance of aortic root abscess and significant vegetation with moderate aortic valve insufficiency. The patient had to undergone an urgent Re-do aortic valve replacement with extensive aortic root reconstruction, the cultivated sample of the removed aortic valve and the aortic wall tissue has confirmed the diagnosis of mycobacterium avium-intracellular complex with histo-pathological picture that in favour of the diagnosis of acute necrotizing mycobacterial endocarditis. Postoperatively, the patient has developed acute kidney injury and liver impairment as part of cardio-renal syndrome that warrant an admission to the intensive care unit for hemofiltration and inotropic support. The patient hospitalised again during the course of her treatment with severe myocardial infarction and she passed away due to cardio-respiratory arrest. Discussion: Prosthetic mycobacterial endocarditis infection is usually refractory to antimicrobial therapy partly due to the difficulty identifying the pathogen as this may require multiple laboratory test before reaching the diagnosis e.g. blood culture, chromatographic techniques, histological staining or molecular analyses. Prosthetic mycobacterial endocarditis still rare compare to other pathogens, therefore there is a lack of elaboration on the literature review, it was noted that there is a shorter latency with endocarditis following cardiac procedures than others predisposing risk factors as demonstrated in this case. The
J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 82
conferenceseries.com
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France majority of patients commonly present with symptoms of fever (from low grade to high grade temperature), dyspnoea and chest pain, often the duration of the symptoms vary from acute onset in few days to slowly progressing disease over the course of months or years. The diagnosis of PVE is a difficult one to establish however the recent European Society of Cardiology (ESC) guidelines emphasised that it is very important to use the new radiological imaging techniques like nuclear medicine imaging, whole body MRI and cardiac CT scan to aid the diagnosis of PVE and to discover peripheral embolic event. The initial treatment started in this case was empiric antimicrobial therapy as per the local hospital guideline, later the patient switched on specific anti-mycobacterium antibiotics as per the antimicrobial susceptibility test, which was in form of clarithromycin, rifampicin and ethambutol for period of 12 months. Antimicrobial therapy with prolonged duration of treatment is often the regimen of choice, amikacin and imipenem have been proved to be effective agents for the disseminated disease. Due to the rarity of the mycobacterium PVE, the condition remains a challenge to the clinician in terms of both diagnosis and treatment, largely due to poor pathogen identification and late presentation that leads to substantial delay in the diagnosis and the subsequent management. This case illustrated the importance of spotting the diagnosis at earlier stage, as every effort should be made to spot and predicts the diagnosis to enable prompt management and minimizing the subsequent complications for better prognosis. Both medical and surgical management may be vital to achieve good outcome. Biography Amjed Eljaili completed MBBS on October 2010 from University of Al-Zaiem Al-Azhari, Sudan, currently practicing in UK, Wales deanery, foundation year-2 trainee, BCUHB, emergency department. He attended several academic meetings, regionally and nationally, He has participated in various national work-shops, congress participation and membership with British Institute of Radiology, UK.
[email protected]
Notes:
J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 83
conferenceseries.com
Yazeed Hamoud Al-Kahaf Al-Shammari et al., J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Evaluation of cardiac enzymes in early detection of acute myocardial infarction Yazeed Hamoud Al-Kahaf Al-Shammari and Yahya Dokhi Al Tamimey Mostafa Rasool Al Turaifi University of Hail, KSA
Background: Acute myocardial infarction (AMI) represents a diagnostic challenge. Diagnosis of AMI is usually established based on the clinical symptoms, electrocardiographic (ECG) changes and the activities of cardiac enzymes such as creatine kinase (CK) and its isoenzyme MB (CK-MB) activities. Aim: Aim of this study is to assess the potential role of serum cardiac markers for early detection of AMI in Hail population, Saudi Arabia. Methods: Serum levels of CKBM, CK and lactate dehydrogenase (LDH) were measured in 111 patients with chest pain included 40 with AMI and 71 without AMI served as control. Receiver operating characteristic (ROC) curve analysis was performed to assess the utility of these enzymes as biomarkers for early diagnosing AMI. Results: The area under the receiver operating (AUC) curve values were: CK; 0.60 (p>0.05), CK-MB; 0.817 (p < 0.001) and LDH; 0.655 (p < 0.01). CK-MB had the highest AUC of all. The sensitivity and specificity of CK-MB were 72.5% and 80.28% at the optimal cut off value of 36.5 U/L whereas for LDH, sensitivity and specificity were 62.5% and 70.42% at 272 U/L as an optimal cut off. The simultaneous use of both markers increased the sensitivity and specificity to 82.5% and 85.92%, respectively. Conclusion: Taking together, the study demonstrated that serum CKBM is a valuable marker for early detection of AMI, but it was found to be much more valuable when analyzed with serum LDH. Biography Yazeed Hamoud Al-Kahaf Al-Shammari is a Medical student at College of Medicine, University of Hail, Kingdom of Saudi Arabia.
Yahya Dokhi Al Tamimey is a Medical student at College of Medicine, University of Hail, Kingdom of Saudi Arabia.
[email protected]
Notes:
J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 84
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Raushan Sadykova, J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Possibilities of treatment obstructive hypertrophic cardiomyopathy: Results of the extend operation of Morrow Raushan Sadykova, Tuleutaev R and Ibragimov T National Scientific Center of Surgery (NSCS) named after A.N. Syzganov, Republic of Kazakhstan
Research objective: To evaluate early and mid-term results of treatment of hypertrophic obstructive cardiomyopathy with Morrow myectomy procedure and interventions on the sub-valvular structures of the mitral valve. Methods: Between May 2015 and May 2017, in the Department of Cardiac Surgery NSC by A.N. Syzganov, performed 13 operations of Morrow expanded myectomy in patients with obstructive form of hypertrophic cardiomyopathy. The mean age was - 41, in all patients the leading symptoms were shortness of breath associated with physical activity associated with dizziness and lipotimy. EDV LV -112.2ml, ESV LV-32.2 ml, IVS-2.4 sm, average pressure gradient at LVOT – 58 mm Hg. Mitral regurgitation of the 2nd degree in 7 patients, EF - 70.4%. SAM syndrome was observed in 11 patients. The isolated extended myectomy was performed in 11 patients, myectomy with mitral valve replacement in one patient with biological prosthesis, supra-coronary ascending aortic replacement in one case. The average follow-up period was 295 days. Results: Intraoperative TEE showed- mean LVOT gradient was 13 mmHg. In 12 patients the early post-operative period proceeded without complications. In one case – was intraoperative aortic dissection, therefore was performed hemiarch procedure. On the 5th postoperative day, the patient died, due to progression of the multiple organ failure. In the other case, on 7-10 days echocardiography showed good hemodynamic results. The mean LVOT gradient was 7 + 2 mm Hg. Mortality cases were not observed in the long-term. EDV - 124.2 ml., ESV - 46.4 ml., IVS - 1.6., PWS - 0.95. The average pressure gradient was 8 + 2 mmHg. Return of symptoms was not observed in 12 patients. Conclusions: Surgical treatment is a "gold standard" in the treatment of hypertrophic cardiomyopathy. Early and mid-term results showed good clinical and hemodynamic results. Long term results should be evaluated in single center experience. HCM 13 operations Before myectomy, with treatment B-blockators or Verapamil: the mean age was - 41 . EDV LV -112.2ml, ESV LV-32.2 ml, IVS-2.4 sm, average pressure gradient at LVOT – 58 mm Hg. Mitral regurgitation of the 2nd degree in 7 patients, EF - 70.4%. SAM syndrome was observed in 11 patients.
Morrow myectomy procedure
The one patient was died on 5th day
Biography
After myectomy- the mean LVOT gradient was 7 + 2 mm Hg. Mortality cases were not observed in the long-term. EDV - 124.2 ml., ESV - 46.4 ml., IVS 1.6., PWS - 0.95. The average pressure gradient was 8 + 2 mmHg. Return of symptoms was not observed in 12 patients.
Raushan Sadykova graduated from the Kazakh National Medical University in 2009. In 2016, she completed residency in cardiology at the Meshalkin Clinic, the Russian Federation. She works as a cardiologist in the cardiology department of the National Surgical Center named after A. Syzganov, in Almaty. My work includes examination, treatment in pre-operative and post-operative period, observation of patients in the long-term postoperative period, checkup in dynamics. She is interested by the results of early and long-term follow-up of patients with hypertrophic obstructive cardiomyopathy. Her heart team includes: the head of the department, cardiac surgeons and cardio-anesthetists. The department performs all types of cardiac surgery. We follow the latest information of the world experience of surgical, drug treatment of cardiac patients. The work of our team is constantly analyzed by an individual approach to the diagnosis, observation and treatment of each patient. The experience of European countries is interesting for us too. This conference will be the first experience of international speech.
[email protected]
J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 86
conferenceseries.com
Raushan Sadykova, J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Thoracoscopic ablation of pulmonary veins in treatment standalone atrial fibrillation: First experience in Kazakhstan Raushan Sadykova, Tuleutayev R, Rakishev B, Ibragimov T and Beguzhinov D National Scientific Center of Surgery (NSCS) named after A.N. Syzganov, Republic of Kazakhstan
Aim: To estimate results of thoracoscopic radio-frequency ablation pulmonary veins in standalone atrial fibrillation. Methods and materials: In our hospital during 2015-2017 years thoracoscopic ablation of pulmonary veins was done in 13 patients with paroxysmal and long standing persistent atrial fibrillation (AF). Operation technique included ablation of pulmonary veins, Marshall's ligament coagulation, resection of left atrial appendage and epicardial mapping to identify exit block and entrance block. Contraindications were: left atrial appendage thrombosis (for monopolar ablation), weakness of the sinus node, adhesive process in pericardium, adhesive process in pleural cavity, chronic obstructive bronchitis of the lungs (difficult long term one lung ventilation), atrium size less than 55mm. 13 patients: 9 men,4 women, mean age 58 years (33-74 years), long standing persistent AF-12 patients, paroxysmal AF-1 patient, mean time of AF-4.2 years (3 month-20 years), mean size of left atrium 4.3±0,9cm, primary catheter ablation were done in 5 patients, EF LV 54% (36-67%), mitral regurgitation was in 3 patients, LV EDV-148 ml (101-223ml). After operation all patients were treated with amiodarone 200 mg per day and anticoagulation therapy with warfarine 6 months. Control efficacy of the treatment were done by 24-Hour Holter Monitor during 1,3,6 months after operaion, mean time of follow-up 180 ±19 days. Findings: All patients were on sinus rhythm after operation and up to 6 months. Average time of hospital stay is 8 days. One patient was readmitted to the hospital due to atrial flutter which was treated in CatLab by ablation of cava-tricuspid isthmus. Recurrent atrial fibrillation after 6 months was in 1 patient. Conclusion: Thoracoscopic ablation of pulmonary veins is a perspective method of treatment standalone atrial fibrillation, accompanied with high efficiency 90.9% in mid-term follow-up, especially in non-effective catheter ablation, with low complications and fast recovery period. Our clinic has the first experience in Kazakhstan on the treatment of atrial fibrillation of thoracoscopic radio-frequency ablation pulmonary veins.
Biography Raushan Sadykova graduated from the Kazakh National Medical University in 2009. In 2016, she completed residency in cardiology at the Meshalkin Clinic, the Russian Federation. She works as a cardiologist in the cardiology department of the National Surgical Center named after A. Syzganov, in Almaty. My work includes examination, treatment in pre-operative and post-operative period, observation of patients in the long-term postoperative period, checkup in dynamics. She is interested by the results of early and long-term follow-up of patients with hypertrophic obstructive cardiomyopathy. Her heart team includes: the head of the department, cardiac surgeons and cardio-anesthetists. The department performs all types of cardiac surgery. We follow the latest information of the world experience of surgical, drug treatment of cardiac patients. The work of our team is constantly analyzed by an individual approach to the diagnosis, observation and treatment of each patient. The experience of European countries is interesting for us too. This conference will be the first experience of international speech.
[email protected]
J Clin Exp Cardiolog, an open access journal ISSN: 2155-9880
Cardiologists 2017
Volume 8, Issue 6 (Suppl)
June 19-21, 2017 Page 87
conferenceseries.com
985th Conference
18th Annual Cardiologists Conference June 19-21, 2017
Paris, France
Accepted Abstracts Cardiologists 2017 Page 88
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J Clin Exp Cardiolog 2017, 8:6(Suppl) DOI: 10.4172/2155-9880-C1-072
18th Annual Cardiologists Conference June 19-21, 2017 Paris, France Oxidative stress-induced effects on proinflammatory cytokines and vascular endothelial growth factor after interventional treatment of coronary heart disease Khaybullina Zarina Ruslanovna, Zarina Khaybullina, Mirjamol Zufarov, Nodir Sharapov, Saidarifkhon Murtazaev and Saodat Abdullaeva Republican Specialized Center of Surgery, Uzbekistan
T
his study aimed to investigate vascular endothelial growth factor (VEGF), reactive oxygen species (ROS) and proinflammatory cytokines: interleykin-6 (IL-6), tumor necrosis factor alpha (TNF-a), C-reactive protein (CRP) in the blood of the patients with coronary heart disease (CHD) after percutaneous coronary intervention (stenting) and coronary bypass operations (CBO). Malondialdehyde (MDA), IL-6, TNF-a, CRP, VEGF was analyzed in 95 patients with CHD preand post-procedure. CRP was made in automatic biochemical analyzer “VITROS-350” (USA). IL-6, TNF-alpha, VEGF was measured using ELISA kits. All of investigated markers increased versus the control before treatment (p