24^th International Conference on Cardiovascular and Thoracic Surgery 2018-06-06 June 06-07, 2018 Osaka, Japan

Biography:

Dr. Koyama is currently a vice director of the Saitama Municipal Hospital in Saitama, Japan. He has expertise in research in myocardial reperfusion injury. He has recently developed a new treatment strategy for myocardial reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI), based on the results of his previous experimental study using guinea-pig myocytes that was published in Am J Physiol in 1991. He is basically a clinical cardiologist, performing percutaneous coronary intervention himself. But his experiences not only in STEMI treatment but also in animal experiments inspired him to develop a new treatment strategy for myocardial reperfusion injury, i.e. postconditioning with lactate-enriched blood. He has already published a review paper on this new approach in IJC Heart & Vasculature, claiming that the new approach may be effective against all four types of myocardial reperfusion injury.

Abstract:

My colleagues and I recently reported a new approach, postconditioning with lactate-enriched blood (PCLeB), for preventing reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI). This approach targets reperfusion-induced hypercontracture, which compresses the microvasculature and mechanically disrupts myocardial cell skeletons. PCLeB comprises intermittent reperfusion and timely coronary injections of lactated Ringer’s solution (Figure 1), aiming to achieve controlled reperfusion with tissue oxygenation and minimal lactate washout. This approach was designed based on the results of our previous experimental study. We have reported that abrupt lactate washout during reperfusion after simulated ischemia induced contracture in guinea-pig myocytes despite a substantial decrease in intracellular Ca²⁺ concentrations ([Ca²⁺]i), which were elevated during simulated ischemia. This reperfusion-induced contracture developed in association with resensitization of myofilaments to Ca²⁺. We therefore attempted to create a transition period between ischemia and reperfusion through our new approach. During this transition period, the elevated [Ca²⁺]i was allowed to resume its normal level safely, while restoration of vigorous myocardial contraction was suspended by keeping tissue lactate concentrations high, which otherwise might lead to hypercontracture. We have treated 76 consecutive patients with STEMI (age, 65.5 ± 14.1 years; 77.6% men; 43.4% anterior STEMI) using percutaneous coronary intervention and PCLeB within 12 h of symptom onset since late 2011. No patient experienced ventricular tachycardia or fibrillation during reperfusion. After PCI, corrected TIMI frame count was 20.4 ± 11.1 (normal value, 21). Peak creatine kinase and creatine kinase-MB levels were 2707 ± 2099 and 264 ± 170 IU/L, respectively. No patient died or experienced worsening/new-onset heart failure at 30 days. Only one patient required oral diuretic therapy at discharge. In conclusion, PCLeB induced augmented microcirculation recovery, abolished reperfusion arrhythmia, and led to zero mortality and no worsening/new-onset heart failure at 30 days in 76 consecutive patients with STEMI.

Biography:

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

Abstract:

Objectives: Heart transplantation is the last surgical option for infants and young children with congenital heart failure after failed conventional repair or palliative procedures. We aim to present our results in a retrospective and descriptive analysis.

Methods: 18 heart transplantations on children (nine female, nine male) were performed from 1988 to 2015. The range of age was between 0 days and 3 years. Indications for a transplantation were hypoplastic left heart syndrome (n=14), non-compaction-syndrome (n=2), Bland-White-Garland-syndrome (n=1) and transposition of the great arteries (n=1). 14 children (78%) had had a previous cardiac surgery. Four patients (22%) required mechanical circulatory support for bridging: ECMO (n=2; 11%), or LVAD and ECMO (n=2; 11%). 15 (83%) underwent a biatrial method, three (17%) a bicaval one.

Results: The median waiting time after listing was 68 days (min: 0 days, max: 386 days, standard deviation (SD): 102.8 days). The overall survival was 61%, 13 children (72%) survived the first year. Two patients (11%) had a retransplantation. The median time patients spent at intensive care unit was 17 days (min: 1 day; max: 121 days). They were respirated for 7 days (min: 1 day; max: 91 days). Perioperative factors we analyzed were: the median myocardial ischemia time was 236 minutes. the median aortic clamp time was 95 minutes, the median time of circulatory arrest was 60 minutes. Three children (17%) got a pericardial effusion. Two patients (11%) suffered each: bleeding, cardiac arrhythmias, diaphragmatic paresis and cerebral complications. Five (28%) got a lymphoproliferative disease. Seven children (39%) got a coronary graft vasculopathy. Two (11%) needed interventional therapy. Three (17%) got a cardiac pace maker. According to our data, six children had a rejection which called for treatment.

Conclusion: Heart transplantation is still the best therapeutic option after end-stage heart failure in children. Cumulative results suggest one additional year of life in more than 70% and a survival of more than 20 years is possible. These results were comparable to those of the ISHLT registry in pediatrics.

Biography:

Abstract:

Sclerosing mediastintis is a rare non -malignant condition characterized by fibrous tissue proliferation in the mediastinum. It could be primary or secondary. It typically presents in adulthood. Sclerosing mediastinits is extremely rare in the pediatric age group. The extensive fibrosis of  mediastinal soft tissues  may cause compression of the mediastinal vasculature, airway or oesophagus. Possible  treatment avenues are medical ,surgical resection and local therapy for complication. We report a  six year old child ,weighing fifteen kilograms , who presented to the emergency department with respiratory collapse. Endotracheal intubation was done with a cuffed 3mm tube because the trachea was found to be slit like and would not accommodate a larger tube. Contrast CT ((Computerized Tomography) scan showed a homogenous non - enhancing mass in the anterior mediastinum and neck , obliterating the normal mediastinal fat planes and compressing the distal 3cm of the trachea. There was no vascular compromise or oesophageal compression . CT guided biopsy was reported as ? thymoma. The child was taken up for excision biopsy/debulking. The intra operative finding was  a very hard mass in the anterior mediastinum extending to the neck. Subtotal resection was done . The child was extubated on the first post operative day and discharged on the fifth day. Histopathological examination  was reported as Sclerosing mediastintis. This was a histological surprise. The child was then evaluated for tuberculosis, fungal infection, retroperitoneal fibrosis and autoimmune disease. All were negative. She returned a month after surgery with a massive right pleural effusion. Pleurocentesis was done twice. Fluid analysis did not help in diagnosing the etiology. The fluid rapidly reaccumulated. Tube thoracostomy was done and Methylpredinisolne begun. The quantum of fluid decreased, but continued to drain. Antituberculous therapy was empirically begun. The patient did well thereafter.

            Etiologically , most cases of Sclerosing mediastintis are Idiopathic / Primary  or Secondary. Secondary cases are caused by (i) infection ( Tuberculosis, fungal infection –commonest being Histoplasmosis) (ii) concurrent intrathoracic malignancy -- commonest being Hodgkin’s disease. (iii) Sarcoidosis (iv) radiation therapy (v) drugs like Methysergide.  Association could be (i) Riedel’s thyroiditis (ii) retroperitoneal fibrosis (iii) autoimmune disorders such as Systemic Lupus Erythematosis & Rheumatoid Arthritis (iv) Sclerosing cholangitis .

The pathological  types are (i) focal - 80% and (ii) diffuse – 20% . It is slowly progressive and hence asymptomatic for a long time. The clinical presentation could be systemic symptoms (fever, weight loss ) or due to airway involvement ( stridor, dyspnoea, wheezing, post obstructive pneumonia, atelectasis ), vascular involvement ( Superior Vena Cava syndrome, pulmonary hypertension, arterial or venous infarct) or oesophageal involvement  (dysphagia, oesophago-bronchial fistula)

Imaging modalities used are CT scan or MRI( Magnetic Resonance Imaging ). It has an unpredictable course. The three possible avenues for treatment are (i) medical – anti tubercular or anti fungal and corticosteroids (ii) surgical resection (iii) local therapy for complications. Prognosis depends on etiology and the structures involved.  

Biography:

Riju Nair is a Resident in Cardiac Surgery at Meenakshi Mission Hospital, Madurai. After obtaining his medical degree from the prestigious Amrita Institute of medical sciences Kochi, he served the Government of Kerala (India) for about 3 years addressing medical needs of the rural sector. His passion for surgery was never-ending and he finally joined cardiac surgery. His interest in academic forums and presentations has won him honors from veterans in the field among others. He has authored multiple articles concerned to his specialty.

Abstract:

Introduction: Even in this era of reperfusion, mortality due to complications of myocardial infarction (MI) still remains high. Post MI complications requiring surgical intervention are ventricular septal rupture (VSR), free wall rupture (FWR) and acute mitral regurgitation (AMR). Timing of surgical intervention has always been a topic of debate among surgeons. Studies comparing intervention at two different times are scarce. In a tier two city where the luxuries of portable diagnostics and advanced cardiac care are limited, diagnosis of any mechanical complication is usually a death sentence. We at Meenakshi Mission Hospital have retrospectively analyzed cases presented to us in the past and have devised a strategy to tackle them with excellent results.

Method: A retrospective analysis of cases presented to us in the past 10 years. A total of 17 patients with mechanical complications were managed in our hospital. Cases were divided into two groups. Those who presented early i.e. within 24 hours of diagnosis and those who presented late i.e. after 24 hours of diagnosis. Both the groups were matched for age, sex, co-morbidities, left ventricular function and end organ damage at the time of presentation. All patients received same treatment as per our routine protocol. Both groups were statistically analyzed for results.

Result & Conclusion: VSR was the most common complication encountered (88.24%). The median age at the time of presentation was 60 years. Cardiogenic shock was the most common mode of presentation (70.59%). The incidence was found to be more among men (88.24%) than women which is contrary to the existing beliefs. Our overall surgical mortality was 29.41%. Mortality was seen more in the group who presented late. This difference was found to be statistically significant (p value-0.001). Sub-group analysis: Using a “double patch” to repair VSR was found to be superior to a single patch and this difference was also found to be statistically significant (p value-0.016).

Biography:

Dikshya Joshi is currently working in Shahid Gangalal National Heart centre in Nepal

Abstract:

Introduction: Left Main Coronary Artery Disease (LMCAD) is associated with higher mortality in patients undergoing Coronary artery bypass grafting (CABG). We sought to review the predictors of mortality in LMCAD population who underwent CABG.

Methods: Hospital records of all consecutive patients who underwent CABG between April 2004 and August 2016 were evaluated in this retrospective study. Data regarding demographic profile, risk factors for coronary artery disease, functional class, left ventricular ejection fraction (LVEF), use of Intra-aortic Balloon Pump (IABP), complications, ICU stay, duration of mechanical ventilation and mortality were assessed.

Results: One hundred seventy patients underwent CABG for LMCAD during the study period. Mean age was 60.4±10 years, and 141(82%) were males. Mean Euroscore for our patients were 6.2±8.3. Mean number of vessels grafted were 3.2±0.9. IABP was used in 52(30.6%) patients perioperatively. The overall mortality was 22 (12.9% 95% CI 7.78-17.82%). Bivariate correlates of mortality were calculated and significant variables were included in multivariate analysis. Independent predictors of mortality were Age (OR 1.85 CI 1.6-2.1; p<0.01), LVEF<50% (OR 3.13 CI 1.26-7.8; p<0.01), and use of IABP, (OR 3.24 CI 1.3-8.08; p<0.008). Follow up was available for 70 patients with a mean duration of 32±2.2 months. Most of the patients are in CCS class I (80%). One of the patients required re-do CABG for graft occlusion 6 months after surgery. 

Conclusion:Surgery for LMCAD has higher risk when performed at older age, lower LVEF and the requirement of IABP. However, requirement for reintervention remains low at intermediate follow-up.

Keywords: CABG, left main disease, LMCAD, surgery

Biography:

Fabián Andrés Giraldo Vallejo is a cardiovascular surgeon with expertise in coronary artery bypass surgery (CABG) and valve surgery (mitral and aortic). He also teaches General Surgery residents in their last year of training.

Abstract:

Self-inflicted intra-cardiac foreign bodies are a rare occurrence. The migration of such objects into the heart chambers can cause cardiac complications including pericarditis, infective endocarditis, cardiac tamponade, arrhythmias, ventricular perforation and death. There is no consensus for the treatment of a cardiac foreign body; some authors suggest surgical removal of a foreign body over a conservative management. We report a case of a self-inflicted injury to the heart by a needle, presenting with nonspecific chest pain and subsequently complicating with cardiac tamponade secondary to right ventricle perforation, this needle was successfully extracted four months after its insertion.

Biography:

Indhu Umapathi, an aspiring medical student is interested in global health and evaluation of various medical practices under her cover. She wants to pave way to new discoveries by learning about their main root cause rather than treating an occurring symptom. She has got her Bachelor of Arts in Psychology and also owns a certificate in Global health course from United States University, San Diego, which strengths her interest in various fields such as health literacy, health economy and inter professional education.  She is also an active member of International Academy of Medical Specialist.

Abstract:

Statement of the problem: Cancer very seldom starts in the heart. But when it does, it can be deadly. An increased incidence of diagnosed primary cardiac tumours has been reported since the improvement of non-invasive imaging modalities. Heart cancer (primary cardiac tumour) arises in the heart which can be malignant and also benign.  There are many types of tumour such as Lipoma, papillary fibroelastoma, rhabdomyoma etc.

Methodologies and theoretical observation: Cancerous (malignant) tumours that begin in the heart are most often sarcomas, a type of cancer that originates in the soft tissues of the body. Metastatic lesions are, by very definition, malignant in nature and are far more commonly encountered than primary tumors. Metastasis to the heart from other primary cancers is 30 times more common. Only 25% of primary cardiac tumors are malignant, and, of these, 75% are sarcomas.

Findings: To cardiologists, the stem-cell technology is a blockbuster discovery, since the heart has been pegged as a disadvantaged organ in terms of injury, healing, and repair.

Conclusion and significance: Scientists have known that adult stem cells can be found in the heart. This has prompted numerous centers in many countries to pursue stem cell therapeutics in patients with heart attacks, heart failure, and even severe angina to repair muscle and improve blood supply, which can also attempt to cure heart cancer in deciduous way.  The work is moving fast and furiously to make it as a standard part of cardiac care. 

Biography:

Graduate of Charing Cross & Westminster Medical School, London University, and trained at St. Mary’s Hospital, Guy’s & St. Thomas’ Hospital, Yiu Che CHAN returned to Hong Kong in 2007 and now works as Associate Professor in Division of Vascular Surgery at the University of Hong Kong. He was UCLA Travelling Scholarship to University of California, Los Angeles in 2012, and he is the Director of Surgical Admissions at University of Hong Kong, and the Secretary General for the Asian Surgical Association. He is a vascular surgeon specialising in open and minimally invasive endovascular surgery involving the aorta, peripheral arteries and veins. He is a holder of multiple international and local research grants, and has published over 100 papers.

Abstract:

Introduction: Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde Type A aortic dissection following initially successful hybrid endovascular treatment.

Methods: Retrospective review of prospectively collected computerised departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde Type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected.

Results: We report 6 patients who developed retrograde Type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, 1 had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stentgrafts (Cook®, Bloomington, USA), and 1 had Medtronic® Valiant stentgrafts (Medtronic Vascular Inc, Santa Rosa, USA). The retrograde Type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128 respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died at 9 month of pneumonia, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived.

Conclusion: Supra-aortic hybrid procedures in treating aortic arch pathology are not protective of retrograde Type A dissection, and patients with this post-operative complication inevitably have poor outcome, even with early diagnosis or treatment is delayed

Biography:

Hossam Eid has expertise in cardiothoracic surgery and is passionate in improving the health and wellbeing. He is currently a senior specialist cardiothoracic surgeon at Dubai health authority (DHA) since 1994. He is currently working as a Professor of cardiothoracic surgery in Ain shams University Cairo, Egypt. He is the regent of The European Society of Thoracic surgeon in UAE since 2008. He is also one of the founders of cardiothoracic surgery department in DHA and introduced many surgical techniques in DHA like PDA clip closure in premature newborns 1994, left ventricular endoaneurysmorraphy 1995, endoscopic vein harvesting 1998, VATS 1999 and surgical atrial ablation for AF in 2005. He has many scientific publications and has also participated in international conferences.

Abstract:

Background & Aim: Over the past ten years, the fast development of Dubai city required establishment of dedicated trauma center. The increasing number of work related injuries and road traffic accidents has increased the number of patients received by Rashid Trauma Center. The purpose of this study is to describe the experience of our center in dealing with chest trauma and to highlight recent updates in the management strategy.

Methodology: We have analyzed more than 4000 chest trauma cases who presented to Rashid Trauma center between 2006-2016, demographically, clinically and radiologically. We have established a protocol for managing blunt and penetrating trauma cases; we analyzed associated injuries as well as morbidities and mortalities.

Findings: The Mortality rate in isolated thoracic injuries depends on the anatomical site and Injury severity score. We found that majority of our thoracic trauma was part of polytrauma cases.

Conclusion & Significance: Thoracic trauma is a common and usually associated with other body injuries. Early diagnosis and management in specialized trauma center with multi-disciplinary team is vital for favorable outcome.

Recommendations: Recent update in management of chest trauma cases time and make intervention less invasive with better survival.

Biography:

Abstract:

Biography:

Abstract:

Biography:

I am graduated in 2005 from university of medicine and pharmacy "Victor Babes" Timisoara, Romania.After internship I gained two years experience in General Surgery, In 2009 I got enrolled in Master of cardiac surgery 6(six) years programe at Post graduate medical institute conducted by University of health science, I did my 6 years cardiac surgery rotation at Punjab institute of cardiology .After completion of my master degree in cardiac surgery i joined department of cardiovascular surgery at Shalamar medical and dental college,

Currently I am working as assistant professor as shalamar medical & dental college,

Abstract:

Acute renal failure after cardiac surgery is a serious complication that is closely associated with postoperative mobidity and mortality. In previous studies that evaluated risk factors for acute renal failure , most of the identified risk factors were not modifiable (eg,

diabetes mellitus, preexisting kidney disease). In this present single center study of 1000 adult patients undergoing cardiac surgery in 2015, we focused on identifying potentially modifiable risk factors for postoperative Acute renal failoure.

We found that acute renal failure, as defined by consensus-based criteria (_25%, _50%, and _75% decrease in estimated glomerular filtration rate or need for dialysis within 1 week of surgery), was independently associated with a _4-fold increase in death rates. Three common and potentially modifiable variables (preoperative anemia, red blood cell transfusions, and surgical reexploration) were highly associated with Acute renal failure, even after adjustment for other perioperative risk factors (eg, preoperative intra-aortic balloon

pump, cardiopulmonary bypass duration). Given these results, we propose that randomized trials are now needed to determine whether interventions that modify these risk factors might also prevent Acute renal failure after cardiac surgery

Cox regression was used to correct for various established demographic preoperative risk indicators, intraoperative parameters, and postoperative complications

Conclusions—Acute renal failure  after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication.

Biography:

Dikshya Joshi is currently working in Shahid Gangalal National Heart centre in Nepal

Abstract:

Background: Preoperative coronary angiogram is routinely performed in high risk age-group in rheumatic population undergoing valve surgery at our centre. Preoperative angiogram itself carries risks. We sought to evaluate the prevalence of coronary artery disease in those patients so that recommendations on preoperative angiogram can be made.

Methods: We reviewed medical records of patients above 35 years who underwent valve surgery from January 2015 to July 2017. We defined significant coronary artery disease as ≥50% stenosis in one or more major coronaries. Overall prevalence and age-specific prevalence were determined.

Results: A total of 675 patients above 35 years of age undergoing valve surgery were assessed for eligibility. Among them, 563 (84.3%) patients had rheumatic heart disease. However, only 337 patients had undergone preoperative angiogram and were included in the analysis. Overall prevalence of coronary artery disease was 13(2.3%). Age-specific prevalence was as follows: age-group 40-50 years 0 of 127 patients (0%), 51-55 years 6 of 95  patients (6.3%), 55-60 years 1 of 56 patients (1.7%), and more than 60 years 6 of 52 patients (11.5%). Prevalence did not significantly differ between male and female population.

Conclusion: The prevalence of coronary artery disease in rheumatic patients requiring valve replacement seems to be lower compared to the available prevalence data of general Nepalese population. There were no cases of angiographically significant coronary heart disease in the age between 40-50 years. However, the results of this study should be inferred with caution and prospectively planned study with risk factor analysis is warranted.

Keywords: Coronary angiogram; Prevalence; Rheumatic heart disease; Valve replacement surgery.

Biography:

Salvatore Spagnolo currently working in Cardiosurgery (ICLAS - Istituto Clinico Ligure di Alta Specialty)

Abstract:

In superior vena cava syndrome (SVCS), the venous blood from the upper torso reaches the right atrium through four well-known collateral pathways. Unexpectedly, numerous imaging studies showed that in the left brachiocephalic venous stenosis the blood reverses its flow direction and heads towards the jugular and cerebral veins. Venous flow direction is always unidirectional and centripetal, while the bidirectional flow is a unique feature of compensatory venous circle. The jugular vein reflux, well described in the literature, can only be interpreted as a typical centrifugal flow of a collateral circulation. Our hypothesis is that the cerebrospinal venous system itself constitutes a compensation circle, which connects the superior vena cava to the inferior one. This hypothesis is corroborated by the current knowledge on the cerebrospinal venous system that is considered a unique, valve less, bidirectional flow circuit that freely communicates with superior and inferior vena cava. From 2010 to today we have operated for plastic enlargement with patches in the saphenous vein, 120 patients with congenital stenosis of the superior vena cava system. Here we report the angiography of first two patients with vena cava stenosis; in one we describe the inversion of flow from the location of the obstruction towards the cerebrospinal circle and in the other we describe the passage of venous blood from peripheral tissues to the cerebrospinal circle. The continuous passage of venous blood from the superior cava system into the cerebrospinal circulation opens up new perspectives in the explanation of etiopathogenesis of many neurodegenerative diseases (infant neurological diseases, multiple sclerosis, Parkinson’s disease and Alzheimer’s). In vena cava stenosis then, the cerebrospinal circle is subjected to an increase in pressure, in volume overload and in the possibility, as demonstrated in literature, that infections, emboli or tumors can be transmitted directly from the periphery to the brain through the venous route.

Biography:

Abstract:

Pleuropulmonary  Blastoma (PPB)  is a rare primitive primary neoplasm of the thorax in children . It may arise in the pulmonary parenchyma ,pleura and / or mediastinum.PPB arises from the primitive mesenchymal cell and is encountered in the first few years of life.  Three subtypes (Type I,II,III) are a continuum from the least to the most malignant lesion . An international registry (ppbregistry.org) has been established. Treatment is multimodal (surgery and chemotherapy, rarely radiation therapy) and depends on the type and aggressiveness of the disease.   We report a  3 year old child weighing, 15 kilograms,  who presented to the pediatrician with history of cough and fever of 2 weeks duration. Contrast Computerized Tomography (CT) scan  of the thorax  displayed a large (100 x 55 x 53mm),well- defined ,heterogeneous (80-120HU) mass ,occupying two - third of the left hemithorax. The mass had a focal enhancing soft tissue component with thin septae. Lung parenchyma was found inferior to the mass. Trachea and main bronchi were normal. CT guided biopsy of the mass was reported as round cell tumor. The patient underwent surgery via a left posterolateral thoracotomy via the 4^th intercostal space. A heterogenous (predomintly solid with few cystic areas) mass ,12x14cm was found occupying the upper two – thirds of left hemithorax,adherent to chest wall, pericardium and the left lobe of thymus . The mass had infiltrated into the lower lobe of lung.The upper lobe and  Lingula were not identifiable. Three hilar lymph nodes which were 1cm in diameter and firm in consistency were present. Enbloc excision biopsy was done and tissue sent for histopathological examination(HPE). The HPE  report  was PPB type lll involving the lymphnodes ; the bronchial surgical margins were free of tumor.The adjacent lung parenchyma showed interstitial pneumonia. Chemotherapy was begun one  month after surgery. The child succumbed after the third cycle of chemotherapy.

PPB is an aggressive tumor accounting for less than 1% of all primary malignant lung tumors in the pediatric population  . Manivel and associates coined the term PPB on the basis of its exclusive clinical presentation in childhood and its pathologic features of primitive embryonic- like blastoma , absence of carcinomatous component and potential for sarcomatous differentiation . Dehner and associates classified PPB into 3 types Type I- Purely cystic , Type II- intermediate or mixed ( cystic &solid), Type III –predominantly solid . A progression from type l to type lll may occur over time . It can  arise from lung,pleura,mediastinum and/or diaphragm.This has raised the possibility that PPB may originate from splanchnopleural or somatopleural mesoderm. Bilateral occurrence is very rare. Common metastatic sites are brain,bone,lymphnodes,liver,pancreas,kidney and adrenal gland.

30-40% children with PPB may have cancers such as multilocular cystic nephromas, ovarian tumors and thyroid tumors---this is known as PPB familial cancer syndrome or the DICER  I syndrome. Many of these patients have mutation of the DICER  I gene.

The tumor has no characteristic findings on imaging studies. Biopsy is the mainstay for diagnosis. Radical surgery followed by chemotherapy and / or radiation therapy is the treatment pathway followed The prognosis is grave. Type II & III PPB have a projected overall survival of 62% at 2  years and 42% at 5 years , even after multimodality therapy and those with pleural , mediastinal  or   extrapulmonary involvement have worse prognosis .

Biography:

Graduate of Charing Cross & Westminster Medical School, London University, and trained at St. Mary’s Hospital, Guy’s & St. Thomas’ Hospital, Yiu Che CHAN returned to Hong Kong in 2007 and now works as Associate Professor in Division of Vascular Surgery at the University of Hong Kong. He was UCLA Travelling Scholarship to University of California, Los Angeles in 2012, and he is the Director of Surgical Admissions at University of Hong Kong, and the Secretary General for the Asian Surgical Association. He is a vascular surgeon specialising in open and minimally invasive endovascular surgery involving the aorta, peripheral arteries and veins. He is a holder of multiple international and local research grants, and has published over 100 papers.

Abstract:

Introduction: The aim of this study is to examine the ascending aortic and arch characteristics in a cohort of Chinese patients who had arch and descending aortic pathology, and to compare with a control group of patients who had abdominal aortic pathology without thoracic aortic pathology.

Methods: Prospectively collected computerized database on 3 groups of patients: 1. degenerative arch aneurysms 2. chronic Type B thoracic aortic dissection with aneurysmal changes 3. patients with infrarenal aortic aneurysms. Their computed tomography images were analysed using Aquarius workstation (TeraRecon, San Mateo, USA) and measurements of aortic diameter was measured at intervals from the root , ascending, arch to just proximally to the left subclavian artery. Comparisons were made and statistical analysis was with ANOVA, with a p-value of ≤0.05 taken as statistical significant.

Results: There were 30 patients in each group. Patient in group 1 were older than group 2 (age 771.1+8.6 versus 61.9+14.5, group 3 73.7+10; p<0.001). Maximum sac sizes were larger in group 1 than group 2 (71.7+2.84cm versus 57.7+1.96; p=0.001). Regarding mean diameters at various levels, Group 1 were statistically larger than groups 2 and 3, whilst there were no statistical difference between group 2 and 3 (Table I). For maximum aortic dimensions, the group 1 diameters were near or more than 40mm, whilst group 2 mean diameters were less than 40mm (p<0.01 at all levels) (Table II). Having an arch aneurysm was the only significant predictor of having a mid- or distal-ascending diameter of ≥40mm (Odds ratio 4.57; p=0.007).

Conclusion: This study showed that ascending aortic diameters are often dilated and unhealthy in patients with degenerative arch aneurysms, compared with those with chronic dissections with aneurysmal changes or with infrarenal aortic aneurysms. Such unfavourable anatomical criteria may prevent the applicability of pure endovascular arch repair.

Biography:

Abstract:

AIM OF THE STUDY: To present the results of surgical treatment of total anomalous drainage of pulmonary veins (TADPV) complicating high pulmonary hypertension (HPH). TADPV is a rare pathology and accounts for 0.1-3.0% among other congenital heart defects.

MATERIAL AND METHODS: Between 2015 and 2017, surgical procedures were performed on 16 patients with TADLV complicating HPH at the age of 2 to 18 (average 3.6 ± 2.4 months.) who has  3.9 to 10 kg body weights (average 6.1 ± 1.8 kg) in congenital heart diseases’ surgery department, at the RSCS named after V.Vakhidov. The interventricular septum was displaced in 6 patients toward the left ventricle by EchoKG signs. All patients received sildenofil and diuretic therapy before the surgery. The time of artificial circulation lasted from 43 minutes to 76 minutes (average 54 ± 9.1 minutes), aortic clamping lasted from 32 to 68 minutes (average 47 ± 6.8 minutes).

RESULTS: Multislice computed tomography with contrasting (MSCT) was performed in 7 (43.7%) patients to clarify the anatomy of the defect. The measurement of invasive pulmonary artery pressure was detected by angiocardiography (ACG) in 5 (31.2%) patients. The radical correction of the defect was seen in 4 (25%) patients by  EchoKG data. The lethal outcome in the early postoperative period was 6.2% (1 patient) and the main cause of the death was a pulmonary hypertensive crisis. According to EchoKG data, systolic pressure in the right heart decreased to 50% on the average from the systemic one in 11 (68.7%) patients in the postoperative period. In 4 (25%) patients, it decreased to 30% from systemic pressure.

CONCLUSION:1.The radical correction of TADPV could be performed without an ACG study. 2. MSCT with contrasting and echocardiography give complete information about anatomy and hemodynamics of the defect. 3. The results of our study show that the radical correction at on early ages would give good immediate and long-term results.