18 CARIBBEAN CARDIAC SOCIETY

Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean

PROGRAMME

EDUCATE INFORM UPDATE

CARIBBEAN CARDIAC SOCIETY 33rd CARIBBEAN CARDIOLOGY CONFERENCE

St. Lucia July 18 - 21, 2018 2

018

Table of Contents

Messages 2

Conference Information 3

Organizing Committee 7

Sponsors/Exhibitors 8

Past Honourees 9

Council Members 10

Profile of St. Lucia 11

Invited Faculty 13

Past Presidents 14

Social Programme 15

Schedule at a Glance 16

Conference Schedule 17

Official Opening Ceremony Programme 18

Abstracts 30

33nd Caribbean Cardiology Conference

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Message from the President

Dear Colleagues, On behalf of the Council and Organising Committee of The Caribbean Cardiac Society, I welcome you to the 33rd Caribbean Cardiology Conference in beautiful St. Lucia. The conference continues to grow and this year with the theme “Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” is highlighted by the presence of The President of the American College of Cardiology, Dr. Michael Valentine as he delivers The Annual Cardiology Lecture: STEMI Systems of Care-

Best Practices in 2018. The conference also features The Keynote Lecture at the Opening Ceremony by Cardiac Surgeon Dr. Duane Sands, Minister of Health in The Bahamas: Clinician to Policy Maker: The View from the Other Side. Their contributions should complement this year’s “theme” and provoke much discussion at the “Caribbean Regional STEMI Network Panel discussion” as we at The CCS strive to introduce a Regional STEMI Network Programme to improve the cardiac care to our citizens and bring our mortality down to acceptable limits. After the very successful Paediatric Cardiology Session last year and encouraged by the many Paediatric Cardiology abstracts submitted we will again have a session dedicated to Paediatric Cardiology on the final day of the conference. Enjoy the science, the friendships and the networking, but also enjoy the social programme put on by the organizing Committee, the wonderful Royalton Complex and St. Lucia. Richard G. Ishmael MBBS, FAAP, FACC, FRCPC, FCCP, FESC. President Caribbean Cardiac Society

Dear All, Welcome to Saint Lucia, a land of enchanting natural beauty, charm, and warm, friendly people. It is a pleasure to have you back having hosted three (3) previous Caribbean Cardiac Conferences. We live in an everchanging world and the Caribbean has changed since the conference here in 1998. There are now more resident Caribbean Cardiac Professionals throughout the region and this presents many challenges to us who have daily resource constraints. Our conference will touch on some of these challenges and seek to address solutions for we are a resourceful people.

We hope you will take the time to relax, renew old acquaintances, make new friends and share old and new knowledge. While here we invite you to enjoy Saint Lucia and all that it has to offer. Dr Martin Didier, SLC CBE MBBS, DM, FACP, FRCP (Edin), FESC, FACC.

Message from the Conference Chairman

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean”

About the Conference

This educational activity is designed to inform, educate and update the Caribbean’s cardiac care professionals on emerging treatments, modalities, diagnostic techniques and equipment appropriate for the optimization of the diagnosis, treatment and management of the cardiovascular patient in the Caribbean. The approaches, treatments and diagnostic tools discussed will be assessed for their applicability and accessibility within the Caribbean.

Accreditation Statement The 33nd Annual Caribbean Cardiology Conference has been planned and implemented in accordance with the essential policies of the Medical Council of Jamaica through the Caribbean Cardiac Society. The conference has been approved for a maximum of twenty-two (22) hours of continuing medical education. Each participant should claim only those hours that he/she actually spent in the activity.

Evaluations and CME Certificates Participants will be asked to complete evaluations electronically at the conclusion of the conference and CME certificates will be sent by e-mail at the conclusion of the meeting. Please ensure that you provided a correct email address at registration.

Faculty Disclosures All participating faculty are expected to disclose to the programme’s audience any real or apparent conflict of interest that may have direct bearing on the subject matter of their presentation. These disclosures are not intended to suggest or condone bias in any presentation, but rather are made to provide participants with information that might be of potential importance in their evaluation of a presentation.

Disclosure of Potential Conflict of Interest The following speakers HAVE indicated the listed relationship(s), which pose a potential conflict of interest.

The following speakers HAVE indicated they will be discussing off-label products in your presentation:

Jose Ettedgui Consultant: St. Jude Medical/Abbott

Racquel Lowe-Jones Grant/Research Support: International Society of Nephrology and Kidney Research UK

Raul Garillo Consultant: Medtronic Latin America

Ross Feldman Speaker’s Bureau: Servier Canada

Kak-Chen Chan

Monique Monplaisir

Conference Information


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The following speakers have indicated that they DO NOT HAVE such a relationship to disclose:

Faculty not listed above HAVE NOT completed Faculty Disclosures and will be required to do so prior to making their presentation. In absence of a written disclosure they will be required to disclose verbally, before they present, any potential conflicts of interest and any discussion of off-label products.

Questions and Answers In order to make sure presenting faculty have the opportunity to address the most important questions we will be using a simple online tool that allows you to easily submit your questions. During discussion segments please open a web browser on your smartphone or tablet, go to www.slido.com and enter the event code #CCS2018. In the app, you can ask questions and vote for the best ones.

WiFi and Social Media WiFi will be available in the meeting room and exhibit hall. Follow us on Facebook, tweet at us @CaribCardiac, and use the hashtag #CCS2018StLucia to engage with faculty, staff and your fellow attendees.

Function Tickets

Social event tickets can be purchased from the Secretariat any time during the opening hours listed above subject to availability.

Registration & Secretariat Hours

The Secretariat is located in the Castries Boardroom. Tuesday July 17, 2018 2:00pm - 5:00pm

Wednesday July 18, 2018 7:00am - 5:00pm

Thursday July 19, 2018 7:00am - 5:00pm

Friday July 20, 2018 7:00am - 5:00pm

Saturday July 21, 2018 7:00am - 2:00pm

Aleem Azal Ali Michael Valentine

Amar Singh Monique Monplaisir

Bathinaiah Doddi Pankaj Gundad

Beatriz Rivera Rodriguez Racquel Lowe-Jones

Dabor Resiere Ravikishore Amancharla

Delphina Vernor Renee Alfred

Demeytri Ramnarase Rizwan Hossain

Dhruva Kumar Krishnan Rosanna Landes

Duane Sands Rosario A Colombo

James R Wilentz Ryan Brooks

Jocelyn Inamo Sripadh Upadhya

Kak-Chen Chan Susie Sennhauser

Kenneth Connell Victor Elliott

Kishan Ramsaroop William B. Moskowitz

Kurlene Cenac

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Name Badges

Your name badge serves as your passport to all educational sessions and the exhibit area. You must wear your name badge at all times. Social function tickets will be included in the name tag holders and must be presented at each event. Participants will not be admitted to social functions without the appropriate ticket.

Blue Full Registration

Grey Guest Registration

Green One Day – Thursday

Orange One Day – Friday

Purple One Day – Saturday

Red Staff

As in any metropolitan area, we recommend for your safety that you do not wear your name badge in public outside of the hotel/Conference function areas.

Refunds and Exchanges Refunds will not be issued until after the Conference. Tickets for Conference social events are NOT refundable.

Dress Code Business casual dress is encouraged for conference sessions. Meeting rooms can get quite cold so attendees are reminded to take with them an extra layer, a light jacket or a sweater. The Annual Awards Banquet is a formal event while the Conference Party Cruise is casual.

Child Policy Children are not allowed in Meeting Rooms or Exhibit Halls. Children tickets can be purchased for the Conference Dinner & Party at the Conference Secretariat.

Lost and Found If you have lost or found an item, please contact the Conference Secretariat.

No Smoking Policy The Caribbean Cardiac Society promotes a No Smoking policy. The use of tobacco products or any type of electronic nicotine delivery system is strictly prohibited in the Conference Centre, all hotel meeting rooms and venues hosting CCS events. Thank you for your compliance.


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Helpful Phone Numbers

Air Caraibes 1-758-452-2348

American Airlines 1-758-459-6500

Caribbean Airlines 1-758-454-8686 / 758-452-7556

Delta Air Lines Inc 1-758-454-3119

LIAT 1-758-452-2348

US Airlines 1-800-622-1015

Avis Car Rentals 1-758-452-2700

Budget Rent-A-Car 1-758-452-9887

Hertz 1-758-452-0680

Thrifty Car Rental 1-758-451-6150

Meals at Royalton Conference Registration includes coffee breaks only. Guests of the Royalton can enjoy lunch at any of the many outlets available on-site. Persons who are not staying at the Royalton Resort may choose to purchase a Lunch Pass at the hotel’s front desk or the conference secretariat. Lunch passes will be available for US$40.

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Organizing Committee

Dr. Ronald Henry Trinidad & Tobago

Dr. Richard Ishmael Barbados

Dr. Martin Didier St. Lucia

Dr. Henry Steward Curaçao

Dr. Romel Daniel St. Lucia


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Sponsors & Exhibitors

PLATINUM

SILVER

Boston Scientific del Caribe JMH International

Pfizer

SPECIAL

Health City Cayman Philadelphia International Medicine

EXHIBITOR

Biomedical International Boehringer Ingelheim

Bryden Strokes/American Hospital Supply Cleveland Clinic Florida

Fundacion Cardiovascular de Colombia - HIC Holy Cross Hospital International Med-X Laboratories Servier

Memorial Healthcare Reva Air Ambulance

Roche Diagnostic TCI Medical Supplies

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Past Honourees

1991 2004 2012

Prof. Mario Garcia Palmieri Centre Hospitalier Universitaire de Fort-de-France

Dr. Mercedes Dullum

Sir Kenneth Stuart Dr. Albert Penco

Dr. H.A.L. McShire

2005 2013

1995 Prof. Trevor Austin Hassell Dr. Roy Tilluckdharry

Prof. Sir Magdi Yacoub The Sir Victor Sassoon (Bahamas)

Dr. Theo Poon King 2014

2006 Dr. Robert Giugliano

1999 Dr. Knox Hagley

Dr. S. Sivapragasm Mrs. Phyllis Francis 2016

Dr. Winston Ince Cardiology Unit, University Dr. Conville Brown

Dr. Tarcisio Kroon Hospital of the West Indies Dr. Hafeezul Mohammed

Dr. Keith McKenzie

Dr. George Wattley 2007 2017

Dr. Cyril Nelson Prof. Gerald Grell Cleveland Clinic

Dr. Dominque Larifla Community Chest

Dr. Phillipe Cohen-Tenoudji

2000

Dr. Cecil Bethel 2008

Prof. Charles Denbow

2001 Mrs. Cynthia Hassett

Dr. Donald Christian

Dr. Richard Haynes 2009

Dr. Ronald Henry

2002 Dr. Richard Ishmael

Dr. James Ling

Dr. Michael Wooming 2010

Dr. Edward Chung

2003 Mrs. Beverley Dinham-Spencer

Dr. Yves Donatien

Prof. Edwin Besterman 2011

Prof. Howard Spencer The Grenada Heart Foundation


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Dr. Donald Christian Jamaica

1989 - 1992

Prof. Trevor Hassell Barbados

1992 - 1994

Dr. Roy Tilluckdharry Trinidad & Tobago

1994 - 1996

Prof. Howard Spencer Jamaica

1996 - 2000

Dr. Yves Donatien Martinique

2000 - 2002

Dr. Ivan Perot Trinidad & Tobago

2002 - 2004

Dr. Edward Chung Jamaica

2004 - 2006

Dr. Conville Brown The Bahamas 2006 - 2008


2008-2010

Caribbean Cardiac Society Past Presidents

Dr. Raymond Massay Barbados

2010 - 2012

Dr. Ronald Henry Trinidad & Tobago

2012 - 2014

Dr. Henry Steward Curaçao

2014 - 2016

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Profile of St. Lucia

S t. Lucia is an island of unblemished landscapes and St. Lucia is an island of unblemished landscapes and post-card perfect scenery. One of the Windward Islands of the Lesser Antilles, St. Lucia is located midway down the Eastern Caribbean chain, between Martinique and St. Vincent, and northwest of Barbados. The Atlantic Ocean

kisses its eastern shore, while the beaches of the west coast are caressed by the calm Caribbean Sea. The climate is tropical, moderated by northeast trade winds. St. Lucia is a volcanic island and is one of the more mountainous Caribbean islands. Its highest point is Mount Gimie, at 950 metres (3,120 ft) above sea level. Two other mountains, the Pitons, form the island's most famous landmark, and are represented on the country’s flag. St. Lucia was named after Saint Lucy of Syracuse by the French, the first European colonizers in 1660. In ensuing years, rule of the island changed frequently. It became known as the "Helen of the West Indies" because it switched so often between British and French control. The influence of the French lives on in the patois spoken in the country. On February 22, 1979, Saint Lucia became an independent state of the Commonwealth of Nations, associated with the United Kingdom.

The Pitons, soaring 2,000 feet above sea level, shelter magnificent rain forests where a variety of flora and fauna flourish. The island's people have earned a well-deserved reputation for their warmth and charm, and the island itself is dotted with aged fortresses, small villages, and open-air markets. The island's reefs offer excellent snorkelling and scuba diving, and the rainforest preserves of the mountainous interior are one of the Caribbean's finest locales for hiking and bird-watching. The Soufriere volcano is the world's only drive-in volcanic crater. St. Lucia Facts-at-a-Glance

• Full name: Saint Lucia

• Population: 174,000 (UN, 2010)

• Area: 620 sq km

• Capital: Castries

• Currency: Eastern Caribbean Dollar (EC$)

Information was retrieved from:

http://www.stlucia.org/

http://www.geographia.com/st-lucia/

http://news.bbc.co.uk/2/hi/americas/country_profiles/1210491.stm

http://www.fco.gov.uk/en/travel-and-living-abroad/travel-advice-by-country/country-profile/north-central-america/st-lucia/

http://www.stlucia.org/

http://news.bbc.co.uk/2/hi/americas/country_profiles/1210491.stm


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Invited Faculty

Dr. C. Michael Valentine President American College of Cardiology

Dr. The Hon. Duane Sands Minister of Health The Bahamas

Dr. Cedric Sheffield Thoracic and Cardiac Surgeon Tampa, Florida

Dr. Ross Feldman Ambassador American College of Physicians


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Council of the Caribbean Cardiac Society

Dr. Henry Steward Immediate President

Curaçao

Dr. Ronald Henry ACC Chapter Governor

Trinidad & Tobago

Dr. Victor Elliott Jamaica

Dr. Caroline Lawrence St. Kitts and Nevis

Dr. Marilyn Lawrence-Wright Treasurer Jamaica

Dr. Pravinde Ramoutar Vice President

Trinidad & Tobago


Dr. Mercedes Dullum USA

Dr. Raymond Massay Barbados

Dr. Richard Ishmael President Barbados

Dr. Jeanice Stanley-Jean Secretary St. Lucia

Dr. Conville Brown Bahamas

Dr. Romel Daniel St. Lucia

Dr. Dabor Resiere Martinique

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Social Programme

Wednesday July 18, 7:00PM - 10:00PM

Official Conference Opening will be held in the Royalton Theatre

Attire: Lounge Suit Tickets: Free to Conference Attendees and Guests

Welcome Reception to follow in Ballroom Foyer

Friday July 20, 7:30PM - 11:00PM

The Annual Awards Banquet will be held in the Sky Terrace, Royalton Resort

Attire: Formal

Tickets: US$180

Saturday July 21, 5:30AM - 7:00AM

Health Walk Assemble in Royalton Resort Lobby at 5:30am.

Attire: Sneakers and athletic gear

Tickets: Free to Conference Attendees and Guests

Sign up at Conference Secretariat

Saturday July 21, 7:30PM - 11:00PM

CCS Conference Party will be held on the Royalton Beach

Attire: Casual

Tickets: Adults US$120, Children: US$70

Additional tickets can be purchased at the Conference Secretariat. Tickets will not be sold at the door. Please remember to bring your tickets to be presented on entry to both ticketed functions.


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Schedule at a Glance

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Conference Schedule

WEDNESDAY - July 18 1 Day

INTERVENTIONAL ROUNDTABLE 9:00AM – 12:00NOON Deanery and Canaries Boardroom

ECG SESSION 2:00PM – 6:00PM Royalton Theatre

2:00 - 2:20 Welcome; History of the ECG and how to Record the ECG Raymond Massay, Barbados

2:20 - 2:40 Electrophysiological Basis of the ECG Henry Steward, Curacao

2:40 - 2:55 Components of the Normal ECG; Waves, Segments and Intervals Dawn Scantlebury, Barbados

2:55 - 3:15 ECG Interpretation (1): Normal sinus rate and Rhythm Ectopy: Atrial, Ventricular and Nodal Victor Elliott, Jamaica

3:15 - 3.30 ECG Interpretation (2): Abnormal rate and Rhythm: Tachycardia, Atrial Fibrillation, and Atrial Flutter Kendall Griffith, US Virgin Islands

3:35 - 4:00 COFFEE BREAK and VIEWING OF EXHIBITS

4:00 - 4:15 ECG Interpretation (3): Conduction blocks Kendall Griffith, USVI

4:15 - 4:30 Chamber Hypertrophy Conville Brown, Bahamas

4:30 - 4:45 Cardiac axis: What, why, and how to Calculate it Jeanice Stanley, St. Lucia

4:45 - 5:15 Myocardial Infarction: ECG Diagnosis Ronald Henry, Trinidad

5:15 – 6:00 ECG Practice Session Raul Garillo, Argentina


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CONFERENCE OPENING CEREMONY 7:00PM – 8:30PM (RECEPTION TO FOLLOW) Royalton Theatre Keynote Lecture: Clinician to Policy Maker: The View from the Other Side

Duane Sands, Minister of Health, The Bahamas

CONFERENCE WELCOME RECEPTION 8:30PM – 10:00PM Royalton Theatre Foyer

Official Opening Ceremony & Welcome Reception Royalton Theatre

PROGRAMME

National Anthem of St. Lucia Opening Remarks Dr. Martin Didier Conference Chairperson President’s Remarks Dr. Richard Ishmael President Caribbean Cardiac Society

Welcome Remarks The Honorable Senator Mary Issac Minister for Health and Wellness, St. Lucia Michael Valentine President, American College of Cardiology

Keynote Lecture Dr. Duane Sands

Minister of Health, The Bahamas Clinician to Policy Maker: The View from the Other Side

Official Opening

Roll Call Dr. Jeanice Stanley-Jean

Secretary Caribbean Cardiac Society Vote of Thanks Dr. Pravinde Ramoutar Vice-President Caribbean Cardiac Society

~Reception Follows Immediately in Foyer~

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THURSDAY - July 19 2 Day

SCIENTIFIC SESSION 1 | Acute Coronary Syndromes 8:00AM – 9:00AM Royalton Theatre

CHAIRPERSONS: Martin Didier; Raymond Massay

8:00 – 8:10 Aleem Ali Trinidad and Tobago

An Unusual Aetiology for Acute Myocardial Infarction #002

8:10 – 8:20 Demeytri Ramnarase United Kingdom

An Unusual Case of Allergic Acute Coronary Syndrome (Kounis

syndrome) in a 28-year-old #036

8:20 – 8:30 Bathinaiah Doddi Trinidad and Tobago

Myocardial Bridging #012

8:30 – 8:50 Yoshida Toyoda United States

Surgery for Pulmonary hypertension: from Pulmonary Thromboendarterectomy to Heart-Lung Transplantation Philadelphia International Medicine - Sponsored Lecture

8:50 – 9:00 DISCUSSION

SCIENTIFIC SESSION 2 9:000AM – 10:00AM Royalton Theatre

CHAIRPERSONS: Martin Didier; Raymond Massay

9:00 – 9:20 Renato Lopes Delascio USA

What’s New in Stroke Prevention in Atrial Fibrillation in 2018? Pfizer Sponsored Lecture

9:20 – 9:30 Renee Alfred Trinidad and Tobago

Dilated Coronaries in a Family with Sudden Cardiac Arrest in the Young Young Clinician Presentation

9:30 – 9:40 Pankaj Gundad Cayman Islands

Unusual Presentation of Reflex Syncope and Diagnostic Challenges Young Clinician Presentation

9:40 – 9:50 Beatriz Rivera Rodriguez Dominican Republic

Type II MI Preceded by Amaurosis Fugax in a Young 28 Year-Old Patient Young Clinician Presentation


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10:00 – 10:45 COFFEE BREAK AND VIEWING OF EXHIBITS

SCIENTIFIC SESSION 3 | Interventional Cardiology 10:45AM – 12:00PM Royalton Theatre

CHAIRPERSONS: Ronald Henry; Richard Ishmael

10:45– 11:05 Gregory Giugliano United States

2017-18 Cardiology Year in Review #018

11:05 – 11:35 C. Michael Valentine United States

STEMI Systems of Care - Best Practices in 2018 Annual Cardiology Lecture

11:35 – 11:50 Ronald Henry Trinidad and Tobago

Regional STEMI Network


SCIENTIFIC SESSION 4 | Interventional Cardiology 12:10NOON – 1:00PM Royalton Theatre


12:10 – 12:20 Victor Elliott Jamaica

Challenges in Establishing a Partner Based Cardiology Centre

in Jamaica #013

12:20 – 12:30 Victor Elliott Jamaica

Review of the First 100 Cases of a New Jamaican Based

Catheterization Laboratory #014

12:30 – 12:50 Ravikishoe Amancharla Cayman Islands

Cryoablation for Cardiac Arrythmias Medtronic Sponsored Lecture


LUNCH BREAK – VIEWING OF EXHIBITS AND POSTERS 1:00 – 2:00

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SCIENTIFIC SESSION 5 | Arrhythmias and Electrophysiology 2:00PM – 3:00PM Royalton Theatre

CHAIRPERSONS: Conville Brown; Pravinde Ramoutar

2:00 – 2:10 Ryan Aleong United States

Impact of Payor Status on Presentation, Therapies, and Outcomes in a Large Patients Hospitalized with Wolff-

Parkinson-White Syndrome #001

2:10 – 2:20 Ravikishore Amancharla Cayman Islands

Utility of Intra Cardiac Echocardiography During Cryo AFIB Ablations: Preliminary Experience at Health City Cayman

Islands #004

2:20 – 2:30 Ricardo Blanchery Dominican Republic

Registration of Implantable Cardiac Electronic Devices and

Infections #007

2:30 – 2:40 Kishan Ramsaroop Trinidad and Tobago

The Heart Stops #037

2:40 – 2:50 Sebastien Pouy Martinique

Efficiency and Safety of PFO Closure in the University

Hospital of Martinique #034

2:50 – 3:00 QUESTIONS

Hypertension Workshop 3:00PM – 4:30PM Royalton Theatre

CHAIRPERSONS: Tricia Cummings; Roy Tilluckdharry

3:00 – 3:20 Kenneth Connell The 2017 AHA/ACC Guidelines for High Blood Pressure in Adults: Big Targets for Small Islands?

3:20 – 3:40 Kurlene Cenac Paediatric Hypertension Guidelines

3:40 – 4:10 Ross Feldman Innovative Approaches to Treatment of Hypertension American College of Physicians Ambassador


Biennial General Meeting (Open to CCS Members) 4:45PM – 6:00PM Royalton Theatre


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SCIENTIFIC SESSION 5 | Arrhythmias and Electrophysiology 2:00PM – 3:00PM Royalton Theatre

CHAIRPERSONS: Conville Brown; Pravinde Ramoutar

2:00 – 2:10 Ryan Aleong United States

Impact of Payor Status on Presentation, Therapies, and Outcomes in a Large Patients Hospitalized with Wolff-

Parkinson-White Syndrome #001


Utility of Intra Cardiac Echocardiography During Cryo AFIB Ablations: Preliminary Experience at Health City Cayman

Islands #004

2:20 – 2:30 Ricardo Blanchery Dominican Republic

Registration of Implantable Cardiac Electronic Devices and

Infections #007

2:30 – 2:40 Kishan Ramsaroop Trinidad and Tobago

The Heart Stops #037

2:40 – 2:50 Sebastien Pouy Martinique

Efficiency and Safety of PFO Closure in the University

Hospital of Martinique #034

2:50 – 3:00 QUESTIONS

Hypertension Workshop 3:00PM – 4:30PM Royalton Theatre

CHAIRPERSONS: Tricia Cummings; Roy Tilluckdharry

3:00 – 3:20 Kenneth Connell The 2017 AHA/ACC Guidelines for High Blood Pressure in Adults: Big Targets for Small Islands?

3:20 – 3:40 Kurlene Cenac Paediatric Hypertension Guidelines

3:40 – 4:10 Ross Feldman Innovative Approaches to Treatment of Hypertension American College of Physicians Ambassador


Biennial General Meeting (Open to CCS Members) 4:45PM – 6:00PM Royalton Theatre

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FRIDAY - July 20 3 Day

SCIENTIFIC SESSION 6 | Epidemiology 8:00AM – 9:00AM Royalton Theatre

CHAIRPERSONS: Romel Daniel; Jeanice Stanley-Jean

8:00 – 8:10 Felix Nunura Jamaica

Initial Clinical Experience With the First Drug (Sacubitril/Valsartan) in a New Class - ARNIs in Patients With Heart Failure With Reduced Ejection Fraction in Afro

Caribbean Population #028

8:10 – 8:20 Delphina Vernor St. Lucia

Cultural Placebos and Cardiovascular Compromise #047

8:20 – 8:40 Rosario Colombo United States

Neglected Cardiomyopathies of the Caribbean and Latin America Jackson Health System - Sponsored Lecture


SCIENTIFIC SESSION 7 | General Cardiology 9:00AM – 10:00AM Royalton Theatre

CHAIRPERSONS: Romel Daniel; Jeanice Stanley-Jean

9:00 – 9:10 Ryan Brooks Jamaica

Rate of Positive Computed Tomography Pulmonary Angiogram at the University Hospital of the West Indies From

August 2015 to July 2016 #008

9:10 – 9:20 Dabor Resiere Martinique

Cardiovascular Toxicity with Metformin Overdose in the Intensive Care Unit: A Prospective Case Series From the

Caribbean #038


Dobutamine Echocardiogram-Induced Hypotension in

Caribbean Patients: Incidence and Predictors #029

9:30 – 9:40 Leila Piorunowski Martinique

Left Ventricular Dysfunction in Patients with Sickle Cell

Disease #033


10:00 – 10:45 COFFEE BREAK AND VIEWING OF EXHIBITS


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SCIENTIFIC SESSION 8 | Cardiac Surgery 10:45AM – 11:45AM Royalton Theatre

CHAIRPERSONS: Victor Elliott; Ronald Henry

10:45– 10:55 Dabor Resiere Martinique

Feasibility Extracorporeal Membrane Oxygenation in a Caribbean Intensive Care Unit; History, Current Indications

and Future Directions #039

10:55 – 11:05 Binoy Chattuparambil Cayman Islands

Extracorporeal Membrane Oxygenation in Cardiopulmonary

Resuscitation-Changing Paradigms #010

11:05 – 11:35 Cedric Sheffield United States

Cardiac Surgery: Are Reports of its Death Greatly Exaggerated? Annual Cardiac Surgery Lecture


SCIENTIFIC SESSION 9 | Cardiac Surgery 11:45AM – 12:45PM Royalton Theatre

CHAIRPERSONS: Victor Elliot; Ronald Henry

11:45– 11:55 Raul Garillo Argentina

Reclassification of the Left Ventricular Ejection Fraction in

Subjects with Mitral Valve Insufficiency #017

11:55 – 12:05 Dhruva Kumar Krishnan Cayman Islands

Transesophageal Echocardiogram in Operation Theatre:

Health City Cayman Islands Experience #022

12:05 – 12:15 Cedric Sheffield United States

When Is the Ventricle Too Sick for Mitral Valve Surgery?

#041

12:15 – 12:25 Iman Simmonds United States

Achieve a Zero Mortality in Cardiac Surgery (ACadEMCS)

#042

12:25 – 12:35 Rosanna Landes Martinique

Percutaneous Expansion of Rheumatismal Mitral Stenosis in

Martinique: A 44 Case Study #024


LUNCH BREAK - VIEWING OF EXHIBITS 12:45PM – 2:00PM

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SCIENTIFIC SESSION 10 | Heart Failure 2:00PM – 3:00PM Royalton Theatre

CHAIRPERSONS: Marilyn Lawrence-Wright; Dawn Scantlebury


Cardiac Contractility Modulation (CCM): Preliminary

Experience at the Health City Cayman Islands #005

2:10 – 2:20 Jocelyn Inamo Martinique

Cardiac Amyloidosis and Unexplained Left Ventricular

Hypertrophy #021

2:20 – 2:30 Racquel Lowe-Jones United Kingdom

The Scope of a Combined Kidney Failure-Heart Failure Clinic #025


12-lead ECG Abnormalities in Adolescent Jamaican Athletes

#031

2:40 – 2:50 Susie Sennhauser United States

What is the Impact of Cardiac Rehabilitation on Patients with

Heart Failure in the Community Setting? #040

2:50 - 3:00 DISCUSSION

Caribbean Regional STEMI Network Panel Discussion 3:00PM – 4:30PM Royalton Theatre


ANNUAL AWARDS BANQQUET 7:30PM – 11:00PM Sky Terrace


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SATURDAY- July 21 4 Day

SCIENTIFIC SESSION 11 | PAEDIATRIC CARDIOLOGY 8:00AM – 9:00AM Royalton Theatre

CHAIRPERSONS: Richard Ishmael; Jose Ettedgui

8:00 – 8:10 Kak-Chen Chan United States

Extreme Prematurity, Chronic Lung Disease, Persistent Ductus Arteriosus and Pulmonary Hypertension: The Potentially

Deadly Quartet Tamed? #009

8:10 – 8:20 Sripadh Upadahya Cayman Islands

Our Experience: Congenital and Structural Heart Disease Treated by Percutaneous Intervention at Health City Cayman

Islands #046

8:20 – 8:40 William Moskowitz United States

World Pediatric Project: Impact on Cardiovascular Health of

Children of the Eastern Caribbean #027

8:40 – 8:50 Steve Bibevski United States

Caribbean Patient Referral to US Program for Congenital

Cardiac Surgery: A 10-Year Single-Center Experience #006


SCIENTIFIC SESSION 12| PAEDIATRIC CARDIOLOGY 9:00AM – 10:00AM Royalton Theatre

CHAIRPERSONS: Richard Ishmael; Jose Ettedgui

9:00 – 9:10 James Wilentz United States

A National Coordinated Cardiac Surgery Registry in Haiti: The

Haiti Cardiac Alliance Experience #048

9:10 – 9:20 Jose Ettedgui United States

Melody Valve Implantation for Pulmonary Valve

Regurgitation: Early Results and Lessons Learned #015

9:20 – 9:30 Shawn Gordon St. Lucia

Pericardial Tamponade in Early Infancy #019

9:30 – 9:40 Jose Ettedgui United States

Impact of Adults With Congenital Heart Disease in a Pediatric

Cardiac Catheterization Laboratory #016

9:40 – 9:50 Sripadh Upadhya Cayman Islands

Challenges in Device Closure of Residual Patent Ductus

Arteriosus, Post-Surgical Clipping of the Ductus #045


10:00 – 10:30 COFFEE BREAK

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” Theme: Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean

SCIENTIFIC SESSION 13| 10:30AM – 11:30AM Royalton Theatre

CHAIRPERSONS: Martin Didier; Henry Steward

10:30 – 10:40 Rizwan Hossain Cayman Islands

Health City Cayman Islands Experience of Renal Sympathetic

Denervation for Resistant Hypertension #020

10:40 – 10:50 Amar Singh United States

Persistent Left Superior Vena Cava and Its Implications for

Placement of Transvenous Devices #043

10:50 – 11:00 Aleem Ali Trinidad and Tobago

The Persistent Superior Left Vena Cava #003


Induced Ischemia Detected by Stress Echocardiography in

Caribbean Patients #030


11:30 – 11:40 CLOSING CEREMONY

CONFERENCE CLOSING PARTY 7:30PM – 11:00PM Royalton Beach


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Poster Presentations

Binoy Chattuparambil Cayman Islands

Successful Repair of a Case of Pentalogy of Cantrell Without Cardiopulmonary

Bypass #011

Dhruva Kumar Krishnan Cayman Islands

Transesophageal Echocardiogram in Cathlab: Health City Cayman Islands

Experience #023

Monique Monsplaisir St. Lucia

A Race Against Time: A Case of an Embolus #026

Felix Nunura Jamaica

Predictive Value of Stress Myocardial Perfusion Scan in Detection of Coronary

Artery Disease in Caribbean Patients #032

Raghu Prasad Cayman Islands

Utility of Compound Motor Action Potentials (CMAPs) for the Prevention of

Phrenic Nerve Palsy #035

Sripadh Upadhya Cayman Islands

Covered Stent as a Treatment for Coarctation of Aorta and Patent Ductus Arteriosus in a Patient with Associated Large Ventricular Septal Defect and

Severe Pulmonary Hypertension #044

*Posters will be on display in the Exhibit Hall July 19 - 21.

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Abstracts

001 TITLE: Impact of Payor Status on Presentation, Therapies, and Outcomes in a Large Patients Hospitalized with Wolff-Parkinson-White Syndrome AUTHOR (S): Dr. Ryan Aleong; Dr. David Kao Submitted for: Epidemiology and Prevention, Arrhythmias and Electrophysiology ABSTRACT BODY: Background: The risk of sudden cardiac death in Wolff-Parkinson-White (WPW) Syndrome is higher in symptomatic patients, especially those with syncope. Ablation is effective but requires significant medical resources. We assessed the mode of presentation and hospital course of patients hospitalized with WPW of different payor statuses. Methods: Hospital records were obtained six states in the United States for the years 1995-2007. Admissions including the ICD-9 CM code 426.7 (WPW) were analyzed. Data dictionaries and ICD-9 codes were used to quantify demographics and outcomes. Association of payor status with atrial fibrillation, syncope, unscheduled admission, admission via the emergency department, and ablation was estimated using univariate and multivariate binomial mixed effects model with random effects terms for hospital and state and age, gender and race as covariates. Results: 31,614 hospital discharges included the diagnosis WPW. The average age at admission was 43.2 +/- 0.14 years old, 54% of patients were male, and 66.8% were white. White patients were significantly more likely to have private insurance than non-white (OR 1.95, p < 0.0001). In multivariate analysis, Medicaid patients were less likely than the privately insured to present with atrial fibrillation (OR 0.75, p < 0.0001), while uninsured patients were more likely to present with syncope (OR 1.29, p= 0.04). Compared with private insurance, Medicare, Medicaid, and no insurance were associated with a significantly higher likelihood of admission via the ED (OR 1.32, 1.5, 2.4, respectively, p < 0.0001 for all) and a lower likelihood of undergoing ablation (OR 0.35, 0.5, 0.55, respectively, p < 0.0001 for all). Conclusions: WPW patients with no private insurance are more likely to present to the hospital urgently or emergently and less likely to undergo definitive therapy with radiofrequency ablation.

002 TITLE: An Unusual Aetiology for Acute Myocardial Infarction AUTHOR (S): Dr. Aleem Ali; D. Lalchansingh, R. Ali, T.A Cummings Submitted for: Acute Coronary Syndromes ABSTRACT BODY: We present the case of a 44-year-old female who presented to the emergency department with acute onset chest pain of four hours duration. She had a three-month history of diaphoresis, dyspnea and severe fatigue and had been unable to exercise due to these symptoms. She had no risk factors for ischaemic heart disease. Her initial electrocardiogram revealed no acute ischemic changes and was reported to be normal. A diagnosis of acute anxiety was made and it was felt that a non-ST segment elevation myocardial infarction was unlikely. Nevertheless a 12-hour troponin was obtained and this was found to be elevated at 14.2 ng/ml (0.20-0.32). Serial electrocardiograms showed evolution of ST segment changes in the anterolateral leads consistent with acute myocardial infarction. She was subsequently admitted and treated for a non-ST segment elevated myocardial infarction. The patient underwent coronary angiography which revealed normal coronary arteries. A transthoracic echo showed a mass in association with the left coronary cusp of the aortic valve. 2D and 3D trans-oesophageal echocardiography revealed a mushroom like mass measuring 1.2 x 1.0 cm on the left coronary cusp of the aortic valve. The mass approached the origin of the left main coronary artery at the end of systole. The features were consistent with a papillary fibroelastoma. The patient was referred for open-heart surgery to remove the mass as it was felt that transient occlusion or coronary embolization was a strong possibility of the aetiology of her acute myocardial infarction.

003 TITLE: The Persistent Superior Left Vena Cava AUTHOR (S): Dr. Aleem Ali; C.B Mootoo, V. Romany, P. Maharaj, T.A. Cummings Submitted for: Congenital Heart Disease:, Non Invasive Imaging

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” ABSTRACT BODY: The persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly of thoracic venous return and is present in 0.3-0.5% of individuals in the general population. It results when the superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other congenital cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of the aorta, coronary sinus ostial atresia, and cor triatrium. It occurs more frequently up to 10% in patients with other congenital heart defects. Incidental discovery of a dilated coronary sinus on echocardiography should always raise the suspicion of a PLSVC as it has important clinical implications. The diagnosis should be confirmed by saline contrast echocardiography. Herein, we present the case of an asymptomatic 44 year old female who had echocardiography to assess an ejection systolic murmur. Echocardiography findings revealed a moderately dilated right heart with right ventriclar overload and a severely dilated coronary sinus. A persistent left superior vena cava and a superior sinus venosus atrial septal defect were identified on trans-oesophageal echocardiography and confirmed with saline contrast. The anatomy was further delineated with multimodality imaging using cardiac computated tomography (CT) scan.

004 TITLE: Utility of Intra Cardiac Echocardiography During Cryo AFIB Ablations: Preliminary Experience at Health City Cayman Islands AUTHOR (S): Dr. Ravikishore Amancharla; Dhruva Kumar MD , Raghu Prasad MD, Srinath Polasani (CVT), Sripadh Upadhya MD, ,

Renuka Devi RN, Pankaj Gundad MD, Rizwan Hossain MD Submitted for: Arrhythmias and Electrophysiology, Non Invasive Imaging ABSTRACT BODY: BACKGROUND: - Traditionally Cryo balloon ablation of atrial fibrillation is currently guided transesophageal echocardiography (TOE). The associated patient discomfort with TOE, need for full time anesthesia support are the disadvantages. We report our experience of using intracardiac echocardiography (ICE) in 6 patients who underwent Cryoballoon ablation for paroxysmal atrial fibrillation. METHODS: Abbotâ€™s view flex catheter was used for the intracardiac echo. It was introduced into the right atrium via a left femoral vein puncture. Intracardiac structures dominantly the IAS, LA, LAA, AV valves and PVâ€™s could be adequately visualised with subtle manipulations of the catheter. RESULTS:- 1. By using ICE guidance a single attempt low anterior transseptal puncture was achieved in all the patients without any complications. 2. Successful cannulation of all the left sided pulmonary veins could easily be achieved in all the patients. 3. Effective balloon occlusion of left sided pulmonary veins and RSPV could be demonstrated easily. 4. Development of Pericardial effusion was effectively monitored during the procedure. 5. LA appendage could only be effectively visualized in only two of the six patients. CONCLUSION: - Thus ICE is a very effective tool for appropriate transseptal puncture, visualization of left sided pulmonary veins and monitoring for pericardial effusion. However visualization of LA appendage with conventional views is difficult. In conclusion, ICE is a very effective tool in AF ablations increasing the comfort level for operator and eliminates the need for TEE. There is also significant reduction of radiation burden.

005 TITLE: Cardiac Contractility Modulation (CCM): Preliminary Experience at the Health City Cayman Islands AUTHOR (S): Dr. Ravikishore Amancharla; Srinath Polasani (CVT), Sripadh Upadhya MD, Dhruva Kumar MD, Renuka Devi RN, Pankaj

Gundad MD, Rizwan Hossain MD, Raghu Prasad MD. Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: BACKGROUND: Cardiac Contractility Modulation(CCM) is a unique and innovative method for patients with NYHA Class II/III CHF symptomatic on optimal medical therapy and ineligible or unresponsive to cardiac resynchronization therapy (CRT) (Narrow QRS complex; No LBBB). The therapy consists of non- excitatory electrical impulses delivered onto the myocardium by the device during the absolute refractory period of the cardiac cycle. This modality eventually enhances left ventricular (LV) contraction which improves exercise tolerance and QOL in patients with HF.


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METHODS: This retrospective single-center study analyses clinical characteristics and in-hospital outcomes of 3 patients who underwent CCM implants from 28th August 2017 to 27th December 2017. During the procedure, 2 leads are implanted into the RV along the septum. Optimizer Smart implantable device is placed in the subclavian fossa like a conventional pacemaker and connected to the leads. RESULTS: Three patients suffering from heart failure NYHA class III and LV systolic dysfunction (2 patients with narrow QRS and one patient with poor response to biventricular pacing), Mean age was 65years ( M=2) and LV EF ranged from 30-35%. In all the 3 patients the leads could be successfully placed along the septum with stable parameters. In the patient with existing BiV, device-device interaction could be eliminated by programming. At 24 hours leads were found to be stable in all the patients. In one patient who completed 3 month follow up, there was a significant improvement in symptoms of heart failure with a marked improvement in QOL and reduction of diuretic intake. The other two patients were doing well at one month after implant with steady improvement in NYHA symptom class and marked reduction in NT Pro BNP levels CONCLUSION: The study demonstrates the acute procedural success for CCM device implants and short term efficacy of this mode of therapy in symptomatic patients with CHF not eligible for CRT device implantation

006 TITLE: Caribbean Patient Referral to US Program for Congenital Cardiac Surgery: A 10-Year Single-Center Experience AUTHOR (S): Dr. Steve Bibevski; Mark Ruzmetov M.D/Ph.D, Immanuel Turner M.D, Richard Perryman M.D, Frank G. Scholl M.D Submitted for: Cardiac Surgery ABSTRACT BODY: Access to specialized healthcare teams needed to manage complex congenital heart defects is limited in the English speaking Caribbean. Establishment of high quality programs within these countries for local care is not ideal given the geography of the region, relatively low patient volume and high cost of care. For this reason, referral to programs abroad has been the mainstay for surgical intervention on complex congenital defects. For the past 10 years, Joe DiMaggio Childrenâ€™s Hospital has provided cardiac care for patients with congenital heart disease from Caribbean countries through its charitable foundation as well as through direct arrangements with local government agencies. From January 2007 to December 2017, a total of 99 children and young adults from the Caribbean have received pediatric cardiac surgery care in our Center (112 surgical procedures). The mean age was 4.9 years (range, 3 days â€“ 39 years) and mean weight was 19 kg (range, 2.5 to 145 kg). Seventeen patients (17%) had chromosomal/syndromic abnormalities. The mean cardiopulmonary bypass and cross-clamp times were 99+52 min and 58+38 min, respectively. The level of complexity by STAT category was an overall average of 2.1+1.2 but has become significantly higher in recent years (after 2013) when compared with previous years (2.4 vs 1.9; p<0.01). Five patients (5%) were the highest risk (STAT) 5 category. Diagnosis included TOF (23), VSD (18), AV canal (6), Norwood (4) Glenn (3), Valve repair (7). Eight patients underwent second reintervention (8%), and three of them underwent third reintervention. Overall there were 98 open heart procedures and 14 closed heart procedures. Forty -one patients (37%) were extubated in operation room. Overall hospital mortality was 2% (n=2) and postoperative mean length of stay was 10 days (range, 3-69). Partnerships between established congenital heart programs, governmental healthcare systems and charitable organizations can facilitate high quality care with excellent outcomes. Further development of these programs can provide lifesaving treatment to a greater number of children with congenital heart disease from the Caribbean and Central America.

007 TITLE: Registration of Implantable Cardiac Electronic Devices and Infections AUTHOR (S): Dr. Ricardo Blanchery; Dra.Pamela Pina , Dra.Elaine Nunez , Dr.Fernando Vidal, Dr.Cesar Herrera Submitted for: Interventional Cardiology, Arrhythmias and Electrophysiology ABSTRACT BODY: INTRODUCTION Infections of implantable cardiac devices have increased in recent years due to greater access of the population to these devices, as well as greater indication in our environment. The goal is to register implantable cardiac electronic devices, describe and establish the prevalence of infections in the Diagnostic Center, Advanced Medicine, Medical Conferences and Telemedicine. METHOD A descriptive and retrospective study was carried out in a universe of 177 patients, who underwent implanting or changing the implantable cardiac device in the (CEDIMAT) in the period July 2014 - March 2017. RESULTS Between July 2014 and

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” March 2017, performed a total of 177 implants of cardiac devices, of which 79% underwent a co-implant and 21% to a device replacement. The average age was 69 years, of which 63.8% (n = 92) were male. 66.4% (n = 99) of patients underwent a pacemaker implant, 16.8% (n = 25) of Implantable Automatic Defibrillator (ICD) and 16.1% (n = 24) of Cardioresynchronizer (CRT), and 1 was performed. Holter explant of Implantable Events. Of all the patients, 1% (n = 2) presented device infection. CONCLUSIONS infection as a major complication in this type of interventional procedures, represents 1% of patients undergoing primary or implant replacement, consistent with the statistics of other series. It is very important to continue prospectively evaluating these points to strengthen the quality and effectiveness of the current equipment. Keyword: implantable cardiac device infections

008 TITLE: Rate of Positive Computed Tomography Pulmonary Angiogram at the University Hospital of the West Indies From August 2015 to July 2016 AUTHOR (S): Dr. Ryan Brooks; Trevor FERGUSON, PAUL SCOTT Submitted for: Vascular Medicine ABSTRACT BODY: Objectives:To determine the rate of positive computed tomography pulmonary angiogram (CTPA) among patients with suspected pulmonary embolism (PE) at the University Hospital of the West Indies (UHWI) and to compare this with international standards. To ascertain the extent to which risk stratification tools and d-dimer were used in the evaluation of patients with suspected PE and identify independent risk factors for PE. Methods: The records of consecutive patients referred for CTPA at UHWI between August 2015 and July 2016 were reviewed and data extracted regarding PE risk factors and clinical characteristics. Descriptive analyses and logistic regression models were performed to obtain estimates and evaluate associations with positive CTPA. Results: PE was confirmed in 23% of patients having CTPA, which was similar to international rates. Only 28% of patients had formal risk stratification. D-dimer was obtained in only 1%. In multi-variable models, signs of deep vein thrombosis (DVT) and hypoxia were statistically significant correlates of PE; odds ratio (OR) were 2.57 [95%CI 1.06-6.22]) and 2.29 [95%CI 1.25-4.17], respectively. A history of smoking was also associated with positive CTPA but had only borderline significance (OR 2.75 [95%CI 0.99-7.61]). Receiver operator characteristic analyses suggested that the Simplified Geneva risk prediction score had the best discriminatory value but was not superior to the Revised Geneva or modified Wells score. Conclusion: PE was confirmed in nearly a quarter of those suspected. There was a low utilization of formal risk assessment tools and d-dimer. A history of hypoxia and signs of DVT were associated with confirmed PE.

009 TITLE: Extreme Prematurity, Chronic Lung Disease, Persistent Ductus Arteriosus and Pulmonary Hypertension: The Potentially Deadly Quartet Tamed? AUTHOR (S): Dr. Kak-Chen Chan; Michelle-Marie Jadotte, MSN, ARNP, Breanna Vandale, BSN, RN Submitted for: Paediatric Cardiology, Congenital Heart Disease: ABSTRACT BODY: Pulmonary hypertension (PH) is known to be one of the major complications of bronchopulmonary dysplasia (BPD) in premature infants. Currently these infants survival has improved, it is imperative that associated co-morbid complications be addressed. BPD with chronic lung disease (CLD) is common and is complicated by the presence of a persistent ductus arteriosus (PDA) and PH. This cardio-pulmonary complication is a significant cause of morbidity and mortality. Ligation of the PDA, sildenafil, nitric oxide, inhaled steroids and expert ventilator management are all treatment options. Infants of less than 25 weeks gestation carry additional risk of developing this complication due to the immaturity of the lungs. We describe a series of three extreme premature infants with severe CLD complicated with PDA and PH who were treated by use of pulmonary vasodilators, closure of the PDA and addition of bosentan, and non-selective endothelin receptor blocker. This drug decreases the inflammatory proliferative effect of endothelin and thus promotes lung remodeling. Clinical Data: Case 1: GSA-23; Birth wt.-630gms; PDA-Surgery; PA Press. 50/29, M-38. Case 2: GSA-25; Birth wt-700gms; PDA- Transcatheter; PA Press.41/24, M- 31. Case 3: GSA-25; Birth wt.-665gms; PDA- Transcatheter; PA Press.66/33, M- 45. Results: All three patients are currently alive with echocardiographic evidence of normal right ventricular function and normal Pulmonary Artery (PA) pressures at rest. At two years of age, all three patients are now clinically ready for weaning off their tracheostomy support.


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Conclusion: These premature infants presented with very severe CLD, PH and large PDAâ€™s. Timing of closure of the PDA is crucial to ensure that pulmonary vasodilator therapy does not augment pulmonary over-circulation when started. Addition of Bosentan has the potential of facilitating lung remodeling but should be monitored closely. These patients, although fragile, can have good cardio-pulmonary outcomes with a multi-disciplinary approach, adopting a protocol to protect the lungs, promote pulmonary vasodilation and lung remodeling.

010 TITLE: Extracorporeal Membrane Oxygenation in Cardiopulmonary Resuscitation-Changing Paradigms AUTHOR (S): Dr. Binoy Chattuparambil; Dhruva Kumar Krishnan,Archita Joshi Bhatt, Mahantesh SankaraGowda Patil,Susan Paul Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Cardiogenic shock and cardiac arrest are life-threatening emergencies with a high mortality rate despite numerous advances in diagnosis and therapy. ECMO is a potentially life-saving procedure for severe respiratory or cardiorespiratory failure refractory to maximal medical therapy.Here we review the strategical considerations of ECMO in cardiopulmonary resuscitation.

011 TITLE: Successful Repair of a Case of Pentalogy of Cantrell Without Cardiopulmonary Bypass AUTHOR (S): Dr. Binoy Chattuparambil; Sumit Jawaharlal Modi , Javier Lopez Mendoza, Dhruva Kumar Krishnan , Sripadh Upadhya Submitted for: Paediatric Cardiology, Cardiac Surgery, Congenital Heart Disease: ABSTRACT BODY: Pentalogy of Cantrell (POC) is an extremely rare and often fatal complex congenital abnormality characterised by ectopia cordis, a defect in the diaphragmatic pericardium, a deficiency of the anterior diaphragm, lower sternal defect, midline supra-umbilical abdominal wall defects and various structural intra cardiac anomalies. A left ventricular diverticulum (LVD) is one of the cardiac defects associated with POC but, is not a very common finding. We describe in detail the multidisciplinary evaluation and techniques of surgical repair of POC with LVD in a 10 month old boy, a first such case performed in the Caribbean.

012 TITLE: Myocardial Bridging AUTHOR (S): Dr. Bathinaiah Doddi; Venkateshwarlu Sakinala, Robins Karimattam Abraham Submitted for: Interventional Cardiology ABSTRACT BODY: Objective: The Coronary Slow Flow Phenomenon (CSFP) is an important, angiographic finding characterised by delayed distal opacification of the Coronary System on angiography in the absence of significant epicardial Coronary Artery Disease. It is well known to Interventional Cardiologists for four decades, but the pathogenic mechanisms remain unclear. More than 80% of patients experiencing recurrent chest pain, resulting in considerable impairment in quality of life. Materials and Methods: (103) consecutive patients with Chest Pain seen between September 2014 to December 2017 were reviewed and followed. We looked at the risk factors and associated medical conditions that may contributed the findings of Coronary Slow flow Phenomenon. Results: Out of 22 patients, 7 (31.8%) were Females, 15 (68.2%) Males, 18 (81.8%) were East Indians, 3 (13.6%) was African and 1 (4.5%) White, Mean Age 55 years, Youngest being 41 years Male and Oldest being 69 years Male, DM in 4 (18.2) patients (1- IDDM & 3-T2DM), HTN 9 (40.9%) patients, Hyperlipidemia 17 (77.3%) patients, Obesity Conclusions : Current understanding is incomplete, but clinicians should be aware of this condition and its clinical significance. But it need further studies regarding pathology of Coronary Slow Flow and therapeutic approaches. Presently using multiple pharmacological and life style approaches of managing Coronary Slow Flow patients. Pharmacologically, Calcium Channel Blockers, b-Blockers, Statins, Trimetazidine, Control of Diabetes and Blood Pressure and life style changes may decrease the frequency of chest pain and limit its complications.

013 TITLE: Challenges in Establishing a Partner Based Cardiology Centre in Jamaica AUTHOR (S): Dr. Victor Elliott; Dr A. Chung; Heather McKoy, Dr Conville Brown Submitted for: Interventional Cardiology

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” ABSTRACT BODY: Providing modern 'state of the art" cardiac care has always been a challenge in the Caribbean. Many times such development requires the input of other similar minded "partners". Partners Interventional Centre of Jamaica was born out of the will to assist a potential 'partner' to meet their cardiology needs to receiving rejections , to formulating new partnership to develop a State of the Art interventional suit and more.

014 TITLE: Review of the First 100 Cases of a New Jamaican Based Catheterization Laboratory AUTHOR (S): Dr. Victor Elliott; Dr Andrene Chung, Dr N. Crooks, Dr Racquel Gordon, Dr. Nordia Clare-Pascoe Submitted for: Interventional Cardiology ABSTRACT BODY: Partners Interventional Centre of Jamaica is a new "state of the art" cardiac centre located in Kingston. The catheterization lab has been in service since November 2017. We would like to give a review of our first 100 cases reflecting the nature of the cases, indications, demographics and outcomes.

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TITLE: Melody Valve Implantation for Pulmonary Valve Regurgitation: Early Results and Lessons Learned AUTHOR (S): Dr. Jose Ettedgui; Ellen Greeley RN, Robert English MD Submitted for: Paediatric Cardiology, Congenital Heart Disease: ABSTRACT BODY: Background: Pulmonary regurgitation is a common complication following transannular patch repair of tetralogy of Fallot (TOF) or when a valved conduit is placed from the right ventricle (RV) to the pulmonary arteries (PA). Conventional treatment is for surgical placement/replacement of the pulmonary valve. This study represents the early experience of transcatheter pulmonary valve (Melody valve) placement at Wolfson Childrenâ€™s Hospital. Methods: Review of all diagnostic and interventional cathterizations performed between January 2012 to December, 2017 revealed 18 patients who presented for consideration of Melody valve placement. Underlying diagnosis was TOF in 13, pulmonary valve stenosis in 2, prior Ross operation in 1, congenitally corrected transposition of the great arteries in 1 and VSD s/p PA band in 1. Results: There was successful Melody valve placement in 11 patients: a Melody valve alone was placed in 5 and bare metal stent plus Melody valve in 6. In the remaining patients the RV outflow tract was too large in 2, unfavorable for Melody placement in 1 and not accessible for preparation of a landing zone in 1. There were 2 complications at the time of implant with an embolized bare metal stent in 1 and a self contained rupture of a calcified RV-PA conduit in the other. Melody valve placement was not indicated in 1. In the 11 patients with successful implants no additional intervention was required in 9 patients followed for 1-41 months. The residual mean gradient is 16 mmHg (range 0-29 mmHg). One patient developed bacterial endocarditis requiring surgical valve replacement 4 years post procedure and another required repeat angioplasty for residual stenosis 19 months post implant. Conclusions: Melody valves are a reasonable, less invasive alternative to surgical pulmonary valve replacement. These patients have a late risk for bacterial endocarditis and the longevity of the valve remains undetermined.

016 TITLE: Impact of Adults With Congenital Heart Disease in a Pediatric Cardiac Catheterization Laboratory AUTHOR (S): Dr. Jose Ettedgui; Ellen Greeley RN, Robert English MD Submitted for: Congenital Heart Disease: ABSTRACT BODY: Problem: The growing number of adults with congenital heart disease require diagnostic and interventional catheterization procedures in a pediatric catheterization laboratory. This study evaluates the number and type of procedures performed between April 1, 2002 and December 31, 2016 at Wolfson Childrenâ€™s Hospital and reviews procedural complications.


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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” Methods/Results: From April 1, 2002 to December 31, 2017, 340 adult patients (205 females and 135 males) with an age range of 21-81 years (mean 43.3 years) underwent a diagnostic or interventional catheterization procedure. There were 257 adult interventional procedure. There were 233 transcatheter closures of atrial communications with 2 complications (<1%): perforation of the right atrium occurred in a patient with an IVC filter with pericardial tamponade that required surgery and embolization of an ASD device that was retrieved successfully in another. There were 24 interventional procedures not involving the atrial septum. These included transcatheter pulmonary valves (4), stent placements (7), balloon dilations (8) and 5 miscellaneous procedures. Complications in this group included stent migrations in 3 patients, 2 of whom required surgical retrieval .There were 83 diagnostic catheterizations with no complications. There were no deaths from diagnostic or interventional procedures. Conclusions: Adults with congenital heart disease represent a significant number of patients undergoing diagnostic and interventional cardiac catheterization in a pediatric facility. These procedures can be performed safely in a Childrenâ€™s Hospital with low complication rates.

017 TITLE: Reclassification of the Left Ventricular Ejection Fraction in Subjects with Mitral Valve Insufficiency AUTHOR (S): Prof. Raul Garillo; Prof. Hugo Villarroel Abrego Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: The left ventricular ejection fraction is a key measurement for the assessment of its systolic function. In case of mitral valve insufficiency, part of the ejected volume regurgitates to the left atrium and the anterograde volume is less than the presumed, maintaining the ejection fraction at a value that does not adequately represent the inotropic state. This does not allow certain patients with heart failure to be correctly classified and treated, especially as regards the indication of devices (resynchronization therapy, implantation of defibrillators). Based on the calculation of the regurgitant fraction, we propose a simple formula to make a "correction" of the ejection fraction in this type of case; it was tested in a group of outpatients cited consecutively. It is confirmed that 27.6% of patients have their prognosis and/or treatment modified when applying the proposed formula.

018 TITLE: 2017-18 Cardiology Year in Review AUTHOR (S): Dr. Gregory Giugliano; Robert P. Giugliano Submitted for: Interventional Cardiology, Acute Coronary Syndromes, Valvular Heart Disease ABSTRACT BODY: Each year important advances in cardiovascular medicine are presented at the various major scientific sessions held throughout the world. However, the demands of clinical practice often make attendance at these meetings challenging. Subsequent delays between the live presentation and publication in the literature leaves practitioners without a reliable tool for integrating new knowledge into their practice. We will present peer-reviewed highlights of the most important cardiovascular clinical trials presented within the past year at major scientific sessions (ESC 2017, TCT 2017, AHA 2017, and ACC 2018). These data will cover a broad range of cardiovascular topics spanning the breadth of cardiovascular diseases. The goal of this presentation is to bring the busy clinician up to speed with the latest developments in clinical cardiovascular studies of the past year.

019 TITLE: Pericardial Tamponade AUTHOR (S): Shawn Gordon; Submitted for: Paediatric Cardiology ABSTRACT BODY: Abstract Pericardial Tamponade Background Emergency drainage of pericardial tamponade in the Paediatric population is rare but it can cause severe morbidity and mortality if is not diagnosed early. Divya Shakti et al, 2014 provided the first large multicentre description of idiopathic or viral pericarditis and pericardial effusion in children. Idiopathic or viral pericarditis/pleural effusions are most common in male adolescents and are treated infrequently with colchicine. Case Presentation: This 6 week old male presented to the Accident and Emergency Department twice during the first month of his life with difficulty breathing. He was admitted on the 1/08/17 and 6/09/17 respectively. His first echocardiogram done on 02/08/17 showed a enlarged right heart , ASD with left to right shunting, tricuspid regurgitation, large right ventricle and atrium, small right pulmonary artery , no PDA ,Small left ventricle poorly contracting ,poorly contracting right ventricle and a narrow descending aorta.


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He was discharged on the 10/08/17 on anti-failure treatment. He was readmitted on the 6/09/17 with difficulty breathing and an echocardiogram done on the 13/09//17 revealed early changes to the right atrial size, left ventricular hypertrophy and a large pericardial effusion He was treated with anti-failure treatment and steroids and but his condition deteriorated. He was diagnosed with cardiac tamponade on 16/09/17 and an emergency pericardiocentesis was performed on 17/09/17. An 18 gauge cannula was inserted in the subxiphoid area and a 14 guide wire was introduced followed by a 16 gauge Fr central line. One hundred and ten (110 mls) of pericardial fluid was aspirated. The patient condition improved immensely. Conclusion In resource limited Countries like St Lucia without adequate resources we successfully diagnosed and treated cardiac tamponade in a six week old male using a central line catheter.

020 TITLE: Health city Cayman Islands Experience of Renal Sympathetic Denervation for Resistant Hypertension AUTHOR (S): Dr. Rizwan Hossain; Ravi Kishore Amancharla MD, Srinath Polasani (CVT), Dhruva Kumar MD , Sripadh Upadhya MD,

Pankaj Gundad MD, Raghu Prasad MD Submitted for: Interventional Cardiology ABSTRACT BODY: Background: The conventional method described for renal sympathetic denervation for resistant hypertension went into disfavor after the Symplicity HTN-3 trial publication. However, clinical experience still confirms benefit in selected patients. Our theory is that the variable results from the procedure were due to the inconsistent quantum of damage inflicted on the renal neural system by the RF delivery using the conventional technique. We modified the procedure to allow better RF delivery and the results of such an approach are described in this case study. Case Study: A 47 year old patient on 4 anti-hypertensive drugs including a diuretic with resistant hypertension confirmed on ambulatory BP recording was offered the procedure after ruling out drug- noncompliance, and eliminating other causes for secondary hypertension. The procedure differed from previously described method 1. Conventional 5Fr ablation catheters and RF delivery system were used. 2. An innovative cooling method was used during RF delivery to allow transmural burns along the renal arteries. 3. 8 lesions were delivered in each renal artery (8 watts, temperature 43) Âº. Repeat renal angiography was performed at the end of the procedure. Results: The results of Ambulatory BP recording at one month and three months after Renal Denervation are shown below:- Baseline 1 month 3 month 24hrs Average BP 150/100 130/90 116/80 Day time BP 162/97 140/85 119/76 Night time BP 159/98 115/75 105/63 Conclusion: Catheter based renal denervation using cooling during RF delivery causes significant blood pressure reduction without serious adverse events in patients with resistant hypertension during a short term follow up.

021 TITLE: Cardiac Amyloidosis and Unexplained Left Ventricular Hypertrophy AUTHOR (S): Dr. Jocelyn Inamo; Nathalie Ozier-Lafontaine; AndrÃ© Atallah; Sego HÃ©dreville; Sylvie Merle; Julien Fabre; Rishika

Banydeen; Remi Neviere1 Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Background Afro-Caribbean regions might have a high prevalence of transthyretin cardiac amyloidosis due to their shared ancestry with Afro-American populations, where a high prevalence of Val122Ile variant of the transthyretin gene has been found. Val122Ile variant is associated with late onset cardiac amyloidosis. Still, the prevalence of cardiac amyloidosis disease (CAM) in patients presenting with unexplained left ventricular hypertrophy (LVH) in AfroCaribbean populations is not known. The aim of this study was to determine the prevalence of cardiac amyloidosis in a consecutive cohort of patients with unexplained left ventricular hypertrophy. Design, setting and patients Three centres in Fort de France, TrinitÃ© (Martinique) and Basse-Terre (Guadeloupe) participated. Patients were consecutively enrolled if they have wall thickness > 15 mm at echocardiography. The first diagnosis line was based on findings of an abnormal

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” cardiac fixation of bone tracer and/or a monoclonal gammapathy. Patients with such abnormalities were then referred for a more complete set of procedures including gingival or cardiac biopsies, MRI, and transthyretin gene sequencing. Results We present here the preliminary results of the first 127 patients enrolled. Mean age was 65 Â± 11 years. Mean septal thickness was 16.2 Â± 2.3 mm and posterior wall 14.6 Â± 2.1 mm. Diagnosis was accurate in all but 9 patients. Cardiac amyloidosis was found in 40 patients (33.9%), including 34 with transthyretin cardiac amyloidosis (CATTR) and 6 patients with AL amyloidosis. Male gender was found in 25/34 (78%) patients with CATTR. Conclusion This study confirms a high frequency of Hereditary Cardiac Amyloidosis in patients with unexplained left ventricular hypertrophy in AfroCaribbean populations.

022 TITLE: Transesophageal Echocardiogram in Operation Theatre: Health City Cayman Islands Experience AUTHOR (S): Dr. Dhruva Kumar Krishnan; Trupti Sumit Modi MD, Submitted for: Non Invasive Imaging ABSTRACT BODY: Introduction: The role of Transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today TEE is a class I indication in most cardiothoracic surgeries and many Cardiology procedures. The TEE should be incorporated into a comprehensive examination in both the pre- and post-operative periods. The detection of new, unexpected findings due to the comprehensive intraoperative TEE examination varies from 4% to 25% and has a huge impact on surgical decision-making. METHODS: At our center TEE was done on 304 patients for varied indications in operation theatre. We present our experience with relevant data:- OPERATION THEATRE: Adult- 146 Paediatric - 158 CATHLAB: ADULT -32 Paediatric -05 ICU: ADULT -66 Paediatric -01 Return on bypass: additional graft (1), Paravalvular leak in Aortic valve replacement (1) & Residual Right ventricle outflow tract gradient in Tetralogy of Fallot and residual shunting (1) New finding Left atrial appendage clot not diagnosed pre op (1 ) Assisting in deairing in all cases Confirmation of diagnosis (Not clear on Transthoracic Echo) Infective Endocarditis (2 ) Cardiac Tamponade leading to reexploration and evacuation of clots (3) Left ventricular assist device (4) Residual shunting in VSD - 6 positioning of an intravascular device for eg: in minimally invasive Surgery (5) and Intra-Aortic balloon pump positioning (1) Left atrial appendage clot before cardioversion (2) Guidewires and Cannula placement on ECMO 6 Conclusion: Transesophageal echocardiography (TEE) has become an important monitor in aiding the diagnosis of cardiac pathologies, in Cardiac anesthesia and surgical interventions.


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023 TITLE: Transesophageal Echocardiogram in Cathlab: Health City Cayman Islands Experience AUTHOR (S): Dr. Dhruva Kumar Krishnan; Trupti Sumit Modi MD Submitted for: Non Invasive Imaging ABSTRACT BODY: Introduction: Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. Thereby enhancing the efficiency and safety of these procedures. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications such as pericardial effusion or thrombus formation. Perioperative echocardiography has helped to meet the growing need for real-time monitoring of patient anatomy, catheter location, surveillance of intraprocedural complications and reduction of radiation exposure represents an important advantage. Real time 3 D offers the most useful 3D perspectives in the following catheter-based percutaneous interventions: transseptal puncture; patent foramen ovale/atrial septal defect closure; left atrial appendage occlusion; mitral valve repair; and closure of paravalvular leaks. TEE was used in the following Cathlab interventions at Health City. ASD device closure -4 VSD device closure -2 LAA DEVICE closure-2 CRYOABLATION-14 MV paravalvular leak-1 RF Ablation -8 TAVI-1 Conclusion: Imaging requirements are procedure-specific. The role of TEE in cath lab for different interventions will be discussed.

024 TITLE: Percutaneous Expansion of Rheumatismal Mitral Stenosis in Martinique: A 44 Cases Study AUTHOR (S): Dr. Rosanna Landes; Julien Fabre MD, Sebastien Pouy MD, Astrid Monfort MD, Dabor Resiere MD, Philippe Cohen

Tenoudji MD, Jocelyn Inamo MD, PhD Submitted for: Interventional Cardiology, Heart Failure and Cardiomyopathies, Valvular Heart Disease ABSTRACT BODY: OBJECTIVE : The goal of this study was to describe and assess the efficacy and safety of percutaneous dilatation of mitral stenosis DVMPC locally, in the UH of Martinique. METHODS : Every patient who underwent a DVMPC between January 2006 and December 2017 in the UH of Martinique was included in this monocentric study. The indication of the intervention was established by a multidisciplinary staff; a symptomatic and severe mitral stenosis, respecting to the European echocardiographic criteria recommendations. Patients were screened retrospectively from medical reports. Each procedure was carried out under local anesthesia and after trans esophagus echocardiography checking. Dilatations were performed for every patient after a transeptal puncture under fluoroscopy using the Inoue Balloon technique by transfemoral access. The length of stay was 48 hours. RESULTS: 44 patients were included in this study. The average age was 38 years-old, mostly women (88.6%).â€¨Prior to the procedure, 27 patients (61%) were stage 3 or 4 of NYHA, 36% had history of atrial fibrillation, and 20% had an embolic episode previously. After the procedure, 21 (78%) of these stage 3 or 4 of NHYA all improved their shortness of breath (NYHA 1 or 2) Gradient after dilatation plummeted to 4.7 mmHg (versus 13 mmHg before). Mean surface after dilatation rose up 1.7 cm2 (versus 0.95 cmÂ² before). Average Systolic Pulmonary Arterial Pressures were 38 mmHg after dilation compared to 48 before procedure.

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” One patient (2.3%) presented a large mitral leak leading to in emergency to surgery, 1 (2.3%) other patient died from mesenteric ischemia. Embolic episodes affected 3 of our patient and 12% had significant MI after the procedure. There is 1 puncture hematoma but no cases of cardiac perforation nor tamponade. CONCLUSION: 44 patients benefited from a dilatation of an MS between 2006 and 2017 in our hospital. This study confirms the efficiency and safety of percutaneous dilatation in our center with figures comparable to those of the previous literature. Hence it is confirmed that mitral percutaneous dilatation remains a good symptomatic and severe MS with which patients mitral valve anatomy is suitable.

025 TITLE: The Scope of a Combined Kidney Failure-Heart Failure Clinic AUTHOR (S): Dr. Racquel Lowe-Jones; Joey Junarta, Ahmad Salha, Bayiha Klaud Francheska, Lisa Anderson, Juan C Kaski, Debasish

Banerjee Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Chronic Kidney Disease(CKD) in heart failure(HF) is common, with high mortality, poor quality of life and multiple clinical issues which does require a multidisciplinary approach. This study investigates the role of a combined nephrology-cardiology clinic to manage CKD-HF patients(pts). We examined the referral patterns, comorbidities, management issues and interventions in pts referred to a combined CKD-HF clinic in a tertiary care hospital. Data was collected as part of an audit for pts referred over ten months. A total of 69 pts were referred; 60 attended a first visit; 33 second visits, 7 third visits and one 4th visit. Clinical characteristics: age 76Â±13(meanÂ±SD) years, males 69%, hypertensives 88%, diabetics 53%, dyslipidemics in 70%; eGFR 33Â±12 ml/min/1.73m2, potassium 4.56Â±0.49 mml/L, creatinine 186Â±88 Î¼mol/L, hemoglobin(Hgb)114Â±21g/L, ferritin 223Â±232Î¼g/L. Mean echocardiogram ejection fraction was 45Â±14% with half the population below 50%. At presentation 57 were on beta blockers, 43 on angiotensin converting-enzyme inhibitors /angiotensin-receptor blockers(ACEi/ARBs) and 20 on mineralocorticoid receptor antagonists (MRA). Maximum dose of ACEi/ARBs was achieved in 6 pts and 1 for MRA. A pre-visit potassium of 5.6 mmol/L was found in 1 patient. 26(45%) had Hgb <110g/dL. 22 pts had a ferritin<200Î¼g/L. In the first visit, 55(79%) received advice on diet, salt and fluid restriction. ACEi/ARB was changed or started in 15(22%); MRA dose was changed or started in 7(10%). 21 pts received intravenous iron, 1 had a 2nd infusion and 10 infusions were administered on day of appointment. Ferritin improved between 1st and 2nd visit (p=0.046). Cardiac interventions performed as result of 1st visits included dobutamine stress test, cardiac MRI and placement of a resynchronization pacemaker. This study shows that the CKD-HF pts referred to the new clinic suffered from multiple morbidities, low kidney function, low Hgb and iron stores. The pts rarely received maximum dose ACEi/ARB or MRA though hyperkalemia was rare. This novel outpatient clinic was able to address multiple renal-cardiac issues in the same visit with a collaborative approach between two disciplines.

026 TITLE: A Race Against Time: A Case of an Embolus AUTHOR (S): Dr. Monique Monplaisir; Dr. Romel Daniel Consultant Cardiologist, Member of Caribbean Cardiac Society Submitted for: Epidemiology and Prevention, Vascular Medicine ABSTRACT BODY: Pulmonary Embolism (PE) is a common and often fatal disease. PE incidence is 29-78 per 100 000 person-years. Presentations of PE are often vague and it can be missed.St. Lucia is a resource-poor island; there is not always ready access to tools such as Computer Tomography Pulmonary Angiography (CT-PA). I want to highlight how using a high clinical suspicion and current guidelines have a favorable outcome despite not having access to every diagnostic tool. A 72-year-old female with hypertension, was on a long flight before presentation. She began to feel short of breath (SOB) soon after the flight, it was exacerbated by exertion and eventually felt at rest. She experienced diaphoresis, but no chest discomfort. No palpitations, cough or wheeze. P 97 BP 110/78 R 26 SPO2 94%. Diaphoretic. S1, S2 and S3. Chest was clear, no crepitations or wheeze. ECG showed right axis deviation, S1Q3T3 pattern, and T-wave inversion in leads V1-V4. Within 1 hour BP dropped to 50/33 and she was started on a dobutamine infusion. An urgent CT-PA was ordered but the CT Scanner was down. D-Dimer-3310. Echocardiogram showed pulmonary artery pressure to be > 80 mmHg, the septum was hypokinetic and the right heart was enlarged. A diagnosis of massive pulmonary embolism was made. Thrombolytic therapy was initiated. The echocardiography was


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repeated 5.5 hours after thrombolytic therapy and the pulmonary artery pressure was estimated to be 45. Patient's symptoms resolved, and she had uneventful admission. As seen by the case, a patient with a PE can have rapid deterioration that can lead to death. As per the American Heart Association, patients with haemodynamic instability and clinical probability of pulmonary embolism are high-risk patients. In these patients echocardiogram is an alternative if a CT-PA is not readily available or the patient has uncontrolled hypotension. Once the D-Dimers are positive and there is right ventricular dysfunction, a diagnosis of pulmonary embolism is made. Treatment includes immediate primary reperfusion plus anticoagulant therapy. In our setting, fibrinolytics are the only reperfusion techniques available, so this was initiated as soon as safely possible.

027 TITLE: World Pediatric Project: Impact on Cardiovascular Health of Children of the Eastern Caribbean AUTHOR (S): Dr. William Moskowitz; N/A Submitted for: Paediatric Cardiology ABSTRACT BODY: Background: World Pediatric Project (WPP) is a US-based nonprofit organization dedicated to healing critically-ill children and building sustainable health care capacity throughout the Caribbean and Central America. WPP partners closely with Ministries of Health, inter-governmental agencies, community groups, hospitals and local healthcare providers to reach more than 2,500 children each year with diagnostic and surgical services. Pediatric cardiac services (congenital heart disease (CHD) screening and care, rheumatic fever (RF) prevention and rheumatic heart disease (RHD) screening and care) represent a significant portion of WPPâ€™s program activities in the region. WPPâ€™s Transformation 2023 plan is a strategic initiative to accelerate outreach and services in the Caribbean region, with a target of 100% access to diagnostic cardiology for all children in the Eastern Caribbean (EC) by the year 2023. Results: Total number of WPP cardiac missions to the EC 8/02-3/18: 36. Total distinct children served: 4755 Cardiology clinic evaluations (including physical exam and echocardiogram; often with ECG, CXR, labs): 2606 From 2606 evaluations on 1238 distinct children (includes follow-up evaluations) referred for intervention: 155 Conclusions: 1. WPP through its EC initiative has been highly successful in providing access to state-of-the-art diagnostic, therapeutic and continuity of cardiovascular care to EC children. 2. The ultimate goal of the RF/RHD program is to reduce the incidence of endemic RF and RHD amongst EC children thereby achieving a reduction in morbidity, mortality and medical and surgical costs and improve the health and productivity of the EC children and their countries. 3. With continued and expanded partnerships, WPP will attain its target of 100% access to diagnostic cardiology for all children in the EC by the year 2023.

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TITLE: Initial Clinical Experience With the First Drug (Sacubitril/Valsartan) in a New Class - ARNIs in Patients With Heart Failure With Reduced Ejection Fraction in Afro Caribbean Population AUTHOR (S): Dr. Felix Nunura; Edwin Tulloch-Reid ; Dainia S Baugh , and Ernest C Madu Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Heart failure (HF) is a complex syndrome whose pathophysiology is based on a progressive neurohormonal activation and alteration in the autonomic control. In previous studies we have demonstrated that Afro-Caribbean patients with heart failure are mainly hypertensive with or without diabetes and half of them develop left ventricular systolic dysfunction due to non-ischemic causes. In addition, we have reported that among Afro-Caribbean patients with Heart Failure and reduced ejection fraction (HFrEF), angiographycally proven Non Ischemic Dilated Cardiomyopathy (NIDCM) was more frequent that Ischemic Dilated Cardiomyopathy (IDCM). Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilisin inhibitors (ARNIs) recommended in the new European and American Heart Failure guidelines instead of ACEIs, or ARBs (angiotensin receptor antagonists) for further reduction in the risk of hospitalization or death, however there are no studies on the use of ARNIs in Afro Caribbean population . The aim of this paper is to present the initial experience with regard to the effectiveness, tolerance and safety of sacubitril/valsartan. In a case

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” series of outpatients with HFrEF from the Heart Institute of the Caribbean in Jamaica it was demonstrated that the use of sacubitril/valsartan is safe and is associated with a significant clinical improvement, as reflected by reduced NYHA class and improved exercise tolerance during the follow-up time.

029 TITLE: Dobutamine Echocardiogram-Induced Hypotension in Caribbean Patients: Incidence and Predictors AUTHOR (S): Dr. Felix Nunura; Ahmed Goha, Kene Mezue, Kristofer C. Madu, Dainia S. Baugh, Felix Nunura, Edwin Tulloch-Reid,

Marshall Tulloch-Reid, Ernest C. Madu Submitted for: Non Invasive Imaging ABSTRACT BODY: Background: The information regarding the incidence and predictors and significance of hypotension during dobutamine stress echocardiogram (DSE) in Caribbean Population is scarce Aim: We sought to define the incidence, predictors and clinical significance of hypotension during DSE in a population of jamaican patients referred to the Heart institute of the Caribbean . Methods: Retrospective analysis of the data of 252 patients referred to the Heart Institute of the Caribbean, Kingston, Jamaica for DSE from 2012 to 2016. Results: The average age of the cohort was 63 years, 64.3% were females. An abnormal BP response, defined as a decrease in blood pressure of more than 20 mmHg was recognized in 20.2% of patients. Compared with Normotensives, Hypertensive patients had a statistically significant BP drop (p < 0.034), in addition we found a statistically significant association with hypotension during w ith clinical presentation of dyspnea (p < 0.046). Although Hypotension also occurred more frequently in females than males, this was not statistically significant. Finally we do not demonstrate any association between the incidence of hypotension and the results of the DSE test. Conclusion: This is the first study to define Hypotension responses during DSE in a Caribbean population. The incidence of Blood Pressure drop with DSE was comparable to other studies in non-Caribbean patients, however we found that Hypertension and clinical presentation of dyspnea were significant predictors for DSE-induced hypotension .

030 TITLE: Induced Ischemia Detected by Stress Echocardiography in Caribbean Patients AUTHOR (S): Dr. Felix Nunura; Ahmed Goha, Kene Mezue, Kristofer Madu, Edwin Tulloch-Reid, Dainia Baugh, Felix Nunura, Ernest

Madu Submitted for: Non Invasive Imaging ABSTRACT BODY: Background: Stress echocardiography (SE) is a recognized, cost-effective way to diagnose significant obstructive coronary artery disease. Its clinical utility in Caribbean Population is still being explored. Aim: To assess independent predictors factors of Echo stress-induced Ischemia by examining the relationship between demographic pretest patient characteristics and the results of SE test in adults who were referred to the Heart Institute of the Caribbean (HIC) , Kingston , Jamaica . Methods: :Retrospective analysis of the data of 481 patients referred to the HIC for SE from 2012 to 2016 by Multivariate logistic regression analysis in order to identify independent predictors of Stress-induced ischemia . Results: The average age of the cohort was 61 years, 58.4% were females. Exercise SE was performed in 32.6% of patients and 67.4 % underwent dobutamine SE. New Wall Motion abnormalities suggestive of ischemia were found in 18.4% . In multivariate logistic regression model, Age (OR 1.028; p=0.012) and Male gender (OR, 2.35; P = 0.005) were shown to be significant independent predictors of a positive stress echo result in this population. Conclusion : The incidence of ischemia among this unselected Jamaican patient population referred for SE at HIC was about 18.4% and Stress-induced ischemia by SE was more likely to be present in men and the elderly

031 TITLE: 12-lead ECG abnormalities in Adolescent Jamaican Athletes AUTHOR (S): Dr. Felix Nunura; Kenechukwu Mezue ; Kristofer Madu; Eric Stewart; Dainia Baugh; Edwin Tulloch-Reid and Ernest

Madu (*) Submitted for: Epidemiology and Prevention ABSTRACT BODY: Physiologic ECG abnormalities are more prevalent and significant in athletes of African descent and highly trained endurance should be evaluated in light of the athleteâ€™s gender, race, level of fitness, and type of sport. The Prevalence of Physiological versus pathological ECG abnormalities in Adolescent Jamaican athletes has not been previously reported. 12-lead ECG Data from


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145 Jamaican Adolescent Athletes (Age 15 Â± 1.77; females: 60 %; height 1.65 Â± 0.08 m; weight 54.05 Â± 9.94 kg) assessed between February 2015 and September 2017 at the Heart Institute of the Caribbean-Jamaica was available for analysis. From 110 (76 %) subjects with ECG abnormalities, the frequency of Training-unrelated ECG changes was 4%. Among subjects with Training-Related ECG Changes (Figure) we found 32.5 % with isolated ECG voltage criteria for Left ventricular Hypertrophy (IVCLVH), 29.2 % with Sinus Arrhythmia (SA), 20.7% with Sinus Bradycardia (SB), 4.5% with Early Repolarization (ER) and 0.7 with First Degree Atrio Ventricular Block (1stAVB). We conclude that training-Unrelated ECG Changes are uncommon in this study population and Physiological abnormalities are more prevalent. Further research is required to confirm this initial observation. Key Words: ECG, Jamaica, Athletes, Caribbean Region , Sports Medicine

032 TITLE: Predictive Value of Stress Myocardial Perfusion Scan in Detection of Coronary Artery Disease in Caribbean Patients AUTHOR (S): Dr. Felix Nunura; Ahmed Goha, Filipa Alves, Kristofer Madu, Kene Mezue, Dainia Baugh, Felix Nunura, Edwin Tulloch-

Reid, Ernest Madu Submitted for: Non Invasive Imaging ABSTRACT BODY: Background: cardiovascular disease is the leading cause of death in Jamaica, an Stress Myocardial Perfusion Scan (SMPS) is an important tool in diagnosis and risk stratification of patients with suspected or known coronary artery disease (CAD). Aim: Ascertain the independent predictors of coronary artery disease detected by SMPS in patients referred to the Heart Institute of the Caribbean, Kingston, Jamaica. Methods and results: Retrospective analysis of data of 202 patients who underwent SMPS from 2015-2016. Ninety one patients underwent symptom-limited treadmill stress test MPI, one hundred and nine patients underwent dobutamine SMPS and two patients had adenosine stress test. Treadmill stress test showed significantly higher hemodynamic response compared to dobutamine stress test (p 0.00034), though there was no significant difference of test results between different stress modalities (p 0.077). Logistic regression model demonstrated that age (odds ratio 1.043; p=0.08), male gender (odds ratio, 0.34; P = .006) and hypertension (or odds ratio, p value0.000) were significant independent predictors of a positive SMPS . Based in the data of Twenty one patients with abnormal MPI had coronary angiography we estimate that the predictive ability of abnormal vascular territory perfusion to correlate with assigned coronary artery is 64.3%, while the predictive ability of abnormal SMPS to detect CAD was 95.2%. Conclusion: We demonstrate that SMPS is a safe and useful modality to assess the presence of CAD with high diagnostic accuracy. Both pharmacologic (Dobutamine/Adenosine) and exercise SMPS were comparable in their ability to predict the presence of significant CAD this Caribbean Population.

033 TITLE: Left Ventricular Dysfunction in Patients with Sickle Cell Disease AUTHOR (S): Dr. Leila Piorunowski; J. Inamo Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Left ventricular dysfunction (LVD) defined as LVEF < 55% is associated with an excess of death in patients with sickle-cell disease (SCD)*. In this study, we analyzed the frequency and clinic characteristics of LVD in the French SCD multicentric cohort initiated from 1999 to 2011 to measure the prevalence of pulmonary hypertension. Patients included had SS or S-Î² Thal SCD and were in stable condition. Patients with severe renal, hepatic or pulmonary dysfunction were excluded. The study variables were collected prospectively. Results : The French cohort included 392 patients. Thirty seven patients (9,4%) had a LVEF < 55%.Their average age was similar to those without LVD (35 vs. 34 years p= 0.55). Sex-ratio was also identical. No significant difference was found in the frequency of systemic hypertension (10,8% vs. 4,7%), systolic (118,05mmHg vs. 116,7mmHg) or diastolic blood pressure (67,3mmHg vs. 66,0mmHg), or heart rate (72 vs. 74), all p>0,15. BMI (21,89 vs. 21,7kg/mÂ² (p=0,34) and creatinine clearance (126 vs.130 ml/min) were also similar (all p>0.10). LV diastolic volume (82,6 vs. 71,7ml/mÂ²) and E/Eâ€™ ratio (8,3 vs 6,7) were increased (all p<0,001), but not cardiac output (6.3 vs. 6.3 l/min), left atrial volume (42,2 vs. 40,8 ml/mÂ²), and the maximal velocity of tricuspid regurgitation (all p>0.10). Frequency of class 3 NYHA (13,5 vs. 6,8%), 6 minutes walk test distance (523 Â± 76 vs. 512 Â± 88 m), Borg score (2,0 vs 2,7), ProBNP value (log expressed, 1,74 vs. 1,83), were similar (all p>0,10).

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” Conclusion : LV dysfunction is uncommon in patients with SCD and is not associated with clinical or biological differences which could explain the excess mortality previously observed. It does not result in functional impairment. However a similarly high cardiac output is observed, owing not to an increase in heart rate in those with LV dysfunction, but rather to a LV dilatation whose prognostic value needs further assessment

034 TITLE: Efficiency and safety of PFO closure in the University Hospital of Martinique AUTHOR (S): Dr. Sebastien Pouy; Julien Fabre MD, Dabor Resiere MD, Rosanna Landes MD, Aissatou Signate MD, Philippe Cohen

Tenoudji MD, Jocelyn Inamo MD, PhD Submitted for: Interventional Cardiology ABSTRACT BODY: OBJECTIVE : The goal of this study was to assess the efficiency and safety of PFO closures in the University Hospital of Martinique METHODS : Each patient who underwent a PFO closure in the UH of Martinique between May 2004 and December 2017 was included in our work. Patients were screened and identified retrospectively from medical reports and other different soft wares making up our data base. Several indications can lead to the intervention: cryptogenic stroke, platypnea-orthodeoxia syndrome (POS) or severe refractory hypoxemia (SRH). The decision was made up by a multidisciplinary staff (neurologists and cardiologists) in ahead of the procedure. RESULTS : From May 2004 and December 2017, 92 patients met the criteria and were included in our study. The main indication remained cryptogenic strokes (79,3%) followed by OPS (9%) and SRH (8%). Sixty nine patients had an atrial septal aneurysm combined to their PFO. Before the procedure, 51% had a mono antiplatelet therapy, 42% an oral anticoagulation and 2% only had both. During the intervention, one patient suffered an ischemic stroke and 5% a femoral hematosis. Four patients died during the current hospitalization (all of them came from medical intensive care department: 2 septic shocks and 2 severe hypoxemias). A contrast transthoracic echocardiography was performed within the first twenty four hours post-intervention: 78% had a total success of occlusion and 12%had a remaining mild shunt. The one year follow-up showed that only 4% had a remaining shunt whereas no endoprothesis thombosis or dislocation occured. CONCLUSION: 92 patients underwent a PFO closure from May 2004 and December 2017. Only 4% had a remaining shunt during the first year of follow up and only one patient suffered an ischemic stroke during the procedure. Our study confirms the safety and efficiency of the procedure under local anesthesia after a multidisplinary. The CLOSE Study recently published in the NEJM, which clarified the indication of PFO closure in cryptogenic strokes, supports our PFO management and proved a long-term efficacy. These patients need to be handled by a multidisciplinary staff.

035 TITLE: Utility of Compound Motor Action Potentials (CMAPs) for the Prevention of Phrenic Nerve Palsy AUTHOR (S): Dr. Raghu Prasad; Srinath Polasani (CVT), Sripadh Upadhya MD, Dhruva Kumar MD, Renuka Devi RN, Pankaj Gundad

MD, Rizwan Hossain MD , Ravi Kishore Amancharla MD Submitted for: Arrhythmias and Electrophysiology ABSTRACT BODY: Introduction: Phrenic nerve palsy (PNP) remains the most dreaded complication associated with cryoballoon-based PVI. We sought to characterize our experience with a unique monitoring technique for phrenic nerve injury in a 61 year old patient who developed a transient PNP during cryoablation of paroxysmal AF. METHODS: A surface CMAP was recorded on modified lead I by placing a standard surface right arm EKG electrode 5 cm above the xiphoid, and a left arm EKG electrode 16 cm along the right costal margin. CMAP is expected to reflect electrical activity from diaphragm and studies have shown that a decrease in CMAP amplitude by 35% from baseline predicted phrenic nerve injury. During RSPV isolation, at 95 seconds after initiating the freeze (temperature -41Âº C), there was a loss of diaphragmatic motion. Therefore, ablation was terminated. Phrenic nerve function returned 15 minutes after stopping the ablation. We later analyzed the CMAP tracing and found there was an initial change in amplitude of CMAP signal when we started the freeze. This was due to respiratory variation. At 12 seconds of freeze (temperature -1Âº C), the amplitude started progressively decreasing from the baseline value, followed by complete absence of CMAP signals at 72 seconds when the temperature was -39 ÂºC. It is important to


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note that during this period, the diaphragmatic excursion remained intact as monitored by pacing-palpation technique. Therefore, CMAP amplitude variation significantly preceded the diaphragmatic motion loss. Conclusion: This case illustrates electromyographic phrenic nerve monitoring using the surface CMAP is reliable, easy to perform, and offers an "early warning" to impending phrenic nerve injury.

036 TITLE: An Unusual Case of Allergic Acute Coronary Syndrome (Kounis syndrome) in a 28 year old AUTHOR (S): Dr. Demeytri Ramnarase; Lin Thiri Toon Submitted for: Acute Coronary Syndromes ABSTRACT BODY: Allergic acute coronary syndrome (Kounis syndrome) is caused by coronary artery vasospasm in a patient with atopy. There is usually an identifiable trigger (allergen) such as food, drug, and exposure to cold or insect bites. Patients may or may not have underlying coronary artery disease. It has not been widely described and we believe that it is an under-diagnosed entity. Our patient is a 28 year old asthmatic female who first presented with acute coronary syndrome at age 25. She initially presented with acute onset central chest pains and dyspnea. ECG showed widespread ST segment depressions of 2-3mm which was associated with two troponin T levels of more than 250 ng/dl. During coronary angiography she developed vasodilator refractory vasospasm in her proximal LAD with no distal flow. It was treated by angioplasty and DES insertion. This episode was associated with a significant rise in IgE which normalized after treatment with hydrocortisone and chlorphenamine followed by a tapering course of oral steroids. CT pulmonary angiography, CT coronary angiography, vasculitic screen and urine toxicology were all normal but cardiac MRI showed evidence of a sub-endothelial infarct. She was non-concordant with her vasodilators and represented six times in the subsequent three years. On these presentations she had troponin negative chest pains (vasospastic angina) associated with ST segment changes which returned to baseline after administration of vasodilators. On her most recent admission she had troponin positive chest pains which prompted a repeat angiogram to look for stent thrombosis. She developed vasospasm just distal to the stent when contrast was injected. We noted that all her exacerbations have occurred during winter months. She smoked cigarettes prior to her first presentation but continues to have vasospasms despite having quit smoking for three years. Her vasospasms seem to be confined only to her coronary arteries. In conclusion we believe that our patient has Kounis syndrome since her vasospastic attacks were associated with a rise in serum IgE, contrast induced vasospasm and cold exposure which is a recognized trigger and she has a history of atopy.

037 TITLE: The Heart Stops AUTHOR (S): Dr. Kishan Ramsaroop; Dr R Singh, Dr P Ramoutar, Dr S Mahabir, Dr S Ganga Submitted for: Arrhythmias and Electrophysiology ABSTRACT BODY: ABSTRACT Bradycardia is one of the most frequently requested referral to the cardiologist [1]. A careful and detailed drug history should always be elicited [1]. Cardiac side effects due to anti-epileptics are rare. Even more unusual is dysrhythmia secondary to oral anti-epileptics [2]. In our case we would like to highlight the effects of oral phenytoin use on the heart. KEY WORDS: Phenytoin, anti-epileptic, bradycardia, arrhythmia

038 TITLE: Cardiovascular Toxicity with Metformin Overdose in the Intensive Care Unit: A Prospective Case Series From the Caribbean AUTHOR (S): Dr. Dabor Resiere; Resiere D (1), Populo A (1), Charbatier C (1), Florentin J (1), Didier M (2), Fabre J (4), Inamo J (4),

Hommel D (2), Roques F (2), MÃ©garbane Bruno (3), Mehdaoui H (1). Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY: Objective: Metformin is the most prescribed anti-diabetic drug worldwide, particularly in the Caribbean. This drug is used in the management of type-2 diabetes mellitus. Its main complication called metformin-associated lactic acidosis (MALA) is rare, but potentially fatal. Acute metformin intoxication may result in severe additional complications including renal failure, cardiogenic shock, acute myocardial injury, cardiac arrest, multiple organ dysfunction, and death. The most common cause is the incidental

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” metformin overdose, often triggered by acute renal failure or sepsis, while massive self-ingestion in suicidal attempt remains rare. The main mechanism of metformin of action is related to the inhibition of a specific mitochondrial isoform of glycerophosphate dehydrogenase, which causes an accumulation of lactic acid. Our objectives were to describe the toxicity and mortality resulting from metformin overdose in patients admitted to the intensive care unit (ICU) in the Caribbean and identify possible prognosticators. Methods: We conducted a single-center prospective observational study over 7 years including all successive patients admitted in the Department of Medical and Surgical Critical Care at the University Hospital of Martinique between 2010 and 2017 for metformin overdose defined by the onset of MALA following 1)- a history of acute renal failure in a known diabetic patient treated with metformin (chronic poisoning); or 2)- a massive ingestion of metformin (acute self-poisoning). When possible, plasma metformin concentration was measured in a Toxicology Laboratory located in Paris. Data analysis was performed using univariate analysis with Chi-2 or Mann-Whitney tests as required. Results: Thirty-two patients were included (22 males/10 females). Chronically metformin-overdosed patients (N=22) differed from self metformin-poisoned patients (N=10) mainly by their co-morbidities and their presentation severity like the SOFA score on admission (p<0.0001). Risk factors of death were plasma lactate concentration > 10 mmol/l (p<0.0001), blood metformin concentration > 10 mg/l (p<0.0002) and onset of acute renal failure (p<0.0003).

039 TITLE: Feasibility Extracorporeal Membrane Oxygenation (Ecmo) in a Caribbean Intensive Care Unit; History, Current Indications and Future Directions. AUTHOR (S): Dr. Dabor Resiere; Resiere D (1), Sanchez B (2), Fabre J (3), Roques F (2), Mehdaoui H (1). 1-Critical Care Unit,

University Hospital of Martinique (French West Indies); 2- Department of cardiovascular surgery, University Hospital of Martinique, FranceÂ ; 3- Department of

Submitted for: Cardiac Surgery ABSTRACT BODY: Extracorporeal membrane oxygenation was used as additional life-saving therapeutic intervention in patients presenting severe acute respiratory distress syndrome (ARDS) or refractory hypoxemia and cardiac failure refractory to the usual conventional management consisting in protective mechanical ventilation, infusion of sedatives and early administration of a neuromuscular blocking agent, adminstration of inhaled nitric oxide, infusion of almitrine, and prone postion. We performed a retrospective study assessing, indications outcome and feasability of ECMO in the ICU. Methods: 220 patients received cardio-respiratory support for cardiogenic shock or Acute Respiratory Distress Syndrome (ARDS) from 2008 to 2018, followed by Extracorporeal Membrane Oxygenation (ECMO). All the patients were hospitalized either in the intensive care unit (ICU) or in the cardiovascular surgery department at the University Hospital of Martinique, after a veno-arterial (VA) or venovenous (VV) ECMO. Results: Retrospective study of two hundred and twenty patients (73Â± 29). The main indications was refractory cardiogenic shock due to ischemic heart disease in 52% of the cases and 28 (56%) acute myocardial infarction. Out-of-hospital refractory CA occurred in 20 (9%) patients, Eighty Six patients (39%) for ARDS predominantly (pandemic influenza A(H1N1) and bacterial pneumonitis (using venovenous ECMO. Our ICU physicians and care givers have been trained to manage Ecmo treated patient as well as ECMO-treated patient monitoring and weaning. This training required a tight collaboration with the departments of cardiac surgery. In the past 10 years, ECMO indications have been extended to treat patients with refractory cardiac arrest and non-toxic cardiogenic shock (using veno-arterial ECMO) and patients with acute respiratory distress syndrome, mainly resulting from viral patients with severe H1N1-suspected ARDS.). The survival rate was 57%. Conclusion: Despite robust training and prolonged experience in ICU, the trained intensivists work closely with cardiac surgeons to manage such patients. Decision to cannulate, Decision to cannulate, for ECMO monitoring, and to wean ECMO require

040 TITLE: What is the Impact of Cardiac Rehabilitation on Patients with Heart Failure in the Community Setting? AUTHOR (S): Dr. Susie Sennhauser; M.Tellez, S. Molina, J. Smith, J. Larned Submitted for: Heart Failure and Cardiomyopathies ABSTRACT BODY:


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Background Cardiac rehabilitation (rehab) is a medically supervised multidisciplinary approach to patients with known cardiac disease. During cardiac rehab patients learn to exercise safely to increase their tolerated physical activity and improve their quality of life. Purpose The purpose of this study was to evaluate findings in ambulatory heart failure patients referred to cardiac rehab from a community heart failure clinic and assess the impact on their quality of life based on readmission. Methods 115 patients were enrolled in heart failure clinic during 2017. Of these patients 51 were referred to cardiac rehab, with 32 patients (27.83% of all clinic patients) participating. 30-day all cause readmission rates of rehab patients were compared to all-payer readmission rates at the same hospital. Results Of the 32 patients who participated in cardiac rehab, over the course of the 2017 calendar year there was only 1 30-day all cause readmission (3.13%). This is compared to an 18.55% all cause readmission rate for the same community hospital during the same enrollment period. Of these patients who participated in cardiac rehab, the average ejection fraction (EF) on enrollment was 37%, with 78% of these patient with predominantly reduced EF. 25% of rehab patients were women. From a demographics perspective, these patients were predominantly Caucasian with 9% African and 3% of Asian descent. Discussion Patients who underwent cardiac rehab had a lower 30-day all cause readmission rate compared to the general heart failure population (p=<0.01). This cardiac rehab population also had a lower 30-day all cause readmission rate compared to patients enrolled in the heart failure clinic trending towards significance (p=0.062). Patient characteristics illustrate a fairly deconditioned population from a cardiac standpoint. We hypothesize that cardiac rehabilitation is a valuable tool for patients with heart failure in the community setting. Future directions include evaluating change in NYHA functional classification, follow up six-minute walk test.

041 TITLE: When Is the Ventricle Too Sick for Mitral Valve Surgery? AUTHOR (S): Dr. Cedric Sheffield; Edward Savage Submitted for: Cardiac Surgery ABSTRACT BODY: There are clear parameters for when mitral surgery should be considered to treat mitral valve disease. Less well defined is when mitral surgery will not benefit the patient either because the patient's disease has progressed too far or because the mitral disease is a secondary, not a primary problem. This talk will discuss various scenarios to help with the decision process to determine the appropriateness of surgery in the presence of significant mitral disease.

042 TITLE: Achieve a Zero Mortality In Cardiac Surgery (ACadEMCS) AUTHOR (S): Dr. Iman Simmonds; Eduardo Mascareno, Daniel Beckles Submitted for: Cardiac Surgery ABSTRACT BODY: Twenty-eight point four million Americans were diagnosed with heart disease, in 2015, resulting in the deaths of 614,348 people. Coronary artery bypass grafting (CABG) remains the safest most durable and effective treatment option for patients with symptomatic ischemia, not improved with medication and/or percutaneous coronary intervention. For the past 30 years, blacks compared to whites have lower rates of CABG utilization for comparable ischemic disease and higher 30 day mortality. In 1994, the observed operative mortality for black patients was 3.84%, by 2013 that rate fell to 3.59 %. And yet, the expected mortality rate from CABG, adjusting for risk factors other than race is 2.3%. This retrospective study aims to describe and understand how a single center in Brooklyn, New York has achieved zero mortality, despite higher percentage of black patients, whom have diabetes, renal insufficiency, lower ejection fraction. The secondary aim of this study examines how central venous pressure (CVP) guided hemodynamic therapy reduces the risk of post operative renal dysfunction, one of the strongest predictors of all cause mortality.

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” Two year old boy with a history of surgical clip closure of PDA, presented to us with recurrent respiratory infections and continuous murmur at left subclavicular area. Echocardiogram revealed 3 mm residual ductal flow across the clip with a peak gradient of 64mmHg with dilated Left atrium and Left ventricle. Decision was made to close the defect with Amplatzer duct occluder(ADO),AGA medical corp. The PDA was crossed antegradely with 0.032 exchange length angled guide wire(Terumo corp), but 5Fr catheter wouldn’t cross the duct over the wire as the clip was obstructing the catheter tip, 4Fr catheter too wouldn’t cross. I crossed the duct retrogradely with the 0.032 exchange length angled guide wire, intending to make an arteriovenous loop and then close the duct antegradely, but the 5 and 4 Fr catheters wouldn’t cross retrogradely. Finally, I decided to close the duct with symmetric ADO II, which could be delivered using the 4 Fr delivery system, which fortunately was in our stores. I could cross the PDA with 4 Fr Amplatzer delivery system over the 0.018 guide wire(Cordis) and deployed the device using fluoroscopic guidance. The device was released after noting that , its not obstructing the arch and left pulmonary artery and no significant residual flow. ADO II could be safely used to occlude difficult to cross residual PDA using retrograde approach.

046 TITLE: Our Experience: Congenital and Structural Heart Disease Treated by Percutaneous Intervention at Health City Cayman Islands. AUTHOR (S): Dr. Sripadh Upadhya; Srinath Polasani, Renuka Lakshman, Binoy Chattuparambil, Sumit Javaharlal Modi, Dhruva

Kumar Krishnan, Ravikishore Amancharla Submitted for: Interventional Cardiology ABSTRACT BODY: Congenital Heart disease(CHD) is the most common birth defect and occurs at a rate of 6-8 per 1000 live births.The prevalence is consistent through out the globe. Majority of the CHD require treatment either in the form of major surgery or percutaneous intervention within the first few years of life.The CHD which are almost exclusively treated by percutaneous interventions are Patent Ductus Arteriosus(PDA) and Pulmonary Valve Stenosis. Secundum Atrial Septal Defects(ASD) and Muscular Ventricular Septal effects(VSD) could be treated by device closure, if they meet the criteria for the rims. Aortic valve stenosis can be palliated by Balloon dilatation, requiring regular follow up and future surgery. The development of metal stents are rapidly evolving and stenting of Coarctation of aorta and pulmonary artery stenosis are taking precedence over surgery as the treatment of choice. There are life saving palliative interventions such as Balloon atrial septostomy and PDA stenting as a bridge for the surgery. We present our data regarding percutaneous interventions done for congenital and structural heart disease in children,adolescents and adults since October 2014 at Health City Cayman Islands.We have treated children and adults with CHD across the Caribbean and other parts of the world and have done 78 percutaneous interventions since October 2014.The numbers are as follows:PDA device closure-20, Balloon pulmonary valvotomy-16, ASD device closure-14, VSD device closure-14, Patent Foraman Ovale(PFO) Device closure-3, Coarctation balloon and stenting-3, Pacemaker and Radiofrequency ablation-3, Twin procedure-2, Aortopulmonary window device closure-1, Balloon atrial septostomy-1, Mitral paravalvar device closure-1.There were 4 major complictions. one in-hospital mortality , a sick neonate with Hypoplastic Left heart, one device embolization of a VSD device and two device were retrieved after implantation. The results have been excellent and most of the children are doing well and giving their best to the society. Our intention is to continue and intensify the program so that we treat 300 kids with CHD a year with a good number of interventions.

047 TITLE: Cultural Placebos And Cardiovascular Compromise AUTHOR (S): Dr. Delphina Vernor; Dr. Romel Daniel; Dr. Martin Didier; Dr. Awlyn Benjamin; Dr. Patrick James Submitted for: Epidemiology and Prevention, Heart Failure and Cardiomyopathies, Arrhythmias and Electrophysiology ABSTRACT BODY: Cardiovascular disease(CVD) is the number one cause of mortality worldwide. It is multifactorial and contributing risk factors have been recognized as lifestyle associated, including diabetes, hypertension, dietary risks, alcohol and drug use and the use of cultural placebos.


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043 TITLE: Persistent Left Superior Vena Cava and Its Implications for Placement of Transvenous Devices AUTHOR (S): Dr. Amar Singh; Bharat Kantaria Submitted for: Arrhythmias and Electrophysiology ABSTRACT BODY: Persistent superior vena cava (PSVC) is present in 1/1500 patients. The number of patients requiring transvenous devices (pacemakers,defibrillators and biventricular devices) have grown exponentially.Invariably it may be necessary to utilize PLSVC for placement of leads. We describe our experience using this venous access. Over a period of 10 years we have had 12 patients with PLVC. This constituted 0.2% of total cases. Four patients had adequate connections to the right superior vena cava,four had minimal connections and three had no connections.One patient hand no right SVCand all drainage was through the PLSVC. Four patients had placement of dual chamber pacemakers, 3 patients had dual chamber AICD and 5 had placement of biventricular AICD. Procedure times tended to be longer. Placement of the atrial leads were without difficulties. RV lead placement required special angulation of the stylet but adequate thresholds were still achieved. In four patients LV transvenous leads were placed but required special tools. In one patient the procedure was abandoned and epicardial leads were placed surgically. Long term, all transvenous leads were stable. Conclusions: In the majority of cases with PLSVC transvenous leads can be placed but requires attention to stylet angulation.

044 TITLE: Covered Stent as a Treatment for Coarctation of Aorta and Patent Ductus Arteriosus in a Patient with Associated Large Ventricular Septal Defect and Severe Pulmonary Hypertension. AUTHOR (S): Dr. Sripadh Upadhya; Sanjay Mehrotra Submitted for: Congenital Heart Disease: ABSTRACT BODY: Stenting of the aorta is considered as the treatment of choice for Coarctation of aorta in older children and adults. Patent ductus arteriosus(PDA) is a well known association with Coarctation and can be treated in the same setting using a Covered stent, which shuts the aortic end of the PDA. A fifteen year old boy presented with class II dyspnea on exertion. On clinical evaluation was found to have isolated upper l imb hypertension and feeble lower limb pulses with features of severe pulmonary hypertension. Echocardiographic examination revealed Large Outlet muscular Ventricular Septal defect(VSD) shunting bidirectionally, Severe juxtaductal coarctation of aorta and moderate sized PDA with severe pulmonary hypertension. Diagnostic cardiac catheterization was done ,the calculated PVR index was 15 wood units at baseline and 10.5 wood units after 100% oxygen. Aortogram showed Coractation which looked suitable for stenting .The strategy was to stent the coarctation with a covered stent so as to close the aortic end of the PDA. A 12mm covered Cheatum-Platinum stent was chosen and mounted on 12X4 Balloon in Balloon catheter. The stent was suitably positioned and dilated with appropriate pressure. Post-stenting aortogram revealed the stent in an excellent position, Coarctation segment well dilated and no residual PDA flow.The boy was put on Pulmonary vasodilators and the PVR re-assessed after a year, which was more than 10 Wood Units and was put on medical therapy. Covered stent is a potential treatment option to close the PDA along with its primary purpose of Coarctation dilatation and stenting and it is a very safe and effective procedure in suitable patients.

045 TITLE: Challenges in Device Closure of Residual Patent Ductus Arteriosus, Post-Surgical Clipping of the Ductus AUTHOR (S): Dr. Sripadh Upadhya; Submitted for: Paediatric Cardiology ABSTRACT BODY: Device closure is the treatment of choice for Patent ductus arteriosus(PDA) in suitable patients.For residual PDA, especially post ligation or clip, device closure is the preferred method.I describe a case of residual PDA, post surgical clip closure and challenges faced during the procedure.

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“Meeting the Challenges of Cardiac Care in an Ever-Changing Caribbean” In St. Lucia, cultural placebos are a significant risk factor associated with morbidity and mortality from CVD. They are widely used for cardiovascular complaints and include oral treatments, mainly bush teas and topical concoctions locally called fiksyon. Many patients opt for treatment from naturopathic medicine practitioners than that of modern medicine practitioners. Highlighted are four cases which demonstrate the significant health compromise because of cultural placebos. 24-year-old male with history of fever, vomiting and diarrhea being treated with fiksyon. He developed severe dyspnea and chest pain & presented in severe cardiopulmonary distress. ECHO revealed 60% of the left atrium was occupied with intracardiac vegetations. Within 6 hours of presentation, the patient arrested. Post mortem concluded the cause of death was bacterial endocarditis. 80-year-old female presented with a history of hypertension, slurred speech and bradycardia. She was using a nutmeg necklace for stroke-like symptoms. Investigations revealed symptoms were secondary to high grade AV block. 35-year-old male presented with dyspnea and edema and using Shiling Oil as a fiksyon. ECHO revealed severe right heart failure with pulmonary hypertension. 51-year-old male diagnosed with hypertension, non-compliant with prescribed medications and using bush tea instead, presented with chest pain. ECG revealed massive STEMI. These cases show just a snippet of the effect of cultural placebos and how they compromise the patient’s health. As medical practitioners we face the impasse of getting patients to trust in evidence-based medicine and deviate from the tradition of folk medicine. Deeper understanding of the intimate relationship between cultural placebos and biological processes will need close ethnic scrutiny and underscores the meaningfulness of conventional medical treatment in our St. Lucian society.

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TITLE: A National Coordinated Cardiac Surgery Registry in Haiti: The Haiti Cardiac Alliance Experience AUTHOR (S): Dr. James Wilentz; Owen Robinson, MPP; Gene F. Kwan, MD, MPP; Jean-Louis Romain, MD; Michael Crapanzano, MD,

MCHM Submitted for: Paediatric Cardiology, Cardiac Surgery, Congenital Heart Disease:, Valvular Heart Disease ABSTRACT BODY: Introduction: Access to cardiac surgical care in Haiti is limited for the many children and young adults with congenital and rheumatic heart disease. Before 2013, doctors and organizations independently advocated for individual patients in need of cardiac surgery; no nationwide effort existed to coordinate surgical access. Objective: We describe the results of a cross-partner collaboration that facilitates diagnosis, surgical referral, and long-term follow-up for Haitian cardiac patients. Methods: Haiti Cardiac Alliance (HCA), founded July 2013, developed a national referral system and registry for Haitian children and young adults awaiting diagnostic evaluation and/or cardiac surgery. Health care workers throughout Haiti can now refer patients into this system. When indicated, HCA matches patients with surgical partners based on urgency and clinical profile. We analyzed the HCA registry to quantify referral, diagnosis, enrollment, cardiac surgical activity and patient mortality both before and after surgery. Results: Between July 2013 and January 2018, HCA performed 3,121 outpatient exams with echocardiograms and enrolled 1175 Haitian patients into its registry. Of this total, 323 (27.5%) have undergone surgery; 44 (3.7%) are matched for surgery; 311 (26.5%) await surgical matches; 175 (14.9%) died on the waiting list before surgery could be arranged; and 322 (27.4%) are being followed clinically for the possibility of future intervention. As of December 2017, an additional 259 new patients await initial cardiologist evaluation. Of the 323 patients who underwent surgery, 109 (33.7%) were operated in Haiti, and 214 (66.3%) in 9 other countries. 17 patients died postoperatively for a 30-day mortality rate of 2.48%. The most common surgical indications have been ventricular septal defect (70), tetralogy of Fallot (60), and patent ductus arteriosus (59).


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Conclusions: In Haiti, the creation of a nationwide registry has facilitated diagnosis and operation of cardiac surgical patients, accelerated expansion of surgical options for these patients and helped catalyze the development of permanent surgical capacity. Surgical mortality is on par with that in the US.

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18 CARIBBEAN CARDIAC SOCIETY