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S13-4 Ergonovine Echocardiography for Noninvasive Diagnosis of Coronary Vasospasm
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Abstracts of the 17th Asian Pacific Congress of Cardiology
realized. A further technical development of real-time 3DTEE is expected. In conclusion, real-time 3D TEE enables accurate visualization and pathological diagnosis in patients with mitral valve disease. S13-2 Natural History of Mitral Value Prolapse: New Problems and Controversies Lieng H. Ling. National University of Singapore, Singapore Abstract not available at time of printing. S13-3 Progression of Isolated Tricuspid Regurgitation Late After Left-Sided Valve Surgery Chisato Izumi, Makoto Miyake, Sumiyo Hashiwada, Shuichi Takahashi, Yoshihisa Nakagawa. Department of Cardiology, Tenri Hospital, Japan Background: Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without significant left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The degree of TR influences functional status in patients after surgery. Clinical characteristics, mechanism and prognosis of severe isolated TR haven’t been enough investigated. Frequency and Clinical characteristics: Severe isolated TR has been reported to develop in 7 15% of the patients after left-sided valve surgery. From our data, atrial fibrillation, especially with slow ventricular rate, and tricuspid annuloplasty at the initial surgery were related to development of severe TR. Mechanism of isolated TR: Serial echocardiographic examinations showed that tricuspid annular dilatation and severe TR developed many years after left-sided valve surgery (4 24 years) but were not detected early after surgery, which suggested that some sort of vicious cycle is involved in development of severe TR. Echocardiographic investigations suggested that functional TR was related to tricuspid valve tethering and disproportionate annular dilatation. Recently, 3D-echo has been used in geometric analysis of tricuspid valve, but 3D-echo evaluation is difficult in patients with atrial fibrillation. Conclusions: Serial echocardiographic examinations are important to detect late progression of TR and to assess its mechanism. S13-4 Ergonovine Echocardiography for Noninvasive Diagnosis of Coronary Vasospasm Jae-Kwan Song. Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Traditionally, spasm provocation testing (SPT) has been performed during invasive coronary angiography. Establishment of non-invasive diagnostic test for coronary vasospasm (CVS) would be clinically very useful for differential diagnosis of chest pain syndrome and assessing the clinical activity of CVS and the therapeutic efficacy of the medications. Monitoring of left ventricular wall motion with 2-dimensional echocardiography during SPT using ergonovine (Erg Echo) has been reported to have acceptably high sensitivity and specificity. Although safety issue has been raised based on sporadic case reports of development of fatal arrhythmia or myocardial infarction during invasive SPT, early detection and termination of myocardial ischemia based on the development of regional wall motion abnormality, an early sign of ischemia, seems to contribute to the safety of Erg Echo. For the last 15 years, more than 5,000 cases of Erg Echo were performed in our institution without development of fatal arrhythmia or myocardial infarction. Erg Echo has been
requested not only for diagnosis of variant angina but also for demonstration of CVS in patients with clinical presentation of unstable angina, myocardial infarction or aborted sudden cardiac death. Considering rare use of SPT during coronary angiography, more widespread use of Erg Echo is anticipated for complete differential diagnosis of ischemic chest pain in various clinical settings. Symposium 14. Cardiovascular Surgery 1: Asian Pacific Experience in Heart Transplantation S14-1 Heart Transplantation in Taiwan Shu-Hsun Chu. Director, Far Eastern Memorial Hospital, Professor Emeritus, National Taiwan University, Taiwan The first successful clinical heart transplantation in Taiwan was performed on July 17, 1987. By Aug. 31, 2008, there were 838 patients received heart transplantation. All patients underwent orthotopic heart transplantation, except for 13 heterotopic transplants including one with two donor hearts in one chest. Among the 377 cases of transplant performed at National Taiwan University Hospital(NTUH) and Far Eastern Memorial Hospital, the ages ranged from 5 months to 70 years old with a mean of 47 years, the etiology of heart disease included dilated cardiomyopathy in 51%, ishcemic cardiomyopathy 30%, valvular heart disease 8%, and others 11%. Because of shortage of donor, marginal donors were used. ECMO, LVAD, BVAD, and Batista operation were used for bridging to heart transplantation. Thirteen patients underwent simultaneous kidney and heart transplantations. After heart transplantation triple therapy with cyclosporine or Tacrolimus, azathioprine or cellcept and steroid were used. OKT3, or antitymhocyte globuline were used as induction therapy or in patients with impaired renal function or severe acute rejection resistant to methylprednisolone. The late mortality was mainly due to cardiac allograft vasculopathy (CVA), sudden death, infection, and neoplasm. CAV and neoplasns were less than those of western countries. For 216 cases of heart transplants done at the NTUH for the last ten years the operative mortality was 8.0%. The actuarial 1 year, 5 year and 10 year survival rates for adults were 82±2%, 67±3%, and 56±5%, respectively. The pediatric group had better survival rates than adult. In conclusion, heart transplantation in Taiwan has been well established as a routine procedure for selected patients with end-stage myocardial failure. S14-2 Heart Transplantation and Mechanical Support in Japan Takeshi Nakatani. Department of Organ Transplantation, National Cardiovascular Center, Japan Several types of ventricular assist systems (LVAS) are applied to 1039 patients in Japan. Of those, 394 were suffered from cardiomyopathy. 50 of them were weaned from LVAS and 80 were transplanted. Extracorporeal type Toyobo LVAS were used in 73% of patients and longest assist duration was 1496 days. Implantable pulsatile LVASs were applied in 13% of patients and new implantable nonpulsatile LVASs were introduced and applied in 38 patients. These new devices are expected to bring about good QOL, long-term support and in-home care, such as destination therapy. 333 patients were listed as heart transplant (HTx) candidates in Japan Organ Transplant Network and 59 HTx have been performed in Japan. The majority of recipients had dilated cardiomyopathy and all were status 1. The mean waiting time was 777 days. Fifty were supported by LVAS and mean support duration was 780
Abstracts of the 17th Asian Pacific Congress of Cardiology
realized. A further technical development of real-time 3DTEE is expected. In conclusion, real-time 3D TEE enables accurate visualization and pathological diagnosis in patients with mitral valve disease. S13-2 Natural History of Mitral Value Prolapse: New Problems and Controversies Lieng H. Ling. National University of Singapore, Singapore Abstract not available at time of printing. S13-3 Progression of Isolated Tricuspid Regurgitation Late After Left-Sided Valve Surgery Chisato Izumi, Makoto Miyake, Sumiyo Hashiwada, Shuichi Takahashi, Yoshihisa Nakagawa. Department of Cardiology, Tenri Hospital, Japan Background: Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without significant left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The degree of TR influences functional status in patients after surgery. Clinical characteristics, mechanism and prognosis of severe isolated TR haven’t been enough investigated. Frequency and Clinical characteristics: Severe isolated TR has been reported to develop in 7 15% of the patients after left-sided valve surgery. From our data, atrial fibrillation, especially with slow ventricular rate, and tricuspid annuloplasty at the initial surgery were related to development of severe TR. Mechanism of isolated TR: Serial echocardiographic examinations showed that tricuspid annular dilatation and severe TR developed many years after left-sided valve surgery (4 24 years) but were not detected early after surgery, which suggested that some sort of vicious cycle is involved in development of severe TR. Echocardiographic investigations suggested that functional TR was related to tricuspid valve tethering and disproportionate annular dilatation. Recently, 3D-echo has been used in geometric analysis of tricuspid valve, but 3D-echo evaluation is difficult in patients with atrial fibrillation. Conclusions: Serial echocardiographic examinations are important to detect late progression of TR and to assess its mechanism. S13-4 Ergonovine Echocardiography for Noninvasive Diagnosis of Coronary Vasospasm Jae-Kwan Song. Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Traditionally, spasm provocation testing (SPT) has been performed during invasive coronary angiography. Establishment of non-invasive diagnostic test for coronary vasospasm (CVS) would be clinically very useful for differential diagnosis of chest pain syndrome and assessing the clinical activity of CVS and the therapeutic efficacy of the medications. Monitoring of left ventricular wall motion with 2-dimensional echocardiography during SPT using ergonovine (Erg Echo) has been reported to have acceptably high sensitivity and specificity. Although safety issue has been raised based on sporadic case reports of development of fatal arrhythmia or myocardial infarction during invasive SPT, early detection and termination of myocardial ischemia based on the development of regional wall motion abnormality, an early sign of ischemia, seems to contribute to the safety of Erg Echo. For the last 15 years, more than 5,000 cases of Erg Echo were performed in our institution without development of fatal arrhythmia or myocardial infarction. Erg Echo has been
requested not only for diagnosis of variant angina but also for demonstration of CVS in patients with clinical presentation of unstable angina, myocardial infarction or aborted sudden cardiac death. Considering rare use of SPT during coronary angiography, more widespread use of Erg Echo is anticipated for complete differential diagnosis of ischemic chest pain in various clinical settings. Symposium 14. Cardiovascular Surgery 1: Asian Pacific Experience in Heart Transplantation S14-1 Heart Transplantation in Taiwan Shu-Hsun Chu. Director, Far Eastern Memorial Hospital, Professor Emeritus, National Taiwan University, Taiwan The first successful clinical heart transplantation in Taiwan was performed on July 17, 1987. By Aug. 31, 2008, there were 838 patients received heart transplantation. All patients underwent orthotopic heart transplantation, except for 13 heterotopic transplants including one with two donor hearts in one chest. Among the 377 cases of transplant performed at National Taiwan University Hospital(NTUH) and Far Eastern Memorial Hospital, the ages ranged from 5 months to 70 years old with a mean of 47 years, the etiology of heart disease included dilated cardiomyopathy in 51%, ishcemic cardiomyopathy 30%, valvular heart disease 8%, and others 11%. Because of shortage of donor, marginal donors were used. ECMO, LVAD, BVAD, and Batista operation were used for bridging to heart transplantation. Thirteen patients underwent simultaneous kidney and heart transplantations. After heart transplantation triple therapy with cyclosporine or Tacrolimus, azathioprine or cellcept and steroid were used. OKT3, or antitymhocyte globuline were used as induction therapy or in patients with impaired renal function or severe acute rejection resistant to methylprednisolone. The late mortality was mainly due to cardiac allograft vasculopathy (CVA), sudden death, infection, and neoplasm. CAV and neoplasns were less than those of western countries. For 216 cases of heart transplants done at the NTUH for the last ten years the operative mortality was 8.0%. The actuarial 1 year, 5 year and 10 year survival rates for adults were 82±2%, 67±3%, and 56±5%, respectively. The pediatric group had better survival rates than adult. In conclusion, heart transplantation in Taiwan has been well established as a routine procedure for selected patients with end-stage myocardial failure. S14-2 Heart Transplantation and Mechanical Support in Japan Takeshi Nakatani. Department of Organ Transplantation, National Cardiovascular Center, Japan Several types of ventricular assist systems (LVAS) are applied to 1039 patients in Japan. Of those, 394 were suffered from cardiomyopathy. 50 of them were weaned from LVAS and 80 were transplanted. Extracorporeal type Toyobo LVAS were used in 73% of patients and longest assist duration was 1496 days. Implantable pulsatile LVASs were applied in 13% of patients and new implantable nonpulsatile LVASs were introduced and applied in 38 patients. These new devices are expected to bring about good QOL, long-term support and in-home care, such as destination therapy. 333 patients were listed as heart transplant (HTx) candidates in Japan Organ Transplant Network and 59 HTx have been performed in Japan. The majority of recipients had dilated cardiomyopathy and all were status 1. The mean waiting time was 777 days. Fifty were supported by LVAS and mean support duration was 780