PDF Version of Conference Book

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JUNE2016

Inspiring Excellence in Cardiac Care

SRI LANKA HEART

ASSOCIATION

th4 Sri Lanka Intervention Meeting

TH16 ANNUAL ACADEMIC SESSIONS

Galle Face HotelColombo

ANNUAL ACADEMIC SESSIONS & SRI LANKA INTERVENTION MEETING - 2016

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Inauguration Ceremony The Grand Ballroom, Galle Face Hotel Colombo

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Message from the President of Sri Lanka Heart Association Dr. Rohan Gunawardena

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Message from Chairperson - Academic Committee Dr. Nimali Fernando

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Message from the Chief Guest Dr. P. N. Thenabadu

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Programme - Sri Lanka Intervention Meeting Detailed academic programme of SIM

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Programme - Academic Sessions Detailed programme of Annual Academic Sessions

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Pre-Congress workshop & Nurses’ Programme24

FacultyOverseas and local faculty

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Free PapersAbstracts of Free Papers presented in the Congress

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Acknowledgments 42

Sponsors Our generous sponsors

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Message from Course Chairman - Sri Lanka Intervention Meeting Dr. Vajira Senaratne

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Council 2016Council of the SLHA for the year 2016

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Organizing Committeesfor Academic Sessions and SIM

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CONTENTS AT A GLANCE

ANNUAL ACADEMIC SESSIONS & SRI LANKA INTERVENTION MEETING - 2016SRI LANKA HEART ASSOCIATION

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INAUGURATION CEREMONY

6.15 pm Guests take their seats

6.25 pm Procession enters the hall

6.30 pm National anthem and Lighting of the oil lamp

6.40 pm Welcome Address Dr. Rohan Gunawardena - President - Sri Lanka Heart Association

6.50 pm Presentation of Awards

7.05 pm Address by Guest of Honour Dr. John P Bourke Consultant Cardiologist - Freeman Hospital & Senior Lecturer Newcastle University, Newcastle upon Tyne, UK

7.20 pm Address by By Chief Guest Dr. P. N. Thenabadu - Consultant Cardiologist

7.40 pm Dr. G. R. Handy Memorial Oration Vasovagal Syncope (The Common Faint) : A Uniquely Human Affliction Dr. David G. Benditt Professor of Medicine & Director-Cardiac Arrhythmia Center University of Minnesota, Minneapolis, USA

8.10 pm Vote of Thanks

8.15 pm Cultural show followed by reception

The Grand Ballroom

Founded in 1969, the Sri Lanka Heart Association today is a member of the World Heart Federation (WHF) and the Asian Pacific Society of Cardiology (APSC).

It is also one of the founder members of the SAARC Cardiac Society.

With a history of more than 40 years; an active council comprising senior most Cardiologists in the country; and an equally active membership, today it has become the main gathering point for the Cardiologists of the country with the aim of further

enhancing their professional knowledge while informing the public about Cardiovascular health.

Annual SLHA Scientific Sessions and Sri Lanka Intervention Meeting (SIM) are its two main academic events which are well patronized by both local and overseas cardiol-

ogists alike.


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MESSAGE FROM CHIEF GUEST

This association with a short history and a small membership has come a long way. Its success has been due to the hard work of the presidents and the councils over the years.

We should all be proud of the contribution it has made towards the improvement of cardiac care in this country. Wishing you success,

Dr. P. N. Thenabadu

MESSAGE FROM PRESIDENT - SLHA

It is with pleasure that I welcome you to this meeting. This is the 16 th consecutive annual academic sessions, which over the years has grown from a small meeting to one which has become a very dynamic event looked forward to by all. This year for the first time, the Sri Lanka Intervention Meeting (SIM) will be held in con-junction with the academic sessions. This will be an exciting addition, giving the delegates an opportunity to witness live cardiac interven-tions, all which can be offered to patients in Sri Lanka. The academic sessions cover a range of topics, from the basics to the most advanced and is relevant to all clinicians in medicine and cardiology. In addition to plenaries and sympo-sia, interactive sessions, debates and interviews have been incorporated in to the programme to make it more interesting and keep the audi-ence awake! Also For the first time This should lead to more interactive and lively discussions.

For these sessions we are bringing together a star studded Faculty from around the world. Everyone, an expert in their field and some, re-nowned worldwide for their skills and teaching

ability. We thank these luminaries for coming all the way to Sri Lanka in order to enhance the quality of this meeting. I congratulate Dr. Vajira Senaratne, Chairman of the SIM and Dr. Nimali Fernando, Chairperson of the Academic sessions and their teams for the tireless and dedicated work. It is not an easy task to put together a complex programme such as ours, juggling the timings for lectures, finding and sorting cases and sorting hundreds of details in order to make this a reality.

Finally a big thank you to the medical trade for the tremendous support they have shown. Without them this programme would not have seen the light of day.

I hope that every one of you not only benefits academically from the meeting but also enjoy the many different aspects it has to offer

Dr. Rohan Gunawardena President - Sri Lanka Heart Association


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MESSAGE FROM CHAIRPERSON - ACADEMIC COMMITTEE It is with great pleasure that I send this short message on the occasion of the 16th Annual Academic sessions and the fourth SIM interven-tional meeting of the Sri Lanka Heart Associa-tion. The SLHA conducts a series of events each year and the above are the main events in our calendar. This year we have combined these two events so that a wider knowledge could be shared and acquired by all the participants. Our Plenary lectures and Symposia cover a wide range of cardiovascular topics that will “inspire excellence in cardiac care” which is the chosen theme for this year. We have a world re-nowned International faculty. Our national fac-

ulty are experts in their fields. Regular academic sessions of this nature help us to keep abreast of the latest developments.

I thoroughly enjoyed working with our dy-namic president Dr. Rohan Gunawardena, my energetic co-chairperson of the SIM Dr. Vajira Senaratne and the rest of the team to make this event a great success. So join us to inspire ex-cellence in cardiac care, have three great days of learning sharing knowledge and experience and hope to see you again in 2017.

MESSAGE FROM COURSE CHAIRMAN - SIM

It affords me great pleasure to send this mes-sage on the occasion of this important event in the academic calendar of the Sri Lanka Heart Association. From its humble beginnings two decades ago, the field of cardiac interventions in Sri Lanka has advanced to be better or on par with those in the region. As we strive towards our ultimate goal of making world class care available for our citizens, we can be proud as Sri Lankans, of what we have already achieved de-spite the challenges we faced in the past.

Started four years ago, the Sri Lanka Interven-tion Meeting has become a platform to share expertise and knowledge among those who contributes immensely to the field of interven-tional cardiology. Our international faculty con-stitute of world renowned experts who have made outstanding contribution in their respec-tive fields to the development of cutting edge technologies in cardiac interventions.

This year the SIM has joined hands with the ac-ademic sessions of Sri Lanka Heart association, thereby opening the forum to a wider audi-ence. Besides, the scope of the forum has been broadened by incorporating interventions on peripheral vascular diseases, structural heart diseases and electrophysiology in addition to complex coronary interventions.

Let’s move forward to achieve excellence in car-diac care as cardiac disease has become a rap-idly progressing epidemic in Sri Lanka. Thus it gives me great pleasure as the Chairperson, to send this message on the occasion of the 4th Sri Lanka Intervention Meeting 2016, held in paral-lel with the Annual Academic Sessions of the Sri Lanka Heart Association.

I am sure it will be an exciting and educational experience to all of us.

Dr. Nimali FernandoChairperson - Academic Committee &

President - Elect of Sri Lanka Heat Association

Dr. Vajira Senaratne Course Chairman - Sri Lanka Intervention Meeting

ANNUAL ACADEMIC SESSIONS & SRI LANKA INTERVENTION MEETING - 2016

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SRI LANKA HEART ASSOCIATION

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COUNCIL - 2016 SRI LANKA HEART ASSOCIATION

ORGANIZING COMMITTEES

Dr. Rohan Gunawardena President

Dr. Ruvan Ekanayaka Immediate Past President

Dr. Nimali Fernando President Elect

Dr. M. R. Mubarak Vice President

Dr. Prakash Priyadarshan Joint Secretary

Dr. Bhathiya Ranasinghe Joint Secretary

Dr. Chandrike PonnamperumaTreasurer

Dr. Pradeep Wijayagoonawardana Editor

Chairperson :

Dr. Nimali Fernando – Consultant Cardiologist, National Hospital of Sri Lanka, Colombo

Secretary :

Dr. Bhathiya Ranasinghe – Consultant Cardiologist, Teaching Hospital, Karapitiya, Galle

Committee :

Dr. W S Santharaj – Consultant Cardiologist, Na-tional Hospital of Sri Lanka, Colombo

Dr. Jayanthimala B Jayawardena - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo

Dr. Rajitha De Silva – Consultant Cardiothoracic Surgeon, Sri Jayewardenepura General Hospital, Kotte

Dr. Shehan Perera – Consultant Paediatric Cardiolo-gist – Lady Ridgeway Hospital for Children, Colombo

Dr. Pradeep Wijayagoonawardana – Senior Regis-trar in Cardiac Electrophysiology, National Hospital of Sri Lanka, Colombo

Course Chairman :

Dr. Vajira Senaratne – Consultant Cardiologist, National Hospital of Sri Lanka, Colombo

Course Directors :

Dr. Gotabhaya Ranasinghe – Consultant Cardiolo-gist, National Hospital of Sri Lanka, Colombo

Dr. M. R. Mubarak – Consultant Cardiologist, Lanka Hospitals PLC, Colombo

Dr. Mahendra Munasinghe – Consultant Cardio-thoracic Surgeon, National Hospital of Sri Lanka, Colombo

Dr. Duminda Samarasinghe – Consultant Paediat-ric Cardiologist, Lady Ridgeway Hospital for Children, Colombo

Dr. Chandrike Ponnamperuma – Consultant Cardiologist, Colombo South Teaching Hospital, Kalubowila

Joint Secretaries :

Dr. Prakash Priyadarshan –Consultant Cardiolo-gist, National Hospital of Sri Lanka, Colombo

Dr. Duminda Samarasinghe – Consultant Paediat-ric Cardiologist, Lady Ridgeway Hospital for Children, Colombo

Committee Members

Dr. Sundaralingam Vinothan - Senior Registrar in Cardiology - National Hospital of Sri Lanka, Colombo

Dr. Milinda Vithana- Senior Registrar in Cardiology National Hospital of Sri Lanka, Colombo

Dr. Aruna Wijesinghe - Senior Registrar in Cardiol-ogy - National Hospital of Sri Lanka, Colombo

Dr. Charitha Herath - Senior Registrar in Cardiology National Hospital of Sri Lanka, Colombo

Dr. W. S. Santharaj Dr. Vajira Senaratne

Dr. Mahendra Munasinghe Dr. (Mrs.) J. B. JayawardenaDr. Gotabhaya Ranasinghe

Dr. Anindu PathiranaDr. S. Mithrakumar

Dr. Naomali AmarasenaDr. (Mrs.) Hemantha Perera

Dr. G. K. MayurathanDr. Rajitha Y. De Silva

Dr. Sanjeewa Rajapakse Dr. Shehan PereraDr. W. Kapuwatta

Dr. Dennis J.AloysiusDr. Chandimani Undugodage

Dr. Gerald Rajakulenthiran

Council Members

ACADEMIC SESSIONS SRI LANKA INTERVENTION MEETING


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DAY 1 (18th June 2016)

REGISTRATION & COMMENCEMENT OF ACADEMIC PROGRAM

SYMPOSIUM 1 : – ADVANCED MANAGEMENT OF HYPERTENSION

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Opening Remarks - Dr. Nimali Fernando – Chairperson, Academic Sessions

PLENARY 2 : PRACTICAL STRATEGIES FOR RISK STRATIFICATION IN STEMI

PLENARY 1 : DIFFICULT ECG’S IN AMI

Diagnosis and management of Hypertensive urgencies and emergencies

Critical appraisal of the JNC 8 guidelines

Diagnosis and management of resistant HT

Indication and interpretation of Ambulatory BP monitoring

Dr. Umesh N. Khot - Vice Chairman - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA

Prof. Sunil V. Mankad - Associate Professor of Medicine - Mayo Clinic College of Medicine, Minnesota, USA

Dr. Om Narayan - Consultant Cardiologist & Clinical Lead for Hypertension Services - MonashHeart, Monash Medical Centre, Victoria, Australia

Prof. Rishi Sethi - Interventional Cardiologist, King George’s Medical University, Lucknow, Uttar Pradesh, India

Dr. Ranil De Silva - Senior Lecturer in Clinical Cardiology - National Heart and Lung Institute, Imperial College London, UK

Dr. Om Narayan - Consultant Cardiologist & Clinical Lead for Hypertension Services - MonashHeart, Monash Medical Centre, Victoria, Australia

ACADEMIC SESSIONS - PROGRAMME

08:20 – 08:30

8:30 – 09:45

10:15 – 10:30

10:30 – 11:00

09:45 – 10:15

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SYMP 3 : PAEDIATRIC CARDIOLOGY – WHAT EVERY PHYSICIAN SHOULD KNOW

TEA

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Application of cardiac MRI in managing heart disease

Role of dobutamine stress Echo in heart disease

How and when to intervene in congenital heart disease

Long term concerns after CHD correction & Do & Don’ts for my grownups with CHD

My approach to a new born with cyanosis : when not to miss a killer

PLENARY 3 : NIGHTMARES IN CCU - DETERIORATING PATIENT AFTER MI

PLENARY 4 : HEART FAILURE – RX OPTIONS FOR DIFFERENT STAGES

Operator : Dr. Varira Senaratne - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo. Moderators : Dr. Umesh N. Khot - Vice Chairman - Heart and Vascular Insti-tute, Cleveland Clinic, Cleveland, Ohio, USA, Dr. Shirish M. Hiremath - Consultant Cardiologist & Director – Cardiac Cath Lab, Ruby Hall Clinic, Pune, India, Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, France

Dr. Russell Bull - Consultant Radiologist - Royal Bournemouth Hospital, Bournemouth, UK

Prof. Kim Greaves - Director of Cardiovascular Research, and Senior Staff Cardiologist - University of Queensland, Australia

Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiologist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK

Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiologist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK

Dr. K. Sivakumar - Head of Paediatric Cardiology & Senior Consultant Madras Medical Mission, Chennai, India


Dr. Howard J. Marshall - Consultant Cardiologist, Cardiac Rhythm Disorders - Queen Elizabeth Hospital, Birmingham, UK

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The place of CT coronary angiogram in diagnosis & treatment of CAD Prof. Sujith Seneviratne - Associate Professor & Head of Cardiac CT and Interven-tional Cardiologist - MonashHeart, Monash Medical Centre, Victoria, Australia

15:15– 16:30

12:15 – 13:30

16:00

13:30 -14:15

14:15- 14:45

14:45 – 15:15

11:00 – 12:15


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Anticoagulation and pregnancy Dr. Nipunika Senadheera - Consultant Haematologist - De Soysa Hospital for Women (Teaching), Colombo, Sri Lanka

DAY 2 (19th June 2016)SYMPOSIUM 4 : PREVENTION OF IHD – NEW APPROACHES

CASE BASED DISCUSSION – SCALPEL OR STENT?

SYMPOSIUM 5 : PREGNANCY AND HEART DISEASE

Diabetes, Obesity and NAFLD-a triad to contend with in IHD

Role of Statins in Primary prevention

Mind and Body in Cardiac Disease

PLENARY 5 : CARDIAC RISK ASSESSMENT IN NON-CARDIAC SURGERY

PLENARY 6 : JOURNEY OF THE PROSTHETIC VALVE

Contraception and obstetric problems in patients with heart disease

Dr. Nimantha De Alwis - Consultant in Diabetes/ Endocrinology & Bariatric Physi-cian - City Hospital, Sunderland, UK

Dr. Rohan Bhagwandeen - Consultant Interventional Cardiologist - John Hunter Hospital, New South Wales, Australia

Dr. Ruvan Ekanayaka - Consultant Cardiologist - Nawaloka Hospitals, Norris Clinic & Neville Fernando - Teaching Hospital, Sri Lanka

Dr. M. R. Mubarak - Consultant Cardiologist, Lanka Hospitals, Colombo, Sri Lanka

Judges : Dr. Ruvan Ekanayaka - Consultant Cardiologist - Nawaloka Hospitals, Norris Clinic & Neville Fernando - Teaching Hospital, Sri Lanka & Dr. Naomali Amarasena - Consultant Cardiologist, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka

Prof. Andrew Boyle - Professor of Cardiovascular Medicine & Head of Discipline School of Medicine and Public Health, The University of Newcastle, Australia

Prof. Ajit P. Yoganathan - Regents’ Professor - Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, USA

Prof. Hemantha M. Senanayake - Professor in Obstetrics & Gynaecology Faculty of Medicine, University of Colombo, Sri Lanka

Prof. Andrew Boyle - Professor of Cardiovascular Medicine & Head of Discipline School of Medicine and Public Health, The University of Newcastle, Australia & Mr. Ravi De Silva - Consultant Cardiothoracic Surgeon - Papworth Hospital, Cambridge, UKCase Presentation - Dr. Bhatiya Ranasinghe - Consultant Cardiologist, Teach-ing Hospital, Karapitiya, Galle, Sri Lanka

OPENING OF TRADE EXHIBITION

VIEWING OF POSTERS

08:00 – 09:15

09:15 – 10:00

11:30 – 12:45

10:30 – 11:00

11:00 – 11:30

10:00 – 10:30

SYMPOSIUM - V - CONTD’

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SYMP 6 : DIAGNOSTIC & MANAGEMENT DILEMMAS IN INFECTIVE ENDOCARDITIS

LUNCH

SLHA RESEARCH AWARD 2016 - LECTURE

INTERACTIVE CASE DISCUSSION : ISCHEAMIC HEART DISEASE

Taking care of high risk cardiac patient during pregnancy

PLENARY 7 : RATIONAL USE OF CARDIAC DRUGS

PLENARY 8 : THE HEART IN SYSTEMIC DISEASE

Moderator : Prof. Andrew Boyle - Prof. of Cardiovascular Medicine & Head of Discipline School of Medicine & Public Health, The University of Newcastle, AustraliaCase Presentation : Dr. Tilak Sirisea - Consultant Cardiologist, Teaching Hospi-tal, Kandy, Sri Lanka & Dr. Chandrike Ponnamperuma - Consultant Cardiologist - Colombo South Teaching Hospital, Kalubowila, Sri Lanka Panel : Prof. Vinay Kumar Bahl - Professor and Head - Department of Cardiolo-gy, All India Institute of Medical Sciences, New Delhi, India, Dr. S. Mithrakumar- Consultant Cardiologist, Sri Lanka , Dr. Nimali Fernando - Consultant Cardiolo-gist, National Hospital of Sri Lanka, Colombo & Prof. Rishi Sethi - Interventional Cardiologist, King George’s Medical University, Lucknow, Uttar Pradesh, India

Prof. Andrew Boyle - Professor of Cardiovascular Medicine & Head of Discipline School of Medicine and Public Health, The University of Newcastle, Australia

Dr. Rohan Bhagwandeen - Consultant Interventional Cardiologist - John Hunter Hospital, New South Wales, Australia

Therapeutic Potential of an Endogenous Enzyme in the treatment of Cardiac Arrhythmias and Heart Failure


Dr. Ruwani P. Hewawasam - Senior Lecturer, Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka


Prof. Yoong Kong Kenny Sin - Deputy Medical Director, Head of Cardiothoracic Surgery - National Heart Centre, Singapore


Diagnosis and management of valvular and device related endocarditis

When to call the Surgeon in

Prophylaxis of endocarditis – should the East follow the West?

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12:45 – 14:00

14:00 – 14:45

15:15 – 15: 45

16:15 – 17:30

15:45 - 16:15

14:45 – 15:15

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09:15 – 10:00

11:15 – 11:45

Managing a patient with cardiac rhythm device

CRT for heart failure. Who will benefit

ICD in Arrhythmogenic syndromes

PLENARY 10 : CARDIAC TRANSPLANTATION IN SOUTH ASIA – A VIABLE OPTION?

Dr. Asunga Dunuwille - Consultant Cardiac Electrophysiologist - National Hospital of Sri Lanka, Colombo

Dr. Howard J. Marshall - Consultant Cardiologist, Cardiac Rhythm Disorders - Queen Elizabeth Hospital, Birmingham, UK

Dr. Stephen W Lord - Consultant Cardiologist - Freeman Hospital Newcastle upon Tyne, UK

Dr. C. Sivathasan - Consultant Cardiothoracic Surgeon - Heart Lung & Vascular Centre, Mount Elizabeth Hospital, Singapore

SYMPOSIUM 8 : ESSENTIALS IN MANAGING SYNCOPE

SYMPOSIUM 7 : PACING AND DEVICES – AN UPDATE

10:00 – 11:15

08:00 – 09:15

PLENARY 9 : ALL YOU EVER WANTED TO KNOW ABOUT AF – Q&A

When to suspect a seizure in a patient with transient LOC

Tools in evaluating syncope

Dr. John P Bourke - Consultant Cardiologist - Freeman Hospital and Senior Lecturer - Newcastle University, Newcastle upon Tyne, UK & Dr. Upul Dissanayake - Consultant Physician - Base Hospital Panadura, Sri Lanka

Dr. Jithangi Wanigasinghe - Honorary Consultant in Paediatric Neurology - Lady Ridgeway Hospital for Children, Colombo, Sri Lanka

Prof. David G. Benditt - Professor of Medicine & Director - Cardiac Arrhythmia Center, University of Minnesota, USACase presentation : Dr. Rohan Gunawardena - Consultant Cardiac Electrophys-iologist - National Hospital of Sri Lanka, ColomboPanel : Dr. Jithangi Wanigasinghe - Honorary Consultant in Paediatric Neurology - Lady Ridgeway Hospital for Children, Colombo, Sri Lanka, Prof. David G. Benditt - Professor of Medicine and Director - Cardiac Arrhythmia Center, University of Min-nesota, USA, Dr. Susitha Amarasinghe - Consultant Cardiac Electrophysiologist - Teaching Hospital, Karapitiya, Galle, Sri Lanka , Dr. I. R. Ragunathan - Consultant Paediatric Cardiologist, Teaching Hospital, Jaffna, Sri Lanka

13:00 – 13:45

13:45 – 15:15

Dr. Rohan Gunawardena - President of Sri Lanka Heart Association

LUNCH

ORAL PRESENTATION OF FREE PAPERS

SYMPOSIUM 9 : ASSESSING RISK OF SUDDEN CARDIAC ARREST 11:45 – 13:00

Assessing the athlete for Sudden Cardiac Arrest

Can we predict those at risk for sudden cardiac death after MI?

Dr. Stephen W Lord - Consultant Cardiologist - Freeman Hospital Newcastle upon Tyne, UK

Dr. Howard J. Marshall - Consultant Cardiologist, Cardiac Rhythm Disorders - Queen Elizabeth Hospital, Birmingham, UKInternational ICD guidelines - Are they Suited for South Asia ?Prof. Narayanan Namboodiri - Additional Professor - Sri Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India

Judges : Dr. Ruvan Ekanayaka - Consultant Cardiologist - Nawaloka Hospitals, Norris Clinic & Neville Fernando - Teaching Hospital, Sri Lanka & Dr. Naomali Am-arasena - Consultant Cardiologist, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka

CLOSING REMARKS

ECG BASED INTERACTIVE CASE DISCUSSION : ARRHYTHMIAS

16:45

15:15 – 16:45

Moderators : Dr. John P Bourke - Consultant Cardiologist - Freeman Hospital and Senior Lecturer - Newcastle University, Newcastle upon Tyne, UK & Dr. Mevan Wijetunge - Cardiac Electrophysiologist – Centrcare Heart and Vascular Centre, St Cloud, Minnesota, USACase Presenters : Dr. Asunga Dunuwille - Consultant Cardiac Electrophysiolo-gist - National Hospital of Sri Lanka, Colombo & Dr. Suresh Kottegoda - Consul-tant Cardiac Electrophysiologist - Sri Jayewardenepura General Hospital, Kotte, Sri Lanka. Panel : Dr. Stephen W Lord - Consultant Cardiologist - Freeman Hospital Newcas-tle upon Tyne, UK, Prof. Narayanan Namboodiri - Additional Professor - Sri Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India & Dr. Susitha Amarasinghe - Consultant Cardiac Electrophysiologist - Teach-ing Hospital, Karapitiya, Galle.

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REGISTRATION & COMMENCEMENT OF PROGRAM

PLENARY : LEFT MAIN STENTING IN 2016

Opening Remarks - Dr. Vajira Senaratne – Course Chairman , SIM

LIVE TRANSMISSION : FROM MOUNT SINAI HOSPITAL, NEW YORK, USA

PLENARY : PRE HOSPITAL THROMBOLYSIS …..THE WAY TO GO?

PLENARY : DUAL ANTI-PLATELET THERAPY IN PCI - FOR HOW LONG?

Operator : Prof. Samin K. Sharma - Dean of international clinical affiliations and Professor of Cardiology – Mount Sinai Health Network, New York , USA

Moderators : Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, France & Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India

Panel : Prof. Do Sun Lim - Professor - Dept. of Cardiology, Internal Medicine, Korea University Medical School, Seoul, Korea, Prof. Andrew Boyle - Professor of Cardio-vascular Medicine & Head of Discipline - School of Medicine and Public Health, The University of Newcastle, Australia, Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia & Dr. Jagath Herath - Consultant Cardiologist, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka

Dr. Shirish M.S. Hiremath - Consultant Cardiologist & Director – Cardiac Cath Lab, Ruby Hall Clinic, Pune, India

Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, France

Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casa-mance, Marseille, France

SRI LANKA INTERVENTION MEETING (SIM)PROGRAMME

08:15 - 08:20

08:20 – 09:00

08:20 – 09:00

08:20 – 09:00

09:00 – 09:45

LIVE CASE: FFR GUIDED MULTI VESSEL PCI

• Step by step approach with the basis for each step - Dr. Ziyad M. Hijazi• Pulmonary Hypertension with ASD – when to close and when not to close? - Dr. K. Sivakumar• Troubleshooting and complications – Dr. K. Sivakumar• Long term follow up - Dr. Ziyad M. Hijazi

Operators : Dr. Shirish M. Hiremath - Consultant Cardiologist & Director – Car-diac Cath Lab, Ruby Hall Clinic, Pune, India, Dr. Gotabhaya Ranasinghe - Consul-tant Cardiologist - Nationa Hospital of Sri Lanka & Dr. R. Gerald - Senior Registrar - Cardiology, National Hospital of Sri Lanka, Colombo

Moderators : Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India & Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia

Panel : Prof. Do Sun Lim - Professor - Dept. of Cardiology, Internal Medicine, Korea University Medical School, Seoul, Korea , Dr. Tamzeed Ahmed - Senior Consultant in Clinical & Interventional Cardiology, Apollo Hospital, Dhaka, Bangladesh, Dr. S. Mithrakumar - Consultant Cardiologist, Sri Lanka, Dr. Rajesh Vijayvergiya - Ad-ditional Professor - Dept. Of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India & Dr. Stanley Amarasekera - Consul-tant Cardiologist, National Hospital of Sri Lanka, Colombo

LIVE CASE: CLOSURE OF ASD : A CHALLENGING CASE

Operators: Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiologist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK. Dr. Bharat Dalvi - Paediatric Cardiologist - Glenmark Cardiac Centre & Nanavati Hospital, Mumbai, India & Dr. S. Vinothan - Senior Registrar- Cardiology, National Hospital of Sri Lanka. Echocardiography : Dr. Prakash Priyadharshan - Consultant Cardiologist - National Hospital of Sri Lanka

Moderators : Dr. Ziyad M. Hijazi - Interventional Cardiologist & Chairman - De-partment of Pediatrics - Sidra Medical and Research Center, Doha, Qatar & Dr. K. Sivakumar - Head of Paediatric Cardiology & Senior Consultant - Madras Medical Mission, Chennai, India

Panel : Dr. Gamini Galappatthy - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo, Dr. Duminda Samarasinghe - Consultant Paediatric Cardi-ologist - Lady Ridgeway Hospital for Children, Colombo, Sri Lanka, Dr. G.K. Ma-yurathan - Consultant Cardiologist, General Hospital, Nuwara Eliya, Sri Lanka & Dr. Mahendra Munasinghe - Consultant Cardiothoracic Surgeon, National Hospital of Sri Lanka, Colombo

10:45– 11:30

09:45 – 10:45

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Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, France


LIVE CASE: LEFT MAIN BIFURCATION

LUNCH

LATEST ADVANCES IN DES

PLENARY : ROLE OF CARDIAC CT IN NON-CORONARY INTERVENTIONS

PLENARY : RADIAL INTERVENTIONS IN CORONARY ARTERY DISEASE

Dr. Russell Bull - Consultant Radiologist - Royal Bournemouth Hospital, Bour-nemouth, UK

Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia

LIVE TRANSMISSION : FROM ERASMUS UNIVERSITY MEDICAL CENTER ROTTERDAM, THE NETHERLANDS

11:45 – 12:30

13:30 – 14:15

14:15– 14:45

12:30 – 12:45

14:45 – 15:00

12:45 – 13:30

Operators : Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Cas-amance, Marseille, France, Dr. Vajira Senaratne - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Ajith Wanniarachchi, Senior Registrar - Cardi-ology, National Hospital of Sri Lanka, Colombo

Moderators : Prof. Do Sun Lim - Professor - Dept. of Cardiology, Internal Medicine, Korea University Medical School, Seoul, Korea & Prof. Sundeep Mishra - Professor of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Panel : Dr. Tamzeed Ahmed - Senior Consultant in Clinical & Interventional Cardiology, Apollo Hospital, Dhaka, Bangladesh, Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India, Dr. Anidu Pathirana - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Debdatta Bhattacharyya - Consultant Cardiologist & Chief of Cath-lab - Rabindranath Tagore International Institute Of Cardiac Sciences, Narayana Health, Kolkata, India

Operator : Prof. Robert Jan Van Geuns - Interventional Cardiologist - The Eras-mus University Medical Center, Rotterdam, The Netherlands

Moderators : Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, France & Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia

Panel : Dr. Shirish M.S. Hiremath - Consultant Cardiologist & Director – Cardiac Cath Lab, Ruby Hall Clinic, Pune, India, Prof. Sundeep Mishra - Professor of Cardi-ology, All India Institute of Medical Sciences, New Delhi, India, Dr. Rohan Bhagwan-deen - Consultant Interventional Cardiologist - John Hunter Hospital, New South Wales, Australia & Dr. Tilak Sirisena - Consultant Cardiologist, Teaching Hospital, Kandy, Sri Lanka

LIVE IN BOX : ACUTE MI

• Preparation FMC to Cath lab• Access radio vs. femoral• Adjunctive pharmacotherapy• Do you aspirate or not?• Management of slow flow and no re-flow• Management of first 24 hr complications

Operator : Dr. Vajira Senaratne - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo.

Moderators : Dr. Umesh N. Khot - Vice Chairman - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA, Dr. Shirish M. S. Hiremath - Consultant Car-diologist & Director – Cardiac Cath Lab, Ruby Hall Clinic, Pune, India , Prof. Andrew Boyle - Prof. of Cardiovascular Medicine & Head of Discipline School of Medicine & Public Health, The University of Newcastle, Australia & Dr. Marc Silvestri - Interven-tional Cardiologist - Hôpital Privé La Casamance, Marseille, France

15:15– 16:30

PLENARY : VENOUS GRAFT INTERVENTIONS


15:00 – 15:15

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PLENARY : PLACE OF DEVICE CLOSURE IN ACQUIRED VSDDr. Ziyad M. Hijazi - Interventional Cardiologist & Chairman - Department of Pediatrics - Sidra Medical and Research Center, Doha, Qatar

15:30 – 15:45

My choice of stent in Complex PCI

Relevance of Stent platform – Genesis of Design innovation

Early healing of Synergy


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LIVE CASE: PFO CLOSURE

CD PRESENTATION : CHALLENGING CASESLIVE CASE : RF ABLATION OF LVOT VENTRICULAR ECTOPICS

09:45 – 10:30

10:45 – 11:4508:45 – 09:45

Operator : Dr. Bharat Dalvi - Paediatric Cardiologist - Glenmark Cardiac Centre & Nanavati Hospital, Mumbai, India, Dr. Anindu Pathirana - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Wasantha Abeywickrema - Senior Registrar - Cardiology, National Hospital of Sri Lanka, Colombo

Moderators : Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiologist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK & Dr. Ziyad M. Hijazi - Interventional Cardiologist & Chairman - Department of Pedi-atrics - Sidra Medical and Research Center, Doha, Qatar

Panel : Dr. K. Arulnithy - Consultant Cardiologist - Teaching Hospital, Batticaloa, Sri Lanka, Dr. P. P. Sathanandan - Consultant Cardiologist, Teaching Hospital, Kara-pitiya, Galle, Sri Lanka, Dr. Roshan Gunaratne - Consultant Cardiologist, District General Hospital, Matara, Sri Lanka & Dr. Shehan Perera - Consultant Paediatric Cardiologist - Lady Ridgeway Hospital for Children, Colombo, Sri Lanka

Moderators : Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiolo-gy - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia & Dr. Atul Mathur - Director, Interventional Cardiology - Fortis Escort Heart Institute, New Delhi, India

Panel : Dr. Tamzeed Ahmed - Senior Consultant in Clinical & Interventional Cardi-ology, Apollo Hospital, Dhaka, Bangladesh,, Dr. Rohan Bhagwandeen - Consultant Interventional Cardiologist, John Hunter Hospital, New South Wales , Australia, Prof. Sundeep Mishra Honorary Editor - Indian Heart Journal & Professor of Cardiology, All India Institute of Medical Sciences, New Delhi, India & Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India

Operators : Dr. Asunga Dunuwille - Consultant Cardiac Electrophysiologist - Na-tional Hospital of Sri Lanka, Colombo & Dr. Suresh Kottegoda - Consultant Cardiac Electrophysiologist - Sri Jayewardenepura General Hospital, Kotte, Sri Lanka

Moderator : Dr. Rohan Gunawardena - Consultant Cardiac Electrophysiologist - National Hospital of Sri Lanka, Colombo

Panel : Dr. John P Bourke - Consultant Cardiologist - Freeman Hospital and Senior Lecturer - Newcastle University, Newcastle upon Tyne, UK , Dr. Stephen W Lord - Consultant Cardiologist - Freeman Hospital Newcastle upon Tyne, UK, Prof. Narayanan Namboodiri - Additional Professor - Sri Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India & Dr. Susitha Amarasinghe - Consultant Cardiac Electrophysiologist - Teaching Hospital, Karapiti-ya, Galle, Sri Lanka

• Introduction to outflow tract ventricular ectopics – Rohan Gunawardena• Principles of outflow tract ablation - John P Bourke

• Do I close all PFOs - Ziyad M Hijazi• Assessment of a PFO - Ziyad M Hijazi • Step by step approach to PFO closure - Shakeel Ahmed Qureshi

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LIVE CASE: PARAVALVAR LEAK

Operators : Dr. K. Sivakumar - Head of Paediatric Cardiology & Senior Consul-tant - Madras Medical Mission, Chennai, India, Dr. Prakash Priyadarshan - Con-sultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Nawshard Ali -Senior Registrar - Cardiology, National Hospital of Sri Lanka, Colombo. Echocardiography : Dr. Wasantha Kapuwatta - Consultant Cardiologist, Teaching Hospital, Anuradhapura, Sri Lanka

Moderators : Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiolo-gist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK & Dr. Ziyad M. Hijazi - Interventional Cardiologist & Chairman - Department of Pediatrics - Sidra Medical and Research Center, Doha, Qatar

Panel : Dr. Sepalika Mendis - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo, Dr. A. Yogananthamoorthy - Consultant Cardiologist, Durdans Hospital, Colombo, Sri Lanka, Dr. M. R. Mubarak - Consultant Cardiologist, Lanka Hospitals, Colombo, Sri Lanka & Dr. P. Lakshman - Consultant Cardiologist, Teaching Hospital, Jaffna, Sri Lanka

08:45 – 08:45


• Indications for closure - Prof. Shakeel Ahmed Qureshi • Step by step approach – Dr. Ziyad M. Hijazi • Devices for Para Valvar leak – Prof. Shakeel Ahmed Qureshi • Complications and troubleshooting - Dr. Ziyad M. Hijazi

PLENARY : BASICS OF AORTIC ENDOVASCULAR REPAIR

Prof. George Joseph - Professor, Department of Cardiology, Christian Medical College & Hospital, Vellore, India

10:30 – 10:45

SIM DAY 2 CONTD’


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15:00 – 15:1512:30– 13:15

Dr. Umesh N. Khot - Vice Chairman - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA

PLENARY : ENSURING OPTIMAL TIME TO TREATMENT ACROSS ALL EMERGENCY PCILIVE CASE: COMPLEX PCI

Operator : Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia, Dr. Tanya Pereira - Consultant Cardiologist, North Colombo Teaching Hospital, Ragma, Sri Lanka & Dr. Champika Withanagma - Senior Registrar - Cardiology, Na-tional Hospital of Sri Lanka, Colombo.

Moderators : Prof. Satoru Sumitsuji - Interventional Cardiologist - Nozaki, Nagoya, and Ogaki Tokushukai Hospitals, Professor, Osaka University, Japan & Dr. T. S. Kler - Executive Director - Cardiac Sciences & Head of Cardiology - Fortis Escorts Heart Institute, New Delhi, India

Panel : Dr. Tamzeed Ahmed - Senior Consultant in Clinical & Interventional Cardi-ology, Apollo Hospital, Dhaka, Bangladesh, Dr. Rajesh Vijayvergiya - Additional Professor - Dept. of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, Dr. S . Mithrakumar - Consultant Cardiol-ogist, Sri Lanka & Dr. M. B. F. Rahuman - Consultant Cardiologist, District General Hospital, Chilaw, Sri Lanka.

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LIVE CASES (PARALLEL SESSIONS) : PERIPHERAL INTERVENTIONS

SIM DAY 2 CONTD’

14:00 – 15:00SUBCLAVIAN STENTING : Operators: Dr. Atul Mathur - Director, Interven-tional Cardiology - Fortis Escort Heart Institute, New Delhi, India & Dr. Chandrike Ponnamperuma - Consultant Cardiologist - Colombo South Teaching Hospital, Kalubowila, Sri LankaABDOMINAL AORTIC ANEURYSM : Operator : Prof. George Joseph - Profes-sor - Department of Cardiology, Christian Medical College & Hospital, Vellore, India

Moderators : Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiolo-gy - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia & Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India

Panel : Prof. S. Mandika Wijeyaratne - Professor in Surgery & Honorary Consultant Vascular and Transplant Surgeon, University Surgical Unit, National Hospital of Sri Lanka, Colombo, Dr. Prasad De Silva - Consultant Interventional Radiologist - National Hospital of Sri Lanka, Colombo, Dr. Rezni Cassim - Senior Lecturer in Surgery & Honorary Consultant Vascular and Transplant Surgeon, University Surgical Unit, National Hospital of Sri Lanka, Colombo & Dr. Lakmali Paranahewa - Consultant Interventional Radiologist - Asiri Central Hospital, Colombo, Sri Lanka

PLENARY : ROTABLATION: CURRENT STATUS AND INDICATIONSDr. T. S. Kler - Executive Director - Cardiac Sciences & Head of Cardiology - Fortis Escorts Heart Institute, New Delhi, India

15:30 – 15:45

PLENARY : LMCA - WHICH TWO-STENT TECHNIQUE FOR DISTAL BIFURCATION ?

Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India

15:15 – 15:30

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• Diagnosis and assessment of a fistula – Prof. Shakeel Ahmed Qureshi • Step by Step approach to fistula closure – Prof. Shakeel Ahmed Qureshi • Complications of fistula closure – Dr. K. Sivakumar

Operators : Dr. Ziyad M. Hijazi - Interventional Cardiologist & Chairman - Depart-ment of Pediatrics - Sidra Medical and Research Center, Doha, Qatar, Dr. Sepalika Mendis - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Charitha Herath - Senior Registrar - Cardiology, National Hospital, Colombo

Moderators : Prof. Shakeel Ahmed Qureshi - Consultant Paediatric Cardiolo-gist - Evelina London Children’s Hospital St Thomas’ Hospital, London, UK & Dr. K. Sivakumar - Head of Paediatric Cardiology & Senior Consultant - Madras Medical Mission, Chennai, India

Panel : Dr. Jayanthimala Jayawardhane - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo, Dr. Naomali Amarasena - Consultant Cardiolo-gist, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka, Dr. Duminda Sama-rasinghe - Consultant Paediatric Cardiologist - Lady Ridgeway Hospital for Children, Colombo, Sri Lanka & Dr. Ajith Kularathene - Consultant Cardiologist, Teaching Hospital, Kandy, Sri Lanka

LIVE CASE: CORONARY FISTULA11:45 – 12:30

LUNCH 13:15-14:00

LIVE CASE: CTO INTERVENTION

LIVE CASE: CTO INTERVENTION CONTD’

15:45 – 17:00

Operator : Prof. Satoru Sumitsuji - Interventional Cardiologist - Nozaki, Nagoya, and Ogaki Tokushukai Hospitals, Professor, Osaka University, Japan, Dr. Stanley Amarasekera - Consultant Cardiologist, National Hospital of Sri Lanka, Colombo & Dr. Sandamali Premaratne - Consultant Cardiologist, District General Hospital, Negombo, Sri Lanka


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CD PRESENTATION : NIGHTMARES IN THE CATH LAB

Moderators - Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia & Dr. T. S. Kler - Executive Director - Cardiac Sciences & Head of Cardiology - Fortis Escorts Heart Institute, New Delhi, India

Panel : Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India, Dr. Atul Mathur - Director, Interventional Cardiology - Fortis Escort Heart Institute, New Delhi, India, Dr. Debdatta Bhattacharyya - Consultant Cardiologist & Chief of Cath-lab - Rabindranath Tagore International Institute Of Cardiac Sciences, Narayana Health, Kolkata, India & Dr. Rajesh Vijayvergiya - Additional Professor - Dept. of Cardiology, Postgraduate Institute of Medical Educa-tion and Research (PGIMER), Chandigarh, India

17:00 – 18:00

CLOSING REMARKS18:00

• Selection of hardware – T. S. Kler

Dr. Rohan Gunawardena - President of Sri Lanka Heart Association

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Dr. Marc Silvestri - Interventional Cardiologist - Hôpital Privé La Casamance, Marseille, FranceProf. D. S. Gambhir Director of Cardiology, Kailash Hospital & Heart Institute, Noida, IndiaProf. Andrew Boyle - Professor of Cardiovascular Medicine & Head of Discipline School of Medicine and Public Health, The University of Newcastle, Australia

DISTAL LEFT MAIN INTERVENTIONS

17 - JUNE - 2016CATHETERIZATION LABORATORY - ASIRI CENTRAL HOSPITAL, COLOMBO

20 - JUNE - 2016 NURSES PROGRAMME : FOCUS ON EMERGENCIES AND CRITICAL CARE

PRE CONGRESS WORKSHOP

NURSES PROGRAMME

08:30 - 10:00 Managing a patient with An Acute MI Monitoring in the ICU Oxygen Therapy10:30 - 13:00 Detection and Management of Arrhythmias Managing a patient on the Ventilator Anaphylaxis Module (by Ceylon College of Physicians)14:00 - 16:00 Workshop on Cardio-Pulmonary - Resuscitation

Moderators : Dr. T. S. Kler - Executive Director - Cardiac Sciences & Head of Car-diology - Fortis Escorts Heart Institute, New Delhi, India & Prof. Sasko Aleksandar Kedev - Professor of Medicine / Cardiology - Medical Faculty, University Ss. Cyril and Methodiusm, Skopje, Macedonia

Panel : Prof. D. S. Gambhir - Director of Cardiology, Kailash Hospital & Heart Institute, Noida, India, Dr. Rajesh Vijayvergiya - Additional Professor - Dept. of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, Dr. Atul Mathur - Director, Interventional Cardiology - Fortis Es-cort Heart Institute, New Delhi, India & Dr. Chinthaka Hathlahawatta - Consultant Cardiologist - Provincial General Hospital, Ratnapura.

LIVE CASE: CTO INTERVENTION CONTD’

A teaching session by the Faculty

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OVERSEAS FACULTY

Prof. David G. BendittProfessor of Medicine & Director - Cardiac Arrhythmia Center, University of MinnesotaUSA

Dr. Rohan BhagwandeenConsultant Interventional Cardiologist John Hunter HospitalNew South Wales , Australia

Dr. John P BourkeConsultant Cardiologist - Freeman Hospital & Senior Lecturer Newcastle University, Newcastle upon Tyne, UK

Prof. Andrew BoyleProfessor of Cardiovascular Medi-cine & Head of Discipline - School of Medicine & Public Health, The University of Newcastle, Australia

Dr. Tamzeed AhmedSenior Consultant in Clinical & Interventional Cardiology - Apollo Hospital, DhakaBangladesh

Dr. Debdatta BhattacharyyaConsultant Cardiologist & Chief of Cath Laboratory - Rabindranath Tagore International Institute of Cardiac Sciences - Narayana Health, Kolkata, India

Dr. Russell BullConsultant Radiologist Royal Bournemouth Hospital, Bournemouth, UK

Dr. Bharat DalviPaediatric Cardiologist Glenmark Cardiac Centre & Nana-vati Hospital, MumbaiIndia

Dr. Nimantha De AlwisConsultant in Diabetes/ Endocri-nology & Bariatric Physician City Hospital, Sunderland, UK

Mr. Ravi De SilvaConsultant Cardiothoracic Surgeon Papworth Hospital, Cambridge, UK

Dr. Ranil De SilvaSenior Lecturer in Clinical Cardiology National Heart & Lung Institute, Imperial College London, UK

Prof. D. S. GambhirDirector of CardiologyKailash Hospital & Heart Institute, Noida, India

Dr. Shirish M.S. HiremathConsultant Cardiologist & Director - Cardiac Cath LabRuby Hall ClinicPune, India

Dr. Umesh N. KhotVice Chairman Heart and Vascular InstituteCleveland Clinic, ClevelandOhio, USA

Prof. Do Sun Lim Professor - Dept. of Cardiology Internal MedicineKorea University Medical School Seoul, Korea

Prof. Kim GreavesDirector of Cardiovascular Research & Senior Staff Cardiologist - University of QueenslandAustralia

Prof. Sunil V. MankadAssociate Professor of Medicine Mayo Clinic College ofMedicineMinnesota, USA

Prof. Sasko Aleksandar Kedev President Macedonian Society of Cardiology & Professor of Medicine / Cardiology - Medical Faculty University Ss. Cyril & Methodiusm, Skopje, Macedonia

Dr. T.S. Kler Executive Director - Cardiac Sciences & Head of Cardiology Fortis Escorts Heart InstituteNew Delhi, India

Dr. Stephen W LordConsultant Cardiologist Freeman Hospital Newcastle upon TyneUK

Dr. Ziyad M. HijaziInterventional Cardiologist & Chairman - Department of Pediatrics, Sidra Medical & Research CenterDoha, Qatar

Dr. Howard J. MarshallConsultant Cardiologist - Cardiac Rhythm Disorders Queen Elizabeth HospitalBirmingham, UK

Dr. Atul MathurDirector, Interventional Cardiology Fortis Escort Heart InstituteNew Delhi, India

Prof. Sundeep MishraHonorary Editor - Indian Heart Journal & Professor of Cardiology, All India Institute of Medical SciencesNew Delhi, India

Prof. George Joseph Professor, Department of Cardiology, Christian Medical College & HospitalVellore, India

Prof. Narayanan NamboodiriAdditional Professor - Sri Chitra Tirunal Institute for Medical Sci-ence & TechnologyThiruvananthapuram Kerala, India


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Dr. Om NarayanConsultant Cardiologist & Clinical Lead for Hypertension Services - Monash Medical Centre, Victoria, Australia

Prof. Sujith Seneviratne Associate Professor & Head of Cardiac CT & Interventional Cardiologist, Monash Medical Centre, Victoria, Australia

Prof. Shakeel Ahmed QureshiConsultant Paediatric Cardiologist Evelina London Children’s Hospi-tal - St Thomas’ HospitalLondon, UK

Prof. Rishi SethiInterventional Cardiologist King George’s Medical University, LucknowUttar Pradesh, India

Prof. Samin K. SharmaDean of international clinical affiliations & Professor of Cardiology – Mount Sinai Health Network, New York , USA

Dr. Marc Silvestri Interventional Cardiologist Hôpital Privé La Casamance Marseille, France

Prof. Yoong Kong Kenny SinDeputy Medical DirectorHead of Cardiothoracic SurgeryNational Heart CentreSingapore

Dr. K. Sivakumar Head of Paediatric Cardiology & Senior Consultant Madras Medical MissionChennai, India

Dr. C. SivathasanConsultant Cardiothoracic SurgeonHeart Lung & Vascular Centre Mount Elizabeth HospitalSingapore

Prof. Satoru SumitsujiInterventional Cardiologist Nozaki, Nagoya, & Ogaki Tokushukai HospitalsProfessor, Osaka University Japan

Prof. Robert Jan Van GeunsInterventional Cardiologist The Erasmus University Medical CenterRotterdam, The Netherlands

Dr. Mevan Wijetunge Cardiac Electrophysiologist Centrcare Heart & Vascular Centre, St Cloud, MinnesotaUSA

Dr. Rajesh VijayvergiyaAdditional Professor - Dept. of Cardiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India

Prof. Ajit P. YoganathanRegents’ Professor - Coulter Department of Biomedical Engi-neering at Georgia Tech & Emory University, Atlanta, USA

Dr. Wasantha Abeywickrema Senior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. Nawshard AliSenior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. Stanley AmarasekeraConsultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. Naomali Amarasena Consultant Cardiologist, Sri Jayewardenepura General Hospital, KotteDr. Susitha Amarasinghe Consultant Cardiac Electrophysiologist - Teaching Hospital, Karapitiya, GalleDr. Piyusha M. Atapattu Senior lecturer, Department of Physiology, Faculty of Medicine, University of ColomboDr. K. ArulnithyCons. Cardiologist, Teaching Hospital, BatticaloaDr. Rezni CassimSenior Lecturer in Surgery & Hon. Consultant Vascular & Transplant Surgeon, University Surgical Unit, National Hospital of Sri Lanka, ColomboDr. Prasad De SilvaConsultant Interventional Radiologist - National Hospital of Sri Lanka, ColomboDr. Upul Dissanayake Consultant Physician - Base Hospital Panadura, Dr. Asunga Dunuwille Consultant Cardiac Electrophysiologist - National Hospital of Sri Lanka, ColomboDr. Ruvan Ekanayaka Consultant Cardiologist - Nawaloka Hospitals, Norris Clinic & Neville Fernando - Teaching Hospi-tal, Malambe. Dr. Dinithi FernandoHead & Senior Lecturer, Dept. of PhysiologyFaculty of Medicine, University of Colombo

Dr. Gamini Galappatthy Consultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. Asoka Gunaratne Consultant Anaesthetist, Colombo South Teaching Hospital, KalubowilaDr. Roshan Gunaratne Consultant Cardiologist, District General Hospital, Matara Dr. Rohan Gunawardena Consultant Cardiac Electrophysiologist National Hospital of Sri Lanka, ColomboDr. Chinthaka HathlahawattaConsultant Cardiologist, Provincial General Hospital, Ratnapura Dr. Charitha HerathSenior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. Ruwani P. Hewawasam Senior Lecturer, Department of Biochemistry, Fac-ulty of Medicine, University of Ruhuna, Galle Dr. Jayathimala B. Jayawardene Consultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. Suresh Kottegoda Consultant Cardiac Electrophysiologist - Sri Jayewardenepura General Hospital, KotteDr. Bimal Kudavidanage Consultant Anaesthetist, District General Hospital, KegalleDr. Ajith Kularathne Cons. Cardiologist, Teaching HospitalKandyDr. Manura Lekamwattage Senior Registrar - Cardiac ElectrophysiologyNational Hospital of Sri Lanka, ColomboDr. P. Lakshman Consultant CardiologistTeaching Hospital, Jaffna

Dr. Vajira Senaratne Course Chairman - SIM, Consultant Cardiologist - National Hospital of Sri Lanka

Dr. Nimali Fernando Chairperson - Academic Committee, Consultant Cardiologist - National Hospital of Sri Lanka

LOCAL FACULTY


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Dr. G.K. MayurathanConsultant Cardiologist, General HospitalNuwara EliyaDr. Sepalika Mendis Consultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. S. Mithrakumar Consultant Cardiologist, ColomboDr. M. R. Mubarak Consultant Cardiologist, Lanka HospitalsColomboDr. Mahendra Munasinghe Consultant Cardiothoracic Surgeon, National Hospital of Sri Lanka, ColomboDr. Anidu Pathirana Consultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. Lakmali ParanahewaConsultant Interventional Radiologist, Asiri Cen-tral Hospital, ColomboDr. Tanya Pereira Consultant Cardiologist, North Colombo Teaching Hospital, RagmaDr. Shehan Perera Consultant Paediatric Cardiologist - Lady Ridgeway Hospital for Children, Colombo Dr. Chamila Pilimathalawa Consultant Anaesthetist, Sri Jayewardenepura General Hospital, KotteDr. Chandrike Ponnamperuma Consultant Cardiologist - Colombo South Teach-ing Hospital, KalubowilaDr. Mithrajee Premaratne Consultant Anaesthetist, Lady Ridgeway Hospital for Children, ColomboDr. Sandamali Premaratne Cons Cardiologist, District General Hospital Ne-gomboDr. I. R. Ragunathan Consultant Paediatric Cardiologist, Teaching Hospital, JaffnaDr. M. B. F. Rahuman Cons. Cardiologist, District General Hospital, Chilaw

Dr. Sanjeewa Rajapakse Consultant Cardiologist, Provincial General Hospi-tal, RatnapuraDr. Bhatiya Ranasinghe Consultant Cardiologist, Teaching Hospital, Kara-pitiya, GalleDr. Gotabhaya Ranasinghe Consultant Cardiologist, National Hospital of Sri Lanka, ColomboDr. Duminda Samarasinghe Consultant Paediatric Cardiologist - Lady Ridgeway Hospital for Children, ColomboDr. P P Sathanandan Consultant Cardiologist, Teaching HospitalKarapitiya, GalleDr. Nipunika SenadheeraConsultant Haematologist - De Soysa Hospital for Women (Teaching), ColomboProf. Hemantha M. Senanayake Professor in Obstetrics & Gynaecology - Faculty of Medicine, University of ColomboDr. Tilak Sirisea Consultant Cardiologist, Teaching Hospital, KandyDr. Chandimani Undugodage Senior Lecturer, Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardene-pura, KotteDr. S. Vinothan Senior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. Jithangi Wanigasinghe Hon. Consultant in Paediatric Neurology - Lady Ridgeway Hospital for Children, ColomboDr. Ajith WanniarachchiSenior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. Champika WithanagmaSenior Registrar - Cardiology, National Hospital of Sri Lanka, ColomboDr. A. Yogananthamoorthy Consultant Cardiologist, Durdans Hospital, Colombo, Sri Lanka

Dr. Ruwani P. Hewawasam PhDSenior Lecturer, Department of Biochemistry, Faculty of Medicine, University of Ruhuna, GalleSri Lanka

SLHA RESEARCH AWARD - 2016

Therapeutic potential of an endogenous enzyme in the treatment of cardiac arrhythmia and heart failure

Glutathione transferases are generally recognized for their role as antioxidant enzymes in phase II detoxification reactions. Recent studies identified a diverse range of other functions which are unre-lated to detoxification. One such action is the specific inhibition of cardiac ryanodine receptor Ca2+ release channel. It is well documented that excessively active RyR2 channels are partly responsible for low store Ca2+ levels and defective Ca2+ release in heart failure. Therefore, inhibition of RyR2 is a potential strategy for the treatment of heart failure as it would help to maintain low RyR2 activity during diastole.

Studies done in the first phase which examined the effects of truncating GSTM2 on its ability to alter Ca2+ release from SR and RyR2 channel activity identified the GSTM2 C terminal domain (GSTM2C) as the region responsible for the inhibitory effect. Although it supported the inhibition of RyR2, it did not support the activation of RyR1 channels which was shown by the full length protein. Activity of smaller fragments from the GSTM2C indicated that the helix 6 in the C terminal domain is critical for the inhibitory effect. Although fragments containing the helix 6 sequences inhibited Ca2+ release from cardiac SR and RyR2 channel activity, helix 6 sequence alone was not effective. Structural anal-ysis on circular dichroism spectroscopy revealed the helix 6 sequence to be unstructured which may have explained the lack of activity, if the helical nature of the fragment was essential for its efficacy. On the other hand, the active fragment of GSTM2 responsible for the inhibition of RyR2 activity may involve not only helix 6 but also the flanking helices.

In order to confirm the importance of helix 6 for the inhibitory effect, the activity of RyR2 was ex-amined in the presence of two GSTM2C constructs with potentially destabilizing mutations in helix 6 region. The mutants, F157A and Y160A failed to inhibit cardiac RyR2 activity in single channel lipid bilayer experiments and Ca2+ release from cardiac SR. Although they retained the helical structure as indicated in circular dichroism spectroscopy, tryptophan fluorescence indicated changes in fold-ing. Interestingly, wild type GSTM2C inhibited cardiac RyR2 only at positive potentials, which may develop during Ca2+ efflux, but not at negative potentials. This further suggested that therapeutics mimicking the structure of GSTM2C may reduce excess Ca2+ release during diastole, which can lead to fatal arrhythmias.

Previous experiments carried out in our laboratory also showed that H5678 fragment of GSTM2C (containing helices 5,6,7 and 8) is capable of binding to the DR3 region of RyR2 which explains the isoform specific activity of GSTM2. Tryptophan fluorescence quenching experiments that were per-formed in this study confirmed the binding between H5678 and 22 amino acid fragment (1869-1890) of DR3 region, which further narrowed down the GSTM2 binding site in cardiac RyR2. Consistent with


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ABSTRACTS OF FREE PAPERS

Background : The ambulatory arterial stiffness index (AASI) is a novel indicator of arterial stiffness which shows the dynamic relationship between systolic and diastolic blood pressure (BP). Addi-tionally, it is a better estimator of atherogenic potential. Objective : To evaluate the AASI in relation to circadian BP variability detected by ambulatory BP (AMBP) monitoring.Method : A cross-sectional study was conducted at Cardiology unit, Kandy evaluating 100 essen-tial hypertensive patients with normal renal functions and no previous cardiovascular events. Se-rial clinic BP monitoring and 24 hour AMBP was carried out. AASI was derived by standard systol-ic-on-diastolic BP slope and the correlation coefficient between systolic and diastolic BP values. Results : There were 88% with AASI<0.7 and 12% with AASI>0.7, which was abnormal. The value of AASI was significantly higher in AMBP uncontrolled group than AMBP controlled group (p=0.001). In contrast, the difference between AASI was not statistically significant among BP controlled and BP uncontrolled groups according to manual clinic BP (p=0.808). AASI had a positive correlation with mean systolic (both day and night) BP (r=0.43, p<0.0001), mean systolic nocturnal BP (r=0.357, p<0.001) and pulse pressure (PP) (r= 0.562, p<0.001). Conversely, AASI does not associate with any of diastolic BP variables (r=0.013, p=0.895).Conclusion : Higher values of AASI is associated with AMBP uncontrolled group, but not with BP uncontrolled group according to clinic BP. Additionally it associates with higher systolic BP and wid-er PP. Thus, evaluation of AASI by AMBP reflects a prognostic significance in hypertensive patients though it is largely over-looked by clinic BP.

Background: To perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI.

O1 : RELATIONSHIP OF AMBULATORY ARTERIAL STIFFNESS INDEX TO CIRCADIAN BLOOD PRESSURE VARIABILITY IN PATIENTS WITH ESSENTIAL HYPERTENSION.

O2 : A Comparison of Rescue and Primary Percutaneous Coronary Interventions for Acute ST Elevation Myocardial Infarction

Bandara HGWAPL1, Kogulan T1, Kodithuwakku NW1, Karunarathne RMSP1, Hathhalawatta C1

1Teaching Hospital, Kandy, Sri Lanka

Faslur Rahuman MB1, Jayawardena JB1, Francis GR1, Niraj M1, Wasantha Kumara AHT1, Wijesinghe UAD1, Haniffa R2,3,4, Ariyapperuma R1, Paramanayakam A1, De Silva AP2,5

1Institute of Cardiology, National Hospital of Sri Lanka, Colombo 2National Intensive Care Surveillance, 3Mahidol Oxford Tropical Medicine Research Unit (MORU), 4Faculty of Medicine University of Colombo, 5Intensive Care Na-tional Audit and Research Center

previous results, binding between the two proteins was weak with dissociation constants in micro molar range. Since DR3 is located in the clamp region of the 3D structure of RyR2, specific binding of GSTM2C to RyR2 could dramatically influence the gating of the channel.

During the last phase of the study, the effect of GSTM2C and the mutants, F157A and Y160A were investigated on the contractility of neonatal cardiomyocytes. Consistent with the results obtained with single channel lipid bilyer experiments and Ca2+ release assays, the mutants failed to reduce the contractility of cardiomyocytes. Ability of GSTM2C to inhibit RyR2 activity hence Ca2+ release from SR was further indicated when the contractility of cardiomyocytes was reduced significantly in the presence of GSTM2C. Although GSTM2C reduced Ca2+ transients in neonatal ventricular cardio-myocytes, mutants F157A and Y160A failed to alter them. A new property of GSTM2C was identified when the GSTM2C was shown to be capable of entering into cardiomyoctytes without a carrier cell penetrating peptide.

The overall results presented in this study identify GSTM2C as a potential therapeutic for the treat-ment of cardiac arrhythmia and heart failure. Inhibitory effect was identified in the C terminal domain of the protein (GSTM2C) hence the well-known antioxidant effect won’t be affected as the active site of the enzyme is located in the N terminal domain. The helix 6 sequence in the GSTM2C and its flanking helices played a major role in stabilizing the molecule and in binding to the DR3 region of RyR2. Due to the voltage dependent activity, GSTM2C could be used during diastole to reduce the abnormal Ca2+ leak through ryanodine receptors. Thus, GSTM2C could be the only isoform specific, endogenous inhibitor of cardiac ryanodine receptor activity reported so far.

research award abstract contd’


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Background : Nocturnal hypertension (NH) is linked with higher mortality and adverse cardiovas-cular events. However, it can only be reviled by ambulatory blood pressure (AMBP) monitoring.Objective :To evaluate the behavior of NH (nocturnal blood pressure (BP) ≥120/70 mm Hg) in pa-tients with chronic essential hypertension.Method : Cross sectional study was conducted at Teaching Hospital Kandy in 2015 on essential hy-pertensive patients with normal renal functions and had no past history of ischemic cardiac insult. AMBP monitoring was performed in all the patients. Results : From the study population (n=100), 72% had nocturnal hypertension, 45% had day-night sustained hypertension and 02% had isolated daytime hypertension. There were only 26% with both day and night controlled BP. Among the patients with nocturnal hypertension, 38% had Iso-lated Nocturnal Hypertension (INH). Patients with INH had significantly low ambulatory daytime systolic (p<0.001), day time diastolic (p<0.001) and pulse pressure (p=0.001) values. Additionally, patients with INH had low manual clinic BP recordings for both systolic and diastolic, which was statistically significant (p=0.024). In the sample, 30% had normal dipping pattern and 5% had ex-treme dipping whereas 45% and 20% being non-dippers, and reverse dippers contributing for NH respectively. Among the patients with BP control by clinic measurements (<140/90 mmHg), only 20% had normal dipping pattern whereas 80% had abnormal dipping pattern. Conclusion : There is high prevalence of NH among essential hypertensives. Since INH having low day time clinic BP values, the existence of such a diagnosis is largely overlooked. Thus AMBP pro-vides a better understanding of 24-hour BP fluctuations with a prognostic clue over clinical BP measurement.

O3 : PATTERN AND BEHAVIOR OF NOCTURNAL HYPERTENSION IN ESSENTIAL HYPER-TENSIVES; AN OVER LOOKED CARDIOVASCULAR BURDENBandara HGWAPL1, Kogulan T1, Hewarathna UI1, Kodithuwakku NW1, Jayawickreme SR1


Methods: From Unit 5 Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we se-lected all consecutive patients who underwent early percutaneous coronary intervention for acute STEMI presenting with ≤ 24 h door-to-balloon delay for primary PCI and ≤ 72 h door-to-balloon delay, (90 minutes after failed thrombolysis) for rescue PCI from March 2013 to April 2015 and their in-hospital results were analyzed, comparing rescue and primary PCI patients.Results: We evaluated 159 patients, of which 78 underwent rescue PCI and 81 underwent primary PCI. The culprit left anterior descending (LAD) vessel (76.9% vs. 58.8%; P=0.015) was more prevalent in rescue than in primary patients. Thrombus aspiration was less frequent in rescue group (19.2% vs. 40.7%; P=0.003). The degree of moderate-to-severe left ventricular dysfunction reflected by the ejection fraction <40% (24.3% vs. 23.7%; P=0.927) and prevalence of multi-vessel disease (41.0% vs. 43.8%; P=0.729) revealed no significant difference. Coronary stents were implanted at similar rates in both strategies (96.2% vs. 92.6%; P=0.331). Procedural success (97.4% vs. 97.5%; P=0.980) and mortality rates (5.1% vs. 3.8%; P=0.674), were similar in the rescue and primary groups.Conclusion: In-hospital major adverse cardiac events (MACE) are similar in both rescue and prima-ry coronary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities

O2- Contd’

Background : Over the last decade, increasing evidence suggests that depression and anxiety have a link to increased morbidity and mortality following major coronary event.Objective : To assess the prevalence and associated factors of depression and anxiety among post myocardial infarction (MI) patients.Method : Cross-sectional study was conducted at Cardiology unit, Kandy in 2015 on post MI pa-tients. Data was collected through the Hospital Anxiety and Depression Scale (HADS) which is a validated, self-administrated questionnaire after obtaining informed written consent.Results : A total of 150 patients (Male: 81%) were included. The duration since last MI was 0.5-5 years. Mean age was 60±9 years. Majority (79%) had no depression. There were 5% with depression while 16% had borderline depression. Borderline depression or depression was not statistically associat-ed with gender (p=0.99). There were (84%) had no anxiety. However, 14% had borderline anxiety and 2% had anxiety. Prevalence of anxiety or borderline anxiety did not have any gender difference (p=0.397). Prevalence of depression was not associated with martial state (p=0.9), monthly income below Rs.20000/= (p=0.653) or educational level less than ordinary level (p=0.599).Conclusion : The prevalence of anxiety and depression is higher in post MI population than the normal population. There is a considerable prevalence of borderline depression and anxiety, which need special attention. Addressing these issues may improve the patient’s quality of life and possi-blythe prognosis. The findings encourage further research pertaining to treatment of generalized anxiety disorder, depression and general distress in post MI population in order to improve long term outcome and quality of life.

Background : Smoking cessation and commencement of exercise play pivotal role in secondary prevention of coronary artery disease. Medication non-adherence following acute myocardial infarction (MI) is known to be associated with poor clinical outcome and adverse cardiovascular prognosis as well.Objective : To evaluate the smoking status, adherence to exercise and medication non-adherence in post MI patients. Method : Descriptive cross sectional study was conducted in 2015 at Cardiology unit-Kandy. Inter-viewer administered questionnaire was used to obtain the data from post MI patients. Medication non-adherence was assessed using MMAS-4 questionnaire.Results :150 patients were studied and 96% of them appreciated that smoking was harmful. From male patients, 62% engaged in smoking during their lifetime (Mean duration: 20±12 years, Mean

O4 : HOW COMMON ANXIETY AND DEPRESSION AMONG POST MYOCARDIAL INFARCTION PA-TIENTS?: A SINGLE CENTER EXPERIENCE

O5 : SMOKING STATUS, COMMENCEMENT OF EXERCISE & MEDICATION NON-ADHERENCE IN A SAMPLE OF SRI LANKAN POST MYOCARDIAL INFARCTION PATIENTS

Kodithuwakku NW1, Kogulan T1, Bandara HGWAPL1, Hewarathna UI1, Weerakoon G1


Bandara HGWAPL1, Karunarathne RMSP1, Kogulan T1, Kodithuwakku NW1, Thenakoon R1



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Background : Sexual life plays an important role in physical and mental well-being of patients and it needs to be finely adjusted following myocardial infarction (MI) to achieve a better quality of life. Objective : To evaluate the advancement of sexual life and patients’ perception on sexual activity following MI. Method : Cross sectional study was conducted at Cardiology Unit, Teaching Hospital Kandy on a sample of post MI patients. Self-administered questionnaire was used to obtain the data, after securing the confidentiality and obtaining informed written consent.Results : A total of 150 subjects were included with a mean age of 60 years (range: 37-85) and 81% was males. The range of the duration following MI was 0.5 to 5 years. Majority (65%) had sexual activity within 12 months prior to the major cardiac event. However only 53% had sexual activity since having the MI and out of them 53% had less frequency, 14% had the same frequency and 1% had increased frequency of engaging in sexual activity while 32% refused to answer. Only 16% received instructions on when to resume sexual activity following MI and7% had discussed about sexual activity with their physician. Among the female population only 1% had actively discussed the sexual matters with the physician. Conclusion : Delivery of information on post MI sexual care is poor and open discussion of the is-sue with the physician is lacking in the study population. This study emphasizes the requirement of implementing a post MI sexual education programme in a stranded manner to improve the safety and quality of life in post MI patients.

O6: ARE WE ADEQUATELY TALKING ON SEXUAL LIFE ADJUSTMENT FOLLOWING MYOCARDIAL INFARCTION?:AN UNREVEALED ASPECT OF FOLLOW UP CARE IN OUR HEALTH SYSTEM

Bandara HGWAPL1, Kogulan T1, Karunaratne RMSP1, Hewarathna UI1, Dolapihilla SNB1


number of cigarettes per day: 11±10). Out of the patients who continued smoking until their last coronary event, 93% tried to quit smoking following MI and 86% received the help from the med-ical staff on that. However, only 82% were able to succeed while 18% continued to smoke. Ma-jority (76%) had the impression that they can engage in exercise after MI, but 37% were unaware about the time of commencement, while only 42% had started exercise after one month following discharge. However 85% was unaware about adjusting their exercise programme by themselves. According to MMAS – 4, 51.5% were highly adherent to treatments, whereas moderate and low adherences were reported in 42.7% and 5.8%, respectivelyConclusion : There is a considerable number of patients continues to smoke in the post MI period and the knowledge and practices are lacking with regard to commencement and adjustment of post MI exercise. Even early after MI, a substantial proportion of patients report suboptimal adher-ence to prescribed medications. These findings highlight the need of implementing a high-quality cardiac rehabilitation programme aiming successful secondary preventive goals.

This preliminary study was carried out to find out treatment times and outcome of a convenient sample of acute STEMI patients who received thrombolysis with streptokinase at the District Gen-eral Hospital, Kalutara (DGHK) with a view of optimizing STEMI care in the district. One hundred and eighty two (182) patients were analyzed for Ischemic Time, Door to Needle Time, in hospital mortality, adverse cardiac events and other complications following thromboly-sis. Median Ischemic and Door to Needle Times are 4.1 hours (245.7min) and 1.36 hours (82min-utes) respectively. The proportion of the sample that achieved guideline recommended optimal Ischemic Time of 2 hours and Door to Needle Time of 30 minutes, both are low and are only about 24% and 27.5% respectively. In addition though 2.2% (4 deaths) in hospital mortality rate is low, 20.85 % of the sample had one or more complications following thrombolysis before discharge. Hypo-tension (7.7%) and recurrent angina (6.6%) was the most prevalent complications and there were 2cases (0.01%) with hemiparesis following intra-cranial bleeding after thrombolytic therapy but no adverse reactions to thrombolytic agent were reported so far. We found 1month, 3months and 6months mortality rates were 0.55%, 1.65% and 0.55% respectively. The low proportions of the sample that achieved guideline recommended treatment delays and the high proportion of in-hospital complications following thrombolysis indicate the necessity of optimizing STEMI care. Establishing dedicated STEMI care networks and introducing newer thrombolytic agents certainly will help to improve treatment delays and major adverse cardiac events in patients with STEMI.

Introduction and objectives: CABG is one of the treatment options for the patients with coro-nary artery disease (CAD). This study was aimed to describe survival up to occurrence of cardiac events and factors associated with them among the CABG patients attending to cardiology clinics at NHSL. Methods: Retrospective analytical study was carried out among the patients who had undergone CABG at least one year before the date of data collection. Cardiac event was defined as new oc-currence of any condition namely; unstable angina (UA), ST elevated myocardial infarction (STEMI), non ST elevated myocardial infarction (NSTEMI) and heart failure (HF). Survival was assessed up to the defined cardiac events. Results: The sample (n=421) consists 74.6% males and mean age was 63.16years (SD = 7.86). Among them UA (13.3%), STEMI (0.5%), NSTEMI (3.1%) and heart failure (8.6%) were detected as post CABG

O7 : A preliminary study on treatment times and outcome of thrombolytic therapy with strep-tokinase, for acute ST segment Elevation Myocardial Infarction, in District General Hospital Kalutara

O8 : CARDIAC EVENTS AND SURVIVAL FOLLOWING CABG

Ranasinghe WG1, Fasil AMM1, Kitsiri PHR1, Sutharshan R2, Dissanayaka U2

1 Institute of Cardiology, National Hospital of Sri Lanka, 2 District General Hospital, Kalutara, Sri Lanka

Seneviratne NHG1, Mendis SAES1, Herath RRGCSB1, Gunaratne S1, Hadagiripathira HMI11 National Hospital of Sri Lanka, Colombo


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O8 - Contd’

P1 : Coronary artery diameters among Bangladeshis and their relationship with co-morbidi-tiesCader FA 1 , Haq MM1

1Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh

Background : Coronary artery diameters are known to vary with demographic parameters and clinical co-morbidities, but have not been studied in a Bangladeshi population. Quantitative Cor-onary angiography (QCA) may be used for a reasonably accurate measurement of coronary diam-eters. This study investigated the diameters of proximal segments of coronary arteries and their association with demographic parameters and co-morbidities.

Methods: This cross-sectional analytical study was conducted at Ibrahim Cardiac Hospital & Re-search Institute (ICHRI) Dhaka, Bangladesh over the period of April 2013 to March 2014. QCA of the left main coronary artery (LMCA), left anterior descending (LAD), Left Circumflex (LCx) and right coronary artery (RCA) were performed, and statistically analyzed.

Results: A total of 523 subjects, 407 males and 116 females were included. Mean diameter of LMCA was 3.65 ±0.69 mm (95% CI=3.59-3.71) while proximal LAD and LCx were 2.78 ±0.57 (95% CI=2.73-2.83) and 2.69 ±0.57(95% CI=2.64-2.73) respectively. Mean RCA diameter was 2.89 ±0.63 mm (95% CI=2.84-2.95). 87% were right dominant, while 9.6% and 3.4% were left and co-dominant respec-tively. There was no significant correlation between age and gender. There was linear correlation between coronary diameters and body surface area (BSA) (p<0.001) and eGFR (p<0.05), and inverse correlation with HbA1C level (p<0.05). Proximal LAD and LCx were significantly narrower among those with eGFR<90 (p=0.002 and p=0.027 respectively). Coronary artery diameters were narrower among diabetic subjects but with no statistical significance. However, LMCA and proximal LAD diameters were significantly narrower among diabetics with increasing duration of diabetic status (p=0.037 ad p=0.017 respectively).

Conclusions: Increased HbA1C level, longer duration of diabetes and chronic kidney disease with low eGFR were significantly associated with narrower coronary diameters. Age and sex had no sig-nificant correlation. Further evaluation by intra-vascular ultrasound (IVUS) is warranted.

events. Kaplan-Mayer survival analysis revealed the probability of survival at 5 years was 79.6% (CI 0.781-0.871) and 10 year was 58.1% (CI 0.516- 0.688). Cox regression revealed significant associations with age (HR- 0.973, p=0.023), family history of hypertension (HR-2.2, p=0.044) compared to nega-tive family history and activities of daily living (ADL) independence (HR=0.16, p= 0.011) compared to the ADL dependency.Conclusions and recommendations: Though the occurrence of cardiac events is not uncommon CABG surgery reserves its own place in management of CAD. Survival data of CABG patients seems to be similar to other countries of the world. Age, status of ADL prior to CABG and family history of hypertension was significantly associated with survival. Pre cardiac assessment of functional status with ADL and FH are important in follow up of CABG patients.

Background : Ambulatory blood pressure (AMBP) monitoring has extended the understanding regarding the circadian rhythm of Blood Pressure (BP) reflecting a better representation of overall BP control of an individual.Objectives : To evaluate the circadian BP profile in essential hypertensives and to make compari-son with clinic BP profile.Method : Prospective cross-sectional study was conducted at Cardiology Unit, Kandy in 2015. Pa-tients with essential hypertension having normal renal functions and who didn’t have previous cor-onary events were included. Twenty-four hour AMBP monitoring was performed in all the patients.Results : The sample included 100 (mean age: 61±9 years) subjects. Mean ambulatory day time systolic BP (SBP) was 137±16.5mmHg and mean nocturnal SBP was 128±18mmHg. The mean day time diastolic BP (DBP) was 80±11mmHg and mean nocturnal DBP was 73±12mmHg. There was a statistically significant difference (p<0.001) between day time versus nocturnal BP measurements irrespective of the control. In comparison to ABPM, the sensitivity of the clinic BP for diagnosing uncontrolled BP was 42%, specificity was 81%, positive predictive value was 77%, negative pre-dictive value was 71% and accuracy was 58%. The agreement between the clinic BP and ABPM in diagnosing control or uncontrolled BP was low (58%, Kappa = 0.23). There were 72% patients with nocturnal hypertension. Additionally, 30% had normal dipping patterns whereas 70% were abnor-mal dippers including non-dippers (45%), reverse dippers (25%) and extreme dippers (5%). Mean morning surge of BP was 30±16mmHg and 6% had abnormal morning surge. Maximum SBP and DBP were noted within 0600-0900 and 1800-2100, whereas minimum SBP and DBP were observed during 2100-0000.Conclusion : AMBP can be used as a versatile tool to evaluate finer variations of diurnal BP which has a greater significance of target organ damage and ultimate prognosis. Thus, AMBP assessment in hypertensive patients yields a higher diagnostic value with a better reliability, in diagnosing ad-verse prognostic BP patterns.

P2 : CIRCADIAN BLOOD PRESSURE PROFILE, RISK CATEGORIES AND ITS’ REPRESENTATIVE VAL-UE IN ESSENTIAL HYPERTENSIVE PATIENTS

Bandara HGWAPL1, Hewarathna UI1, Kogulan T1, Karunarathne RMSP1, Ralapanawa DMPUK2

1Teaching Hospital, Kandy, Sri Lanka ; 2Teaching Hospital, Peradeniya, Sri Lanka

Background : Left ventricular (LV) hypertrophy signifies a physiological response to chronic pres-sure overload over the myocardium which may associate with adverse prognosis. Objective : To evaluate the correlation of specific constituents of ambulatory blood pressure (AMBP) variables to parameters of Left Ventricular Hypertrophy (LVH) in essential hypertension. Method : A descriptive cross sectional study was conducted at Cardiology Unit, Kandy in 2015 on essential hypertensive patients with normal renal functions and no history of ischemic cardiovascu-lar events. AMBP monitoring and echocardiographic evaluation was performed in all the patients.Results : Among 100 patients (Mean age: 61±9 years), 60% had uncontrolled BP according to

P3 : THE INFLUENCE OF AMBULATORY BLOOD PRESSURE PROFILE ON STRUCTURAL MODIFI-CATION OF LEFT VENTRICLEBandara HGWAPL1, Hewarathna UI1, Karunarathne RMSP1, Kodithuwakku NW1, Jayawickreme SR1



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P4 : POST MYOCARDIAL INFARCTION EDUCATION AND THEIR SOURCE OF HEALTH INFORMATION

Bandara HGWAPL1, Karunaratne RMSP1, Kodithuwakku NW1, Hewarathna UI1, Dolapihilla SNB1


Background : Adequate knowledge about the disease and awareness on therapeutic options is important in managing patients with Coronary Artery Disease (CAD).Objective : To evaluate the knowledge on their CAD and to assess the sources of health informa-tion among post MI patients.Method : Descriptive study was conducted at Cardiology Unit, Teaching Hospital Kandy in 2015. Data was obtained from patients through interviewer administered questionnaire.Results : Out of 150 patients, 60% were aware about the existence of several types of CAD. Howev-er 72% were not alert about the type of their CAD. Only 6% were aware about the relevant pathol-ogy of CAD. From the group, 58% were aware about the prognostic medications and 62% patients knew that they are taking aspirin, though only 42% were conscious that aspirin is essential in CAD. Only 33% had discussed about the necessity of advance therapies after last event of CAD. There were 69% patients who were informed over the future risks of CAD. With respect to communica-tion, the main source of health information was the clinic doctor (53%) whereas other clinical staff (23%) and family physician (11%) were the other major resources. Majority of participants had no access to Internet (78%) and only 7% of those who had Internet access had searched health infor-mation via on-line. Conclusion : Awareness regarding the nature of CAD disease is poor among the study population. Only a minority have discussed about advance therapeutic options with their physician, although the physicians at clinic is the main source of health information. This highlights the necessity of upgrading patient’s knowledge on the nature of their disease and available therapeutic options to deliver a better quality of post MI care through a good cardiac rehabilitation programme.

P3 - Contd’

AMBP (BP>130/80 mmHg). There were 82% patients had left ventricular (LV) hypertrophy by intra ventricular septum (IVS) thickness. BP uncontrolled group had a higher IVS thickness compared to the control group, which is statistically significant (p= 0.02). AMBP uncontrolled group had a significantly higher LVM compared to BP control group (p<0.001). IVS thickness and LV mass had a positive correlation with mean ambulatory systolic (r=0.3, p<0.01) and mean ambulatory diastolic (r=0.28, p<0.01) BP. The presence of day time hypertension (p=0.032) and nocturnal hypertension (p=0.015) were significantly associated with higher LVM. There was no significant association be-tween isolated nocturnal hypertension (p=0.994) or abnormal dipping patterns (p=0.648) with higher LVM.Conclusion : Occurrence of structural alterations of the LV, as a marker of cardiovascular end organ damage in hypertension, best correlates with mean ambulatory systolic, diastolic and nocturnal BP. Therefore, evaluation of BP by ambulatory monitoring can be used as a sensitive tool and a better predictor for the evaluation of hypertensive cardiac remodeling.

Introduction : The specific causative mechanisms in Coronary Artery Ectasia (CAE) are essentially unknown. However, since some pathological characteristics are similar to coronary atherosclerosis it is worthwhile to study the angiographic pattern and risk factors. This may facilitate identification of unique patterns in Sri Lankan population.Objectives : To evaluate coronary angiographic characteristics of patients with coronary artery ectasia.Method : A retrospective cross-sectional study was conducted at Cardiology Unit Kandy on pa-tients who underwent coronary angiograms from January 2015 to April 2016. Coronary angio-graphic interpretation was made by two examiners individually. Demographic and clinical data were obtained from medical records.Results : A total of 2200 coronary angiograms were reviewed. CAE was found in 2.27% (n=50) pa-tients with a mean age of 52.96±8.75 years and majority were males (86%). All patients presented with acute coronary syndrome (ACS).CAE was seen more frequently (66%) in the right coronary artery (RCA). Ectasia of the Left Anterior Descending artery (LAD) and Left Circumflex (LCX) were seen in 52% and 48% respectively. Among ectatic RCAs, proximal RCA was the commonest (66%) segment involved. Of this, 86.4% were fusi-form and 13.6% were saccular in character. Severe generalized coronary ectasia [Markis classifica-tion type I] was seen in 26%, and type II and III were found in 16% and 20% respectively. Localized ectasia was seen in 38% of cases, of which 63.2% saccular and 36.8% were fusiform in character. There were 58% with concomitant obstructive [>70% stenosis] coronary artery disease (CAD) and 6% with coronary slow flow syndrome. Only 10% with ectasia showed left main stem involvement. Dilated coronaropathy (i.e. ectasia without coronary obstruction) was seen in 26%.Conclusion : CAE is less frequently observed among patients with ACS. RCA is the commonest site involved and ectasia is frequently observed with atherosclerotic CAD. The phenomenon of dilated coronaropathy opens an entity for further research as an etiological factor for ACS.

Background : Assessment of health related quality of life in post myocardial infarction (MI) patients is an important indicator of long term health status. This also provides information on future risks for deterioration of health status in such patients.Objective : To evaluate the health related quality of life among post MI patients.Method : A descriptive study was conducted, recruiting 150 post MI patients attending to Cardi-ology Clinic Kandy. Health related quality of life (HRQoL) was assessed using SF-36 questionnaire,

P5 : CORONARY ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH CORONARY ARTERY ECTASIA

P6 : HOW DOES IT AFFECTS THE HEALTH RELATED QUALITY OF LIFE IN POST-MYOCARDIAL INFARCTION PATIENTS?; FREQUENTLY UNNOTICED HEALTH BURDEN

Bandara HGWAPL1, Jegavanthan A1, Kogulan T,1 Kodithuwakku NW1, Jayawickreme SR1


Kogulan T1, Hewarathna UI1, Karunarathne RMSP1, Bandara HGWAPL1, Hathhalawatta C1



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Introduction : Aim of this study was to determine the effect of high dose vitamin D given to patients with early diabetic renal disease on systolic and diastolic blood pressure, total cholesterol (TC), low-density lipoproteins (LDL), triglycerides (TG) and high density lipoproteins (HDL) in a ran-domized controlled trialMethods : Patients with early diabetic nephropathy were recruited. Selected patients were allocat-ed to two groups by Block randomization method. Treatment group received 50,000 IU of vitamin D3 intramuscularly and the control group was given an equal volume of distilled water (0.25 mL) monthly for six months. Blood and urine were collected at the baseline for biochemical analyses and blood pressure was measured. After six months all the measurements done at the baseline were repeated.Results Of 155 patients invited, 85 were randomly assigned to two groups. No significant differ-ences were found between treatment and control groups at the baseline. Vitamin D therapy sig-nificantly reduced DBP, total cholesterol and LDL but the between group differences were not sig-nificant. There was an increase in HDL cholesterol level in the treatment group while there was no change in the control group Between groups difference was significant (P=<0.001)Conclusions : There was a significant improvement of serum HDL level with six months therapy of high dose vitamin D in patients with early diabetic nephropathy

P7 : EFFECTS OF SIX MONTH, HIGH-DOSE PARENTERAL VITAMIN D THERAPY ON LIPID PRO-FILE AND BLOOD PRESSURE IN PATIENTS WITH DIABETIC NEPHROPATHY; A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL

Liyanage PLGC 1, Lekamwasam S1, Weerarathna TP1, Liyanage C1

1Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka

which assess physical, mental and social health in 09 categories. Responses to each question were scored and summed according to a standard scoring protocol. The score ranged from 0-100, where 0 denoted poor HRQoL and 100 denoted a better HRQoL.Results : Mean age was 61±9 years (Male: 81%). The duration following MI was 0.5-05 years. The HRQoL with regard to social functioning (78±24), energy/fatigue (84±24), and emotional well-be-ing (80±16) are relatively high, reflecting better HRQoL. Males scored higher than female in all cat-egories, but statistically significant association was noted only for physical functioning category (p=0.009). Physical functioning (p=0.002) and energy/fatigue (p=0.006) categories were signifi-cantly higher among age group below 60 years compared to above 60 years group. Patients who had diabetes had lower scores than non-diabetic group in all categories, with significantly lower values in energy/fatigue (p=0.012) and emotional wellbeing (p=0.028) categories.Conclusion : Female as well as diabetic post MI patients have relatively poor HRQoL in all catego-ries. Therefore, these groups need special attention with respect to improvements of their HRQoL, through a well-designed cardiac rehabilitation programme.

P8 : OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION(PCI) PERFORMED FOR THE PATIENTS PRESENTED WITH STEMI TO DR. NEVILLE FERNANDO TEACHING HOS-PITAL, MALABE

Pathiratne PASR1 , Ranawaka H1, Waduge RN2, Herath GDWK1, Ranaweera PHMRC1, Fernando JD1

1Cardiothoracic Surgery unit, Teaching Hospital, Faculty of Medicine, University of Peradeniya, Peradeniya

Background and Objective : Cardiovascular diseases, including myocardial infarction (MI) and heart failure, are the leading causes of death in developed as well as in low-and middle-income countries. Use of percutaneous coronary intervention (PCI) is the preferred re-perfusion strate-gy (compared to best thrombolytic agents such as tenestaplase), as primary PCI.Methods : We respectively reviewed 25 consecutive patients transferred from NFTH to Nawalo-ka Hospitals Cardiac Catheterization Laboratory to undergo primary percutaneous translumi-nal coronary angioplasty. The Procedure was carried out by the resident Consultant Cardiolo-gist at NFTH. The patients were between 30-76 years of age and male to female ratio is 4:1. Results : Among 25 consecutive patients who underwent primary percutaneous coronary intervention for STEMI , 80% were males and 20% were females. Age ranged from 31-80 years(mean(40%) between 51-60years of age). The Analysis of indications for primary PCI re-vealed that majority due to ANTERIOR STEMI(52%) ,consecutively 36% due to INFERIOR STEMI and 12% due to POSTERIOR STEMI. These angiography results showed that the culprit lesion for STEMI was mainly Left anterior descending artery(57%) and consecutively 13% due to Circum-flex artery and 30% due to Right coronary artery lesion. Out of all 56% were with Total occlu-sion, 32% with subtotal occlusion and 4% with only minor lesion of the culprit artery. Of all, 12% had pre procedure cardiac arrest ,8% Complete heart block. And 16% cardiogenic shock. The Primary PCI was 100% successful and All the patients achieved excellent angiographic results with TIMI iii flow in blocked arteries.Conclusions : The results of this study raise the possibility that outcomes of PCI after STEMI is highly successful.


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The president and council of the SLHA wish to express their deep appreciation of the generous sponsorships offered by our valued industry partners to make this event a success.

ACKNOWLEDGMENTS

• All our generous sponsors without whom the funding of this event would have been impossible• The International Faculty, many of whom traveled at own expense to impart their knowledge and skills, enhancing the quality of this meeting• Our event managers, Dileesha and team at Asia Tours for making our lives that much easier • Event productions for a fantastic job with audiovisuals• Mr Sumittha and his team at ITN for a job well done• Mr. Thakshila Galappaththi and all the staff of Galle Face hotel for helping to make this event a success• Mr. Devendra and his team at Ananda Press for an exceptional job at short notice

The organizing committee thanks the following for their contribution to the success of the Annual Academic Sessions and Sri Lanka Intervention Meeting.

SRI LANKA HEART ASSOCIATION ANNUAL ACADEMIC SESSIONS & SRI LANKA INTERVENTION MEETING - 2016

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