RH Sum07 single pages

MICA (P) 023/09/2007 Issue No. 11 • January – June 2008

Prof Chia Boon Lock receives theSMA Honorary Membership Award

Prof Chia Boon Lock receives the

– READ MORE ABOUT IT ON PAGE 2

SMA Honorary Membership Award

05CAROTID ARTERY STENTING

A/Prof Tan Huay Cheem, Chief, Cardiac

Contents are not to be reproduced without thepermission of The Heart Institute

THI PULSE | 2THI PULSE | 2

20DIRECTORY AND AWARDS

1116TH ASCVTS ENDOVASCULARAORTIC STENTING COURSE

16HAPPENINGS

02PROF CHIA BOON LOCKRECEIVED SMA HONORARYMEMBERSHIP AWARD

13CHICAGO ACC SUCCESS

GIVING THE SICK HEART A BREAK14NMRC GRANT AWARD

COARCTATION STENTING –PERCUTANEOUS THERAPY FOR ARARE PROBLEM

CIT BEIJING MEETING

12SINGAPORE CARDIAC SOCIETYLECTURER AWARD

FIRST PRIZE – YOUNGINVESTIGATOR’S AWARD

1016TH ANNUAL CONGRESS OF THEASIAN SOCIETY FORCARDIOVASCULAR AND THORACICSURGERY

WET LAB WORKSHOP

RECEIVING THE SMA HONORARY

081ST SINGAPORE-ASIA CARDIACRESYNCHRONISATION THERAPYCOURSE

CARDIAC REHABILITATIONPROGRAMME

04UPCOMING PUBLIC SYMPOSIUMON SUDDEN CARDIAC DEATH

MRCP (UK) PREPARATORYCOURSE

06INFORMATION TECHNOLOGY @THE HEART INSTITUTE

Prof ChiaProf Chia Boon Boon

FEEDBACKPlease direct your feedback toThe Editor, PULSEc/o The Heart InstituteNational University HospitalCardiac DepartmentLevel 3, Main BuildingSingapore 119074Tel 6772 5565Fax 6778 6057Email [email protected]

EDITOR

Dr Poh Kian Keong

ADVISOR

A/Prof Tan Huay Cheem

“The name Prof Chia Boon Lock, immediately conjures up an imageof a superb clinical cardiologist who can interpret any cardiacmurmur accurately, a dedicated educator who enjoys imparting hisknowledge to the medical students and the younger doctors, a clinicalresearcher devoted to the pursuit of the intricacies of theelectrocardiogram and above all, a fatherly figure who is alwayswilling to lend a hearing ear and who is also always unstintingwith his advice.” This is the citation by Assoc Prof Tan Huay Cheemfor Professor Chia Boon Lock, who was conferred honorarymembership of the Singapore Medical Association for the Year 2008at the recent SMA Dinner.

One of the early pioneers of cardiology in Singapore, ProfChia was in charge of cardiology in Medical Unit II (later knownas the University Department of Medicine II) at SGH from 1975to 1985 and was also Head of this Department from 1981 to 1983.After moving over to NUH, he became Head of the hospital’sDivision of Cardiology, Department of Medicine, from 1986 to1989 and Chief of the Cardiac Department from 1996 to 1999.Amongst his many achievements, he was one of the first twocardiologists to introduce echocardiography and the first tointroduce ambulatory blood pressure monitoring in Singapore.

Prof Chia is the current Chairman of the Ministry of HealthWorkgroup for the Clinical Practice Guidelines on Lipids and aMember of the Workgroup on Hypertension. He was formerlyPresident of the Singapore Cardiac Society, Chairman of theChapter of Physicians, Academy of Medicine (now the College ofPhysicians, Singapore) and a Member of the 17th and 18th Councilof the Singapore Medical Association.

An outstanding and inspiring teacher who is a favourite ofthe NUS medical students and also registrars training in Cardiology,Prof Chia has contributed significantly to the training of generationsof doctors and cardiologists in Singapore. For this and othercontributions, the NUS conferred him the title of Emeritus Professor

in this issuein this issue

18ABSTRACTS, PUBLICATIONS ANDNEW DOCTORS ON BOARD

07NHG HMDP EXPERT VISIT –A/PROF DAVID CAMPBELL

Dept @ NUH

in 2006. Other awards which he has received include the LeeFoundation-National Healthcare Group Lifetime Achievement Awardand the Dato Paduka Mahkota Brunei.

Remarkably, most of Prof Chia’s achievements have beenattained despite a long battle with advanced nasopharyngealcarcinoma – initially with the treatment 24 years ago andsubsequently with the late side-effects arising from the radiotherapywhich he had received. This is truly atestimony of his great courage and hisindomitable spirit.

The award at the dinner waspresented to Prof Chia by the PermanentSecretary of Health, Miss Yong Ying-I.


AWARD

LockLock

The Singapore MedicalAssociation will beorganising the 39th SMAAnnual National MedicalConvention on 5th July2008 at the Raffles CityConvention Centre. TheHeart Institute, National

Healthcare Group is privileged to co-host this year’s importantnational healthcare convention.

The recent extensive and frequent media coverage ofsudden death among our youth propelled the quest to educate oursociety about the issues related to sudden cardiac death. Thereforethis year the theme for the medical convention is “Prevention ofSudden Cardiac Death: Perception and Reality”. We have thepleasure of having the senior parliamentary secretary of health,Mr Hawazi Diapi to grace the occasion as our guest of honour.

Despite a substantial reduction in age-adjusted rates of deathfrom cardiovascular causes during the past 40 to 50 years,cardiovascular disease remains the single most common cause ofnatural death in developed nations. Sudden cardiac death (SCD) isestimated to account for approximately 50 percent of all deathsfrom cardiovascular causes. In US, it accounted for 20% of all deaths

Dr Abdul Razakjr Omar, Cardiac Dept @ NUH

annually (>300,000 SCD), while in Europe ~100 SCD per 100000 and in our society ~ 1 per 1000 individuals.

The majority of such sudden deaths are caused by acuteventricular tachyarrhythmias, often triggered by acute coronaryevents (coronary artery disease)

Clinical trials have shown that antiarrhythmic- drug therapyis not effective in reducing mortality among patients who areassumed to be at risk for such death, but recent randomized trialshave demonstrated a survival benefit in high-risk patients of therapywith an implantable cardioverter–defibrillator, compared toconventional drug therapy.

The Centers for Medicare and Medicaid Services estimatethat as many as 500,000 Medicare beneficiaries might be eligibleto receive a prophylactic ICD in the United States. Given thesubstantial cost of the ICD, the economic effect of this strategymust be considered in future healthcare planning.

The importance of educating all doctors on SCD should berecognized. The highlights of the Medical Convention will includea one-day medical symposium and workshop for healthcareprofessionals and public forum. The interesting program will befinalized by Dr Eric Hong & Dr Ong HY (Chairmans for PublicSymposium) and Dr Seow SC (Scientific Chairman for MedicalSymposium) focusing on prevention and latest management of SCD.

Dr Eric Hong, Cardiac Dept @ NUH

MRCP (UK)Preparatory CoursePreparatory Course

UPCOMING SYMPOSIUM ON

Sudden Cardiac DeathSudden Cardiac Death


The Final MMed (Int Med)/MRCP PACES ExaminationPreparatory Course was held from 14-19 April in various hospitalsin Singapore under the auspices of the Division of Graduate MedicalStudies, Yong Loo Lin School of Medicine. This was an intensiveprogramme consisting of practice sessions in all stations of the

examination, culminating in a fullmock examination on the last

2 days of the course.The Heart Institute is

proud to organize theexamination held in theNational University Hospital.

This demonstrates thedepartment’s strongcommitment in trainingnew generation of youngmedical specialists.

The examinationwas well received by theparticipants. Many foundthe cases useful in honingtheir clinical skills assisted by tutors at hand who critique theparticipants’ examination and presentation skills.


Percutaneous transluminal angioplasty and stenting have becomean established therapeutic modality for coronary and peripheralarterial diseases, complementing surgical treatment. Theapplication of this technique in carotid artery stenosis is anexpected progression. The perceived advantages of carotid arterystenting (CAS) compared to carotid endarterectomy (CEA)include avoidance of general anesthesia and open surgical incision,shorter procedural time and hospitalization, and increasedpatients’ acceptance.

Since FDA approval of CAS in 2004, it has been increasinglyused for patients considered as high risk for surgery. In contrast tomost endovascular peripheral arterial interventions, CASrepresents a more challenging procedure because it requires theuse of smaller guidewire system (0.014-in vs 0.035-in guidewiresystem as in peripheral intervention), distal embolic protectiondevice and rapid exchange system (vs. over-the-wire system). Theuse of long guiding sheath via common femoral artery to performballoon angioplasty and stenting also represents new challenge forphysicians with less CAS experience.

CEA has long been the gold standard for the treatment ofcarotid artery stenosis. In North American Symptomatic CarotidEndarterectomy Trial (NASCET), symptomatic patients withcarotid artery stenosis (70-99%) in CEA arm compared to medicalgroup had higher perioperative stroke/death (5.8% vs 3.3%) butsignificantly lower major/fatal ipsilateral stroke at 2 years (2.5%vs 13.1%, p<0.001). In Asymptomatic Carotid Artery DiseaseCarotid Endarterectomy(ACST), 3120 patients were randomizedto CEA and medical therapy. With an perioperative risk of strokeof 3.1%, stroke or death risk at 5 years was lower in CEA group(6.4% vs 11.8% medical).

More recently, there were three prospective randomizedtrials comparing CAS (with carotid neuroprotection) and CEA.SAPPHIRE (NEJM, 2004) was the first trial comparing CAS usingSMART stent(Cordis) and AngioGuard neuroprotection device(Cordis), and CEA in high risk patient. The trial showed that CASwith neuroprotection device in high risk patients is not inferior toCEA. Three year results of SAPPHIRE (NEJM, 2008) showed nodifference in target vessel revascularization (2.4% CAS vs 5.4%CEA, p=0.26).

However, the findings in SAPPHIRE are discordant withtwo other trials: EVA-3S (NEJM, 2006) and SPACE (Lancet,2006). Results of the Stent-Supported Percutaneous Angioplastyof the Carotid Artery vs Endarterectomy (SPACE) trial, showeda higher rate of ipsilateral ischemic stroke and death at 30 daysin patients undergoing carotid stenting vs those who wererandomized to receive endarterectomy. The Endarterectomy vsAngioplasty in Patients with Symptomatic Severe Carotid Stenosis(EVA-3S) study, found carotid stenting failed to meet

noninferiority criteria compared with endarterectomy in patientswith symptomatic stenosis of 60% or more: at both one and sixmonths after the procedure, death and stroke rates were lowerwith endarterectomy.

There are ongoing trials, such as the Carotid RevascularizationEndarterectomy versus Stenting Trial [CREST] that involve low-to-moderate risk patients, and will provide further insights.

Based on available evidence, CAS is a viable alternative toCEA in high risk patients. The constant improvement ofendovascular devices, procedural techniques and adjunctivepharmacological therapy will likely improve CAS outcome.

This is an exciting field that holds promise for reducingstroke risk. Having trained in Endovascular fellowship in VascularSurgery Division in Cleveland Clinic, I am fortunate to work withProf Lenny Tan (DDI) and A/Prof Peter Robless (Vascular Surgery),as well as to be part of a multidisciplinary team involvingneurologists and neurosurgeons in providing percutaneous carotidintervention service for selected patients.

Carotid Artery StentingCarotid Artery StentingDr Teo Swee Guan, Cardiac Dept @ NUH

Top 68 year-old patient with previous neck surgery. Baseline carotid angiography (A) showed highgrade internal carotid artery stenosis. With distal embolic protection, a nitinol self expanding stentwas deployed from distal common carotid artery to internal carotid artery (arrows)

RUBICON

Top Various distal embolic protection devices

SPOTLIGHT

Information Technology

Within the ‘heart’ of operations at the The Heart Institute runs aunique software that has been storing critical information of ourpatients since 1991. This database, the cardiology informationsystem (CIS) was initially spawned by Professor Maurice Choo,when he was then chief of the cardiac department in NUH. It wasinitially a report generator for our echocardiography, treadmilland ambulatory blood pressure investigations and networked on aseries of Macintosh computers. In 1998, the system was revampedto include research data and a new engine which helpedcardiologists track their cases. In 2000, the system was moved to aWindows platform and the system was exported to AlexandraHospital for use. It also boasted of a hospital interface which allowedits reports to be seen in NUH’s Hospital information system. Wealso developed an expert system for our percutaneous interventionswhich allowed full text reports to be generated from data capturedduring a procedure. We expanded our repertoire of investigationsin the system to include 35 unique cardiology investigations rangingfrom Nuclear, CT angiography, Cardio-pulmonary exercise,Electrophysiology, congenital heart and vascular interventions.

In 2001, we bravely entered the world of real time digitalimaging. We began storing all images from echocardiography,cardiac catheterization, electrocardiograms and nuclear. One ofour overriding principles, was that all ‘raw’ source data from anysystem had to be stored and shared with everyone. In 2003, thisdatabase was installed in Tan Tock Seng Hospital and a NationalHeathcare Group (NHG) cardiology network was established. Ourcardiology reports became available to the whole cluster in 2005on the computerized patient record system (CPRS). In 2003, wewon a grant from The Enterprise Challenge from the PrimeMinister’s office and we became the first medical unit in Singaporeto use tablet personal computers for our daily ward rounds. Thisallowed all cardiology reports and images to be disseminated tothe patients bedside. This improved our overall efficiency andallowed patients to have a shorter length of stay for our inpatients.In 2004, our CIS won the prestigious National Infocomm Awardsfrom the Infocomm Development Authority (IDA) for the bestimplementation of IT in a public institution. In 2005, our ITdirector, Dr James Yip was inducted into the IT Hall of Fame ofthe Singapore Computing Society for the Friend of IT award.

On a daily basis, the CIS allows our cardiologists to reviewpatient information on a timely basis and to complete theircardiology reports. It has the capacity, for our doctors to workfrom home and to store interesting cases for teaching and research.

The CIS contains coded fields which allows directed research tobe conducted by our cardiologists and data to be collectedprospectively. Thanks to this database, our research output eachyear grows by leaps and bounds, and doctors are able to submitnumerous abstracts for local and overseas meetings, with someour young researchers frequently clinching young investigatorawards. Part of the success of our CIS system, is that it is selfdeveloped and self managed. It is an organism which continuallyevolves to meet the new challenges, which is what expensiveproprietary systems cannot promise to deliver. In the futuredevelopment of the CIS, we hope to increase its connectivityto other systems and to deliver clinical decision support forthe cardiologists.

Dr James Yip & Ms Fauziah Azizi, Cardiac Dept @ NUH


@ The Heart InstituteInformation Technology

@ The Heart Institute


The Department of Cardiac, Thoracic & Vascular Surgery at NUHwas honoured to host Prof David Campbell from Beth IsraelDeaconess Hospital and Harvard Medical School, Boston, USAduring his visit as NHG HMDP Expert in Vascular Surgery. ProfCampbell is one of the most well-known figures in the field of limbsalvage bypass surgery for peripheral vascular disease and diabeticfoot preservation. His group in Boston have published extensivelyon limb salvage surgical techniques and outcomes for the last 20years and their results for limb salvage and low perioperativemortality are the gold standards others aim for.

Prof Campbell’s visit included a mix of lectures anddemonstration surgery, in addition to a vascular anastomosismasterclass. In his series of lectures, he shared with an extensiveaudience of surgeons, physicians and anaesthetists, the experienceand outcomes from his surgical series numbering more than 6000lower limb bypass surgeries.

Prof Campbell has been instrumental in developing diabeticlimb salvage programmes in the Vietnam and India in the lastdecade. He has been traveling to hospitals in Hanoi, Danang andHo Chi Minh City for the last ten years to promote limb salvageand has reported this in the Bulletin of the American College ofSurgeons. It was during one of these trips that he met Prof KOLee from the Dept of Endocrinology at NUH and was invited tovisit Singapore to promote diabetic limb salvage.

He was welcomed at NUH by the vascular surgery,endocrine, renal and diabetic foot teams. Prof Campbell assistedin two patients undergoing carotid endarterectomies. He alsovisited the vascular surgery units at Singapore General Hospitaland Tan Tock Seng Hospital, where he participated in the vascularradiology meetings. At TTSH, he demonstrated his techniques ofdistal bypass surgery. Despite his busy schedule, Prof Campbell

A/Prof David CampbellNHG HMDP EXPERT VISIT 26-20 MAY 2008

A/Prof David CampbellA/Prof Peter Robless & Dr Benjamin Chua, CTVS @ NUH

also found time to conduct a masterclass on vascular anastomotictechniques using animal cadaveric vessels models held in theSmartLab of the Advanced Surgery Training Centre at NUH.Supported by Ethicon, J&J and Terumo Vascutek, it was wellattended by an enthusiastic group of 10 surgeons and advancedsurgery trainees. Prof Campbell remarked that, “This is the mostnumber of surgeons I have trained in one afternoon ever!” Valuablelessons in surgical technique and a great time by all. He was alsothe guest of honour at a dinner hosted by the Vascular SurgicalSociety of Singapore held at the Peranakan restaurant,True Bluein Armenien Street. This was indeed a novel culinary experiencefor our visiting New England surgeon.

Prof Campbell delivered his talk on “Infection,Neuropathy and Arterial Insufficiency in the Diabetic” at the NUHhospital grand rounds. After that he participated in the DiabeticFoot Ward Rounds conducted by Prof Aziz Nather and the NUHdiabetic foot team, where he shared his knowledge and experiencein management in diabetic patients with foot wounds. This wardround was well-received and attended by a large group of surgeons,nurses and podiatrist.

Prof Campbell’s visit as HMDP Expert was a resoundingsuccess, judging from the number of people who attended hislectures, ward rounds and masterclass. It was our pleasure to hosthis visit and we certainly hope that he too had a great time and willvisit us again soon.

don’t bypass Cardiac RehabilitationCardiac rehabilitation is increasinglyrecognised as an integral component ofthe continuum of care for patients withcardiovascular disease. Its application is aclass I recommendation in mostcontemporary cardiovascular clinicalpractice guidelines. Despite thedocumentation of substantial morbidityand mortality benefits, cardiacrehabilitation services are vastly underutilised.

Established in the late 1990s, the CardiacRehabilitation Programme (CRP) at National UniversityHospital (NUH) is characterized with a provisionalcomprehensive long term services involving medical evaluation,prescriptive exercise; cardiac risk factor modification, education,counseling and behavioural interventions.

It is paramount that a good CRP is multifaceted andmultidisciplinary in nature consisting doctors, specialized cardiacnurses, physiotherapists, dietitians, pharmacists, medical socialworkers, occupational therapists, psychologist and psychiatrist. InNUH, cardiologist Dr. Eric Hong Cho Tek leads this uniquespecialised individualised programme. Dr Roger Ho, a psychiatrist,

is also part of this dynamicmultidisciplinary team.

Upon the completion of theNational University Heart Centre forCardiovascular Services, a dedicatedcardiac rehabilitation gym with thestate-of-the-art exercise equipmentand facilities will help to meet theneeds of the evolving society.

Numerous studies have demonstrated that cardiacrehabilitation programmes can reduce the cardiac death rate by asmuch as 20 to 25 per cent. It has been shown to be as important ascompliance to prescribed medication and following, of a strictrecommended diet. Despite the presence of cardiac rehabilitation,only 15 to 20 per cent of appropriate candidates participated in aformal CRP in Singapore. In our survey, most quoted ignoranceof the existence of a CRP.

In NUH CRP, our goals are manifolds. Besides reducingmorbidity and mortality, improvement of the quality of life,reduction in subsequent rehospitalization, and getting patientback to normality, if not better. We provide supervised exercisetraining, multidisciplinary education programme to patients

Dr Eric Hong, Cardiac Dept @ NUH

don’t bypass Cardiac Rehabilitation

minimally functional levels to adapt to their poor heart functionwhile they lived their lives under the spectre of certain death byprogressive heart failure or sudden cardiac arrest.

The advent of device therapy for chronic heart failure hasliterally brought new life and hope for these patients. Individualswith very poor heart function often have uncoordinated contractionof their heart walls. By implanting a pacemaker with multiple leads,these walls can be made to move together again in a coordinated,synchronized fashion resulting in improved symptoms, cardiacoutput and even a reduction in mortality. Aptly termed “cardiacresynchronization therapy” (CRT), this modality has been shownin large clinical trials to reverse the process of progressive heartenlargement seen in chronic heart failure.

Heart failure patients are also at high risk of sudden cardiacarrest due to life-threatening heart rhythm abnormalities. Bycombining a CRT pacemaker with a defibrillator in a single device,this other major cause of death in heart failure is addressed, andresults in a further reduction in mortality in the COMPANIONand MIRACLE-ICD trials.

Heart failure is a major public health issue in developed countries,exacting a heavy toll on medical resources and more importantly,a high mortality and morbidity on the patients. Until recently, littleother than medication could be done for patients with chronic heartfailure who are not suitable for coronary revascularization or cardiactransplant. Patients were forced to restrict their activities often to

1 st Singapore-Asia Cardiac Resynchronisation1 st Singapore-Asia Cardiac ResynchronisationDr Seow Swee Chong & Dr Abdul Razakjr Omar, Cardiac Dept @ NUH


ProgrammeProgramme

recovering from cardiac events such as a heart attack,interventional procedures like angioplasty, heart surgery (bypass,transplant or valvular) and congestive heart failure. This is totarget the motivated individuals who want to reduce traditionalcardiovascular risk factors. In NUH, we have also developed adedicated smoking cessation programme

In our experience, we are aware that many cardiacpatients have high levels of stress and anxiety. Depression isprevalent after acute cardiac events, with 20 to 45 per centof patients having significant depression after acute myocardialinfarction (AMI). Depression is an independent risk factorfor mortality in patients with AMI, or unstable angina. Several

studies suggest improvement with cardiac rehabilitationintervention. Patients with depressive symptoms have a five-fold increased risk of non-completion of cardiac rehabilitationand therefore require enhanced attention and support. Wehave also dedicated a team to focus on neuropsychologicalaspect of these patients.

A review of 46 randomised trials of secondaryprevention, in 18821 patients with coronary heart disease wasrecently conducted by the agency for Health care research andquality: Secondary prevention programs were demonstrated toreduce hospitalization, recurrent MI and long term mortality.Physicians can initiate the referral if their patient is appropriatefor CRP in NUH.

It is little wonder therefore that there is much interestworldwide in the technique of performing CRT implants, whichis more complex than a routine pacemaker implant. With thegenerous support of St Jude Medical, the Cardiac Department atthe National University Hospital was able to conduct the 1st

Singapore-Asia CRT implant course, which hosted foreign doctorsfrom South Korea and the Philippines. Over the course of 3 daysfrom 28th till 30th April 2008, live cases of CRT implant wereperformed, spaced apart by didactic lectures on the indicationsand trial evidence for such therapy as well as methods foroptimization of CRT devices post-implant. Led by course directorsDr Abdul Razakjr Omar and Dr Seow Swee Chong, the programmealso included a practical session demonstrating optimization of thedevices using echocardiography.

With overwhelmingly positive feedback from courseparticipants, the Department is geared up to continue conductingsuch courses on a regular basis; sharing knowledge andexperiences and fostering friendships with fellow cardiologistsacross the region.

(CRT) Therapy Course (CRT) Therapy Course

Please visit www.nuh.com.sg/_cardiac/ourServices_cardiacRehabilitation.htm or contactthe CRP nurses for more information.

Lai Shuet Ming – 67725563 / 95402582Rachel Chan Wang Hia – 67722436 / 95669078Ooi Lean See – 67722497 / 98028205


Singapore hosted the 16th Annual Congressof the Asian Society for Cardiovascular andThoracic Surgery (ASCVTS) held over 13–16 March 2008 under the Chairmanship ofProfessor Lee Chuen-Neng, Chair, UniversitySurgical Cluster, Head, Department ofSurgery and Department of Cardiac, Thoracic& Vascular Surgery, National UniversityHealth System. It was attended by over 870 participants from 50countries.

Since its foundation in 1993, the ASCVTS had becomethe largest cardiothoracic Society In Asia. Its goals have been topromote the study of the art, science and practice of cardiovascularsurgery, hence facilitating the exchange of ideas in the field ofcardiovascular surgery. Journeying into the 21st century,advancements in the field of healthcare have been accompaniedby unexpected challenges and greater responsibilities. The themethis year – “Putting Patients first in the Era of Modern Technology”,embodies the purpose of this congress, which is to equip healthcarepersonnel as well as patients with medical knowledge that isbecoming increasingly relevant in our society.

For the first time outside of America, the AmericanAssociation for Thoracic Surgery (AATS) held a post-graduatereview course. This was well received.

The congress received over 250 free paper submission, ofwhich 50% were for oral presentation over 14 sessions and 50%were for poster presentation. Alongside the main congress, severalworkshops namely the Haemodynamic Workshop, EndovascularAortic Stenting Course and Minimally Invasive ThoracicSymposium were conducted at the Advanced Surgery TrainingCentre, National University Hospital. All the workshops wereconvened by our doctors with international and regional panelists.

The nursing symposium which was attended by more than200 participants was coordinated by a nursing committeerepresented by all the major hospitals in Singapore.

for Cardiovascular and Thoracic Surgery16 th Annual Congress of the Asian Society16 th Annual Congress of the Asian Society

Prof Uwe Klima, CTVS @ NUH

Prof Uwe Klima, CTVS @ NUH

In conjunction with ASCVTS 2008, St. Jude Medical took theopportunity to run a wet lab workshop on the 12th March 2008.

A total of 11 doctors, coming from various Asia countriesparticipated in the workshop which was held at the AdvancedSurgical centre at the National University Hospital of Singapore.The workshop was conducted by Prof Uwe Klima and A/ProfTheodoros Kofidis from the National University Hospital and DrChua Yeow Leng from the National Heart Center.

The workshop started with Dr Chua sharing a presentation onHIFU (High Intensity Focus Ultrasound) technology for open cardiacablation for the treatment of Atrial Fibrillation. He shared thedifferences between HIFU and other technologies, as well as themethod of performing a procedure using the EPICOR machine. The

main advantage for HIFU is the ability to providetransmural ablation effectively and safely.There was also a short hands-on sessionwhere Dr Chua demonstrated an ablationusing EPICOR on a porcine heart.

This was followed by Prof Klima giving a presentation onthe treatment of Valvular Disease using MHV (Mechanical HeartValves). RegentTM valve was highlighted as one of the best performingMHV with outstanding performance for EOAI (Effective Orific AreaIndex) and profile. A/Prof Kofidis spoke on Current Trend for TissueHeart Valves, the EpicTM Heart Valves was featured for its superbprofile and unique anticalcification technology. The participantsbroke out into smaller groups where the trainers gave a detaileddemonstration on the tips and tricks of sewing the RegentTM valveand EpicTM Supra valve onto a porcine heart. Each participant alsohad a chance to assist or replace a valve onto a porcine heart underthe supervision of the trainers.

Overall, the feedback and response towards the workshophave been positive. All participants mentioned that they found thesession insightful, and the various advice given by the trainers duringthe session were invaluable in helping them provide better patientcare through better techniques and skills learn through the workshop.

wet lab workshopwet lab workshop

for Cardiovascular and Thoracic Surgery


The 16th AnnualMeeting of theAsian Society forCardioVascular &Thoracic Surgerywas held from the12–16th March2008 in Singapore.As part of themeeting, the HeartInstitute was pleased

to host the ASCVTS Endovascular Aortic Stenting Course held atthe Tan Sri Khoo Teck Puat Advanced Surgery Training Centre atthe National University Hospital on the 15th March 2008. Theworkshop was fully subscribed with over 60 delegates fromSingapore, Indonesia, Phillipines, India, Taiwan, Thailand, Malaysiaand Japan attending.

We were pleased to bring together an international facultyof eminent cardiovascular surgeons and interventionists involvedin the training and development of thoracic endovascular aorticstenting programs. The guest faculty included Drs Roy Greenberg,Joe Bavaria, John Wolfe, Wei Zhou, Bart Muhs, Hassan Tehrani,Stephen Cheng, Ian Nixon, Shih Chun Che and Sophia Ang.

A/Prof Peter Robless, CTVS @ NUH

16th ASCVTS EndovascularAortic Stenting Course

16th ASCVTS EndovascularAortic Stenting Course

This workshop aimed to address the practical aspects of patientselection, planning, case preparation and stent deployment. Thecurrent evidence base for thoracic aortic endovascular stenting wasalso presented and discussed.

The participants were able to have a practical hands ondemonstration of the leading thoracic aortic stentgrafts in clinicaluse such as the Gore TAG, Medtronic Valiant, COOK TX2 andDjumbodis Saint Come Chirurgie. There was intense interactionwith experienced physician proctors and technical product specialistsfrom the manufacturers.

In addition to didactic presentations and small group hands-on demonstration there was also interactive case discussions. Inorder to promote participation and discussion, several of the facultybrought their own teaching cases which were prepared on our 3-DDextrobeam workstation for planning and discussion. This wasfacilitated by Dr Luis Serra and the team from Volume Interactions.This unique combination allowed the audience to view cases in thestandard axial, coronal and sagitall planes as well as in 3-D to fullyappreciate the tortousity, landing zones, branching and access issuesin thoracic endografting. Several cases involving thoracic aorticaneurysms, dissection and traumatic transections were discussed.Endovascular strategies involving hybrid repair of the thoracic aortawere also presented.


Associate ProfessorTan Huay Cheem ishonoured as theSingapore CardiacSociety Lecturer forYear 2008 at itsrecently held AnnualScientific Meeting(ASM). This is an

award bestowed upon member who has contributed significantlyto the Society. A/Prof Tan has served in the Council of the Societyfor the last 9 years since 1999, and was the Secretary, VicePresident and eventually President of the Society for two terms

from 2003–2005. He has contributed actively to many of theSociety’s continuing educational activities including helping toorganize the 13th SCS Annual ASM in Year 2000 and manyinternational meetings such as the 13th ASEAN Congress ofCardiology in Year 2000 and 14th Asian-Pacific Society ofCardiology in Year 2003. Cited by Dr Richard Ng, President ofthe SCS, A/Prof Tan is described as a dynamic and winsome doctorwho is popular with both patients and colleagues locally and abroadfor his enthusiastic and invaluable collaboration and fellowship. Inhis lecture, A/Prof Tan gave his insights on the “Management ofCoronary Artery Disease-Diagnostic and Therapeutic Advances” whichwas warmly received by the audience.

Singapore Cardiac Society lecturer awardSingapore Cardiac Society lecturer award

Young Investigator’s AwardDr Chan Wan Xian, Cardiac Dept @ NUH

It started with our department’s research grand round. Afterpresenting my project entitled “Cardiorespiratory Gas ExchangeAnalysis During Dynamic Exercise Predicts Surgical Indicationsfor Severe Mitral Regurgitation”, fellow colleagues encouragedthe submission to the annual Singapore Cardiac Society meeting.I started working with my mentor, Prof Ling LH, to beat thedateline of submission. We went through our data and statisticsmany times to draw accurate conclusions from months of hardwork of patient recruitment and data collection. We thenproceeded with the drafting of our abstract and finally submittingjust before the deadline.

After weeks of waiting, I received an e-mail from theSingapore Cardiac Society notifying us that the abstract has beenselected for presentation at the Young Investigators’ Award sessionat the annual Singapore Cardiac Society Meeting. I immediatelystarted preparing for the presentation.

Our post-graduate education director, Dr Poh KK, arrangeda practice session for us to present our studies to the departmentbefore the actual presentation. I was not fluent in my presentation.Fortunately, many colleagues from the department gave valuablecomments from presentation style to slides content. That providedme feedback to reflect and improve.

After that weresleepless nights tomodify my presentationcontents and to rehearsemy presentation style.Seniors and secretariesfrom the departmentlent their help in all waysthey could. Specialacknowledgements to

Dr. James Yip, who lent me his books and articles on CPET and spenttime explaining to me the concepts of CPET; and my mentor, Prof Ling,who patiently corrected my presentation and gave me invaluable advice.

The presentation itself was an experience which one couldnot learn from books. It also provided me an opportunity tolearn from my competitors, research methods and presentationskills. It widened my exposure to ongoing cardiovascular researchin other instituitions.

I feel most honoured to win the Young Investigator’s Award.I will continue to put in my best efforts and hope to do well in thecoming Asean’s Young Investigators’ Award presentation in Hanoi.

Young Investigator’s AwardFIRST PRIZE


giving the sick heart a break...FOR THE BETTER

Heart disease is one of the leading causes of death worldwide.Open-heart surgery is a major operation indicated for

patients to bring about relief of their debilitating symptoms andcardiac dysfunction.

The surgeon requires a motionless heart and a bloodlessfield to do his job. Blood that normally course through the heartand lungs is diverted to the Heart Lung Machine. This providesan alternative and artificial means of keeping the blood going,mimicking the natural organs it replaces. The process is calledcardiopulmonary bypass or more commonly known as HeartBypass Surgery. The vital functions of the heart and lungs arenow being performed by a mechanical device that works like thereal organs but look far from it!

Once cardiopulmonary bypass is established, the heart isparalysed and the lungs shut down. The surgeon then go aboutmending the hibernating heart.

To quote one of our surgeons, “these hearts get to rest,not ours!”

Perfusionist is an allied-health specialty intimatelyrelated to cardiac surgery.They work alongside thesurgeons, anesthetists andnurses. They are specially trained professionals who manage theheart lung machine and provide optimal life support for patientsundergoing heart surgery.

Cardiopulmonary bypass is a form of “insult” to theintegrity of the human body.”

It elicits a host of adverse responses that put patient atfurther risks. However, it is a necessary evil, from which, mostpatients benefit, coming out of it with a renewed lease of life. Itenables them to get back on with things they would otherwise betoo incapacitated to perform.

Today, some heart surgery procedures can be done withoutthe need of the heart lung machine, known as beating heart surgery.Robotics is another exciting advancement that has entered therealm of heart surgery.

Goh Si Guim, CTVS @ NUH


Chicago ACC SuccessDr Eric Chong, Cardiac Dept @ NUH

American College of CardiologyAnnual Scientific Meeting was held atChicago this year. We had anoutstanding 8 abstract presentationsduring the meeting. Dr Poh KK fromour department was an invited facultyspeaker in the echo seminar (E3:Essential Echocardiology with Experts)and A/Prof Tan HC was the onlyinvited Singaporean faculty member atthe ACC/SCAI (Society of Cardiovascular Angiography &Intervention) i2 Interventional Cardiology Summit meeting. It wassnowing and freezing in Chicago at the beginning of the meeting.But the huge attending crowds warmed up the entire conferencehall. Every room was crowded with attendees from all over theworld and it was hard to find oneself a standing place during themore popular talks. Many world renowned speakers frominstitutions like the Cleveland and Mayo clinic gave impressivelectures. Dr Poh KK spoke on imaging of right heart masses which

was well received by the packedinternational audience. In addition, DrAbdul Razakrj bin Omar wasconferred the ACC Fellowship at themeeting. A/Prof Tan HC arranged awonderful dinner meeting at arestaurant called the “Hugo Frogs”.This restaurant was so named becauseof its famous fried frog leg dishes.However, I think our Singapore styled

frog dishes taste even better. It was a great pleasure to meet upwith all the overseas NUH doctors in training during the dinner.Mark, Raymond, Chao Yang and Caroline gave speeches about theirtraining in the States and shared their wonderful experiences. Itwas great to learn that NUH has provided us with a solid foundationin cardiology before the HMDP overseas stint. This was our firstever alumni gathering overseas. We hope that everyone will meetagain in the next year’s ACC. It’s a truly memorable experience.

Chicago ACC Success

giving the sick heart a break...

PERCUTANEOUS THERAPY FOR A RARE PROBLEM

Coarctation StentingCoarctation StentingCoarctation of the aorta is a rare congenital defect which occurs in40 out of 100,000 live births. It occurs when tissue from around theductus arteriosus forms a shelf or sling around the proximaldescending aorta. Patients with this problem can present withpremature cardiac failure or premature hypertension. In the past,surgery was the only option for this condition, in which the ductaltissue was excised, and end to end anastomosis performed. In youngchildren, where this was not possible, a subclavian flap procedurewas done using arterial tissue from the left subclavian artery. Thisprocedure sometimes caused the left upper limb to be smaller ingrowth size than the right. Occasionally, even after surgical correctionhas been performed, re-coarctation can occur. Patients withcoarctation of the aorta need to be followed up long term as 30% ofthese patients can go on to have premature hypertension and coronaryartery disease, even in the absence of a stenosed segment. Thiscondition is often associated with a bicuspid aortic valve in 50-70%of cases which can cause aortic stenosis or regurgitation.

Dr James Yip, Cardiac Dept @ NUH

On the 31st of October 2007, NUH performed its firstcoarctation stenting in a 21 year old man with restenosis of asubclavian flap procedure. This is believed to be the first procedureperformed in Singapore, led by A/Prof Quek Swee Chye and AdjProf William Yip. Two days later, on 2nd Nov 2007, the first patientwith native coarctation of the aorta was successfully performed ina 41 year old man, by Dr James Yip. Both patients had a repeat CTScan 3 months after the procedure which showed improvement ofthe coarctation and no complications such as aortic dissection orpseudoaneurysm formation.

This procedure is done under general anesthesia, as the paincan be intolerable when stenting is performed. This is akin to causinga controlled localized dissection at the coarctation segment.Percutaneous access is obtained through the right femoral artery anda large 12F long sheath inserted. The lesion is crossed with a wire, anda Palmaz stent, hand-crimped onto a balloon, is inserted across thecoarctation segment. The stent is deployed under fluoroscopic guidance

with hand inflations. This procedure is often done in stagesas sudden total correction of the coarctation segment canresult in aortic rupture. Often, the patient has to return in 6to 12 months’ time for a repeat catheterization with a viewfor repeat dilation of the stented segment. Both patients weredischarged just 2 days after the procedure and were able towalk home. Our patient with the stented native coarctationof the aorta is happy to have never undergone open surgeryand has since resumed his game of golf.

Atrial fibrillation (AF) is the most common sustained arrhythmia,reaching epidemic proportions in the aging population, and resultingin significant morbidity, mortality, and socioeconomic burden. In asubset of younger patients (<60 years of age), AF develops in theabsence of known risk factors (e.g., congestive heart failure, structuralheart disease), a condition classified as lone AF. Genetic polymorphismshave been reported to confer susceptibility to AF. Heritability of AF isfurther suggested by two population-based studies; the presence ofAF in first-degree relatives increases the risk of developing AF.

The overall aim of this project is to identify novel geneticdeterminants of AF in an Asian population. To avoid the effect ofconfounding factors, patients with lone AF who lack traditional riskfactors will be enrolled. Using this cohort, the aims are to:

Dr Chen Lin Yee, Cardiac Dept @ NUS, NUH

“Identification of Novel Genetic Determinantsof Atrial Fibrillation in an Asian Population”is a continuation of my research focus thatstarted when I was undergoing cardiology andcardiac electrophysiology training at the MayoClinic College of Medicine, Rochester, MN.With start-up funds from the Yong Loo Lin

School of Medicine, and the support of the Cardiac Department,NUH, and Department of Medicine, NUS, I started to lay thegroundwork for this project in August 2006. The process was madesignificantly easier through the guidance and mentorship of ProfChia Kee Seng, Center for Molecular Epidemiology, and Assoc ProfLing Lieng Hsi, Cardiac Department, NUH.

NMRC Winning GrantNMRC Winning Grant


Top left Cardiac MRI of a 21 year old patient with re-coarctation of previous subclavian flap procedureTop middle & right CT Aortogram of a 41 year old patient with native coarctation of the aorta,

before and after stent implantation.


1. Identify disease susceptibility polymorphisms for AF usingcandidate gene association analysis

2. Define interaction of genetic factors with acquired factors inmodifying AF risk and phenotypic expression

3. Pave the way toward establishing a larger cohort to facilitategenome-wide association analysis in the future

With preliminary data derived from this cohort of lone AFpatients, I successfully obtained a National Medical Research Councilgrant that will support this research effort for the next three years.Presently, approximately 100 lone AF patients have been enrolled;I anticipate the enrollment process will be accelerated throughcollaboration of colleagues in National Heart Center and Tan TockSeng Hospital. In addition, mutation scanning of candidate genessuch as potassium and sodium channel genes is underway.

This project would not have been possible if it was notfor the support of the following: Chief, Cardiac Department,NUH, Assoc Prof Tan Huay Cheem; Head, Department ofMedicine, NUS, Prof Ho Khek Yu; my mentors, Prof Chia andAssoc Prof Ling; colleagues in the Cardiac Department, NUH;research nurses, Ms. Quay Chwee Neo and Ms. Loh Fong Chee;collaborators in National Heart Center and Tan Tock SengHospital; the Yong Loo Lin School of Medicine and the NationalMedical Research Council. Ultimately, the success of this projectwill not only advance our understanding of a significantcardiovascular disease, but also underscore the feasibility andimportance of multi-center collaboration in Singapore.

CIT Beijing 2008 (ChinaInterventional Therapeutics,Beijing) is an annual majormeeting for interventionalcardiologists. It was held this yearfrom 19 to 23 March at the BeijingInterventional Convention Center.We were privileged to be given anopportunity for live-transmissionto showcase our interventional techniques.

The live-transmission was held on the morning of the 2ndday (20th March). We had 2 teams on hand: Prof Tan Huay Cheemand Dr Lim Ing Haan; Dr Adrian Low and Prof Ronald Lee. As wastraditional, there was an introductory segment to Singapore; fusinga blend of Singapore skyline, cultural activities, and images of ouresteemed interventionists, to a pulsating soundtrack. The montagewas expertly executed, earning praises even from professional media.

Prof Tan started the live-transmission with a case of “in-stent restenosis”. This patient had had previous stenting to the heartartery but returned because of re-narrowing of the same segment.This was addressed with a novel drug-eluting balloon. This balloonis coated with a medication that inhibits recurrent renarrowing ofthe heart artery and has been shown in a recent published study tobe effective at least in patients with narrowing of the leg arteries.The blockage was expertly cleared and treated with this new devicewith good results. In contrast to the usual placement of another

CIT Beijing meetingmedicated stent, this approach does awaywith deploying an additional metal coatwhich may have deleterious consequences.

The second case was anintervention of a saphenous vein graft.Traditionally, this is addressed using a distalprotection device, either a filter wire orballoon occlusion device, to catch theanticipated downstream flow of clots and

other debritus. We however demonstrated the safety and efficacy ofa new proximal protection device. This was a special catheter withan inflatable balloon at its tip that can be inflated to seal off thesaphenous vein graft, thereby preventing flushing of debrisdownstream. An advantage of this is the virtual protection from allembolism, even with initial passage of our guide wire across theblockage. This case was similarly well received. In addition, it was thefirst time that a live-transmission of such as device was demonstratedregionally. The audience’s curiosity was obviously piqued.

As usual, there was the usual banter by the chairpersonand other prominent interventional cardiologists. Our doctorsjoined in the spirited exchange and responded well to the varietyof questions fielded. The teams enjoyed themselves doing difficultcases under the glare of the media, and the live-transmission wasall too soon over. As the day came to a close, Prof Tan made hissojourn to Beijing, representing our interventional cardiology teamand of course NUH.

Dr Adrian Low, Cardiac Dept @ NUH

CIT Beijing meeting

happeningshappenings

PCI SIMULATOR COURSE24 MAY 2008

ACC 2008 PRESENTATIONS31 MARCH 2008

3D-TRANSESOPHAGEAL

ECHOCARDIOGRAM

WORKSHOP –ORGANISED BY

PROF TI LIAN KAH

AND DR SOPHIA

ANG12 MARCH 2008

CARDIAC DEPT MO FAREWELL DINNER

28 APRIL 2008

SINGAPORE CARDIAC

SOCIETY 20TH ANNUAL

SCIENTIFIC MEETING

22 MARCH 2008


CCU PARTY14 JANUARY 2008

“WHY THIS HEART SPECIALIST GETTINGBUSY?” NEWSPAPER ARTICLE ON DR ABDULRAZAKJR OMAR1 JUNE 2008

OVERSEAS FELLOW (ECHOCARDIOGRAPHY)FAREWELL DINNER29 JANUARY 2008

OVERSEAS FELLOW (INTERVENTIONAL

CARDIOLOGY) FAREWELL DINNER

19 NOVEMBER 2007


GP SYMPOSIUMBY DR JAMES YIPAND DR ABDULRAZAKJR OMAR12 APRIL 2008

THI PULSE | 18THI PULSE | 18THI PULSE | 18THI PULSE | 18

9. Relation of ventricular-arterial coupling to exercisecapacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study. Wong R, Dumont C, Austin B,Kwon D, Flamm S, Thomas J, Starling R, Desai M.

10. Ventricular-vascular stiffening is more strongly associatedwith Exercise Capacity compared to left ventricularoutflow tract gradient in Hypertrophic Cardiomyopathy.Austin B, Kwon D, Dumont C, Wong R, Thamilarasan M,Flamm S, Lever H, Desai M.

11. Greater degree of LV septal hypertrophy and associatedcoronary arteriole dysplasia are significantly associatedwith myocardial fibrosis in hypertrophic cardiomyopathy.Kwon D, Rodriguez E, Wong R, Tan C, Thamilarasan M,Smedira N, Lytle B, Lever H, Desai M.

19TH ANNUAL SCIENTIFIC SESSIONS OF THE

AMERICAN SOCIETY OF ECHOCARDIOGRAPHY,TORONTO, CANADA, 7-11 JUNE 2008

1. Predictors of Pulmonary Artery Systolic Pressure inSignificant Mitral Regurgitation Secondary to Mitral ValveProlapse. Zhang J, Lee LC, Tan HC, Yip JWL, Poh KK

2. Progression and Predictors of Left Ventricular DilationSecondary to Significant Organic Mitral Regurgitation:Insights from Tissue Doppler Imaging. Zhang J, Lee LC,Tan HC, Yip JWL, Yeo TC, Poh KK

3. Reperfusion therapies reduce ischaemic mitralregurgitation following an inferoposterior ST elevationmyocardial infarction. Lee LC, Poh KK, Tee HW, Tan HC,Chia BL, Zhang J, Ong HY, Yeo TC

4. Late Diastolic Mitral Annular Velocity in Aortic Stenosis:Relation to Left Atrial Morphophysiology. Chan WX,Gong L, Poh KK, Daw HY, Ling LH

HEART RHYTHM 2008, SAN FRANCISCO,CALIFORNIA, USA, 14-17 MAY 20081. Utility of Electrocardiogram and Programmed Ventricular

Stimulation for Risk Stratification in Brugada Syndrome.Singh D, Chong E, Seow SC, Poh KK, Omar AR

abstractsAMERICAN COLLEGE OF CARDIOLOGY

SCIENTIFIC SESSIONS 2008 AND SCAI-ACCI2,CHICAGO, 29 MARCH–1APRIL 2008

1. The Impact of Gender on the Outcomes of Invasive versusConservative Treatment of Patients with Acute CoronarySyndrome. Lee LC, Leng P, Tang T, Tan YL, Tee HW, Shi L,Poh KK, Tan HC

2. Myocardial Doppler Imaging Can Detect SubclinicalCardiac Dysfunction After Anthracycline-BasedChemotherapy. Wong RC, Gong L, Chan WX, Daw HY,Goh BC, Lee SC, Lim SE, Soo R, Ling LH

3. Left Ventricular Performance and its DeterminantsImmediately Prior to and Post-Marathon Running:Insights from Two Dimensional Speckle TrackingEchocardiography and Serum Biomarkers. Poh KK,Tournoux FB, Picard MH, Wood MJ

4. One -Year Clinical Follow-Up of Endothelial ProgenitorCell Capture Stent versus Uncoated Stent in PatientsUndergoing Primary Percutaneous Coronary Interventionfor Acute Myocardial Infarction. Lee YP, Tay Edgar, MelissaCo, Yeo WT, Lee CH, Low A, Teo SG, Lim J, Lim IH, LimYT, Tan HC.

5. Risk Scoring System for Prediction of Contrast InducedNephropathy In Patients With Preexisting RenalImpairment Undergoing Percutaneous CoronaryIntervention. Chong E, Shen L, Poh KK, Tan HC

6. Comparison of Eighteen-Month Clinical Outcomes ofEndothelial Progenitor Cell Capture Stent versusSirolimus-Eluting Bioabsorbable Polymer-Coated Stentversus Bare Metal Stents In Patients Undergoing PrimaryPercutaneous Coronary Intervention for Acute MyocardialInfarction. Chong E, Lee CH, Shen L, Low A, Teo SG, PohKK, Tan HC

7. Risk and Clinical Predictors for Patients with UnstableAngina and Non-ST Segment Elevation MyocardialInfarction Post Early Percutaneous Coronary Intervention.Chong E, Shen L, Poh KK, Tan HC

8. Comparison of Risk Predictors for Contrast InducedNephropathy Post Percutaneous Coronary Interventionin Patients with Normal versus Impaired Baseline RenalFunction. Chong E, Shen L, Poh KK, Tan HC

abstractsAMERICAN COLLEGE OF CARDIOLOGY

SCIENTIFIC SESSIONS 2008 AND SCAI-ACCI2,CHICAGO, 29 MARCH–1APRIL 2008

19TH ANNUAL SCIENTIFIC SESSIONS OF THE

AMERICAN SOCIETY OF ECHOCARDIOGRAPHY,TORONTO, CANADA, 7-11 JUNE 2008

HEART RHYTHM 2008, SAN FRANCISCO,CALIFORNIA, USA, 14-17 MAY 2008

ESC HEART FAILURE CONGRESS 2008, MILAN,ITALY, 14-17 JUNE 20081. An Asian comparison of cardiologist versus non-

cardiologist care of heart failure. Ling LF, Shen L, Chai P

ESC HEART FAILURE CONGRESS 2008, MILAN,ITALY, 14-17 JUNE 2008

THI PULSE | 19THI PULSE | 19THI PULSE | 19THI PULSE | 19

10. International Journal of Cardiology; In Press. Fulminantdengue myocarditis masquerading as acute myocardialinfarction. Lee CH, Teo C, Low AF.

11. Annals of Academy of Medicine, Singapore 2008 May; 37(5):365-7. Risk Factor Profile and Treatment Patterns ofPatients wih Atherothrombosis in Singapore: Insight fromthe REACH Registry. Yeo TC, Chan YH, Low LP,Venketasubramanian N, Lim SC, Tay JC, Tan RS, Eng P,Lingamanaicker J.

12. European Journal Echocardiology 2008; In Press.Prognostic value of Left Atrial Size in Chronic KidneyDisease. Chan MY, Wong HB, Ong HY, Yeo TC.

BOOK CHAPTER

1. Post-operative Management of the Cardiac TransplantPatient. Immunosuppression and Drug Interaction.Fink J, Wong RC, Sipahi I, Taylor D.

1. European Heart Journal 2008; In Press. Assessing AorticValve Area in Aortic Stenosis by Continuity Equation – ANovel Approach using Real-time Three DimensionalEchocardiography. Poh KK, Levine RA, Solis J, Shen L,Flaherty M, Kang YJ, Guerrero JL, Hung J

2. Circulation 2008; In Press. A Phase 1b Randomized Studyof Antidote-Controlled Modulation of Factor IXa Activityin Patients with Stable Coronary Artery Disease. Mark Y.Chan, Mauricio G. Cohen, Christopher K. Dyke, et al.

3. Journal Thromb Haemost 2008 May; 6(5):789-96. Arandomized, repeat-dose, pharmacodynamic and safetystudy of an antidote-controlled factor IXa inhibitor. ChanMY, Rusconi CP, Alexander JH, Tonkens RM, HarringtonRA, Becker RC.

4. Journal Nucl Cardiol 2007 Jul; 14(4):617-20. Hybridcardiac imaging: complementary roles of CT angiographyand PET in a patient with a history of radiation therapy.Hong EC, Kimura-Hayama ET, Di Carli MF.

5. Circulation 2008 Apr 1;117(13):1693-700. Interrelationof coronary calcification, myocardial ischemia, andoutcomes in patients with intermediate likelihood ofcoronary artery disease: a combined positron emissiontomography/computed tomography study. Schenker MP,Dorbala S, Hong EC, et al.

6. European Journal Neurol 2008; In Press. Takotsubocardiomyopathy associated with status epilepticus. SeowSC, Lee YP, Teo SG, Hong EC, Lee CH.

7. Annals of Academy of Medicine, Singapore 2008 Mar;37(3):243-2. A Case of Myopericarditis in a Patient withMethicillin-resistant Staphylococcus aureus (MRSA)Community-acquired Pneumonia. Lee YP, Hoi WH,Wong RC.

8. Journal Heart Lung Transplant 2008. Tricuspidregurgitation after cardiac transplantation: an old problemrevisited. Wong RC, Abrahams Z, Hanna M, et al.

9. Echocardiography 2008; In Press. Echocardiographic LeftVentricular Mass in a Multi-ethnic Southeast AsianPopulation: Proposed New Gender and Age-SpecificNorms, Wong RC, Gupta A, Yip JWL, Yang H, Ling LH.

publicationspublications

BOOK CHAPTER

National University Hospital

Dr Benjamin Chua Soo Yeng – Associate Consultant,Vascular Surgery- CTVS

Dr Sujeeb Rajbhandari – Honorary Fellow, Cardiology

Dr Yeo Wee Tiong promoted to Registrar, Cardiology

new doctorsnew doctorson boardon board

National University Hospital

Dr Benjamin Chua Soo Yeng – Associate Consultant,Vascular Surgery- CTVS

Dr Sujeeb Rajbhandari – Honorary Fellow, Cardiology

Dr Yeo Wee Tiong promoted to Registrar, Cardiology

THE HEART INSTITUTE,NATIONAL HEALTHCARE GROUPSecretariat Officec/o Cardiac DepartmentNational University Hospital5 Lower Kent Ridge RoadLevel 3, Main BuildingSingapore 119074Tel 6772 5596Fax 6778 6057Website www.thi.nhg.com.sg

ALEXANDRA HOSPITAL378 Alexandra RoadSingapore 159964Tel 6472 2000Fax 6379 3880

Appointment Line 6476 8828Fax 6379 3880Specialist Outpatient Clinic 6379 3190

NATIONAL UNIVERSITY HOSPITAL5 Lower Kent Ridge RoadSingaore 119074Tel 6779 5555Fax 6779 5678

Cardiac Clinic HClinic Appointment 6772 5730Fax 6775 1617

Cardiac CentreClinic Appointment 6772 5277/6772 5278Fax 6772 5279

TAN TOCK SENG HOSPITAL11 Jalan Tan Tock SengSingapore 308433Tel 6526 6011Fax 6252 7282

Cardiology ClinicCentral Appointment 6357 7000Fax 6357 7011Private Appointment 6357 8000Fax 6357 7011Direct Line to Clinic 6357 8011Fax 6357 8680

directorydirectoryGEMS AWARDS MARCH 2008Go the extra miles, are Exemplary role models whoMade a difference and Spectacular contributionsDr Chai Ping, Consultant, CardiacDr Low Fatt Hoe Adrian, Consultant, CardiacDr Ooi Oon Cheong, Associate Consultant, CTVS

THORACIC SURGERY FOUNDATION FOR RESEARCH

AND EDUCATION SCHOLARSHIP

The Heller School Executive Leadership Program inHealth Policy and Management – An intesiveprogram in health policy and management for thesenior level health care providers.Brandeis University, Walktham, Massachusetts, USA, 2008Dr Ooi Oon Cheong, Associate Consultant, Cardiothoracic Surgery

NATIONAL RESEARCH FOUNDATION

Ministry of Health Healthcare Research Scholarship(Master of Clinical Investigation, MCI)Dr Ooi Oon Cheong

ELECTION AS MEMBER OF THE AMERICAN

ASSOCIATION FOR THORICAC SURGERY

Prof Lee Chuen Neng has been elected as Member ofthe American Association for Thoracic Surgery, beingone of the 12 cardiothoracic surgeons to be electedoutside of North America this year. Membership ofAATS is prestigious and Prof Lee is the only one fromSingapore so far. This took place during the recent88th Annual Meeting of the AATS in Washington DC,USA from May 10–14, 2008

awardsawards

RH Sum07 single pages

Documents

Transcript of RH Sum07 single pages