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The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s<br />

ADVANCES IN MANAGEMENT OF CONGENITAL CARDIAC DISEASES AND<br />

CHANGING OUTCOMES<br />

Zohair Al Halees, MD<br />

Congenital heart surgery is special. It is a pr<strong>of</strong>ession that combines art and science, skill and<br />

decisiveness. Though it is considered a young specialty, great advances have been made over<br />

the last 50 years. Almost all congenital cardiac defects are now manageable one way or another.<br />

Fetal diagnosis helped in better planning intervention.<br />

In the presentation, we go through the milestones <strong>of</strong> cardiac surgery and talk about the advances<br />

that have occurred over the years through the pioneering efforts <strong>of</strong> many innovative and visionary<br />

surgeons. Advances were also related to critical reviews <strong>of</strong> outcomes and adopting changes<br />

that prove beneficial. Pediatric Cardiology became a subspecialty <strong>of</strong> its own which helped in<br />

better defining management pathways <strong>of</strong> patients with congenital cardiac defects. Cardiac<br />

morphology improved the understanding <strong>of</strong> the structural changes associated with congenital<br />

cardiac defects and allowed both cardiologists and surgeons to better plan repairs and avoid<br />

complications. A good example <strong>of</strong> this is the delineation <strong>of</strong> the conduction system within the<br />

heart and avoidance <strong>of</strong> heart block postoperatively. Improved technology particularly imaging<br />

technology [echocardiography, CT scanning, MRI] together with advances in anesthesia, critical<br />

care, and surgical techniques all made an impact in improving outcomes <strong>of</strong> these patients.<br />

This also led towards operating on patient at an earlier age with a strong trend towards early<br />

corrective surgery. Palliation became less and mostly have become a part <strong>of</strong> planned strategy<br />

towards full repair.<br />

HEART FAILURE UNIT: IS IT ESSENTIAL TO ESTABLISH?<br />

Hadi Skouri MD<br />

Heart failure is a leading cause <strong>of</strong> hospitalization and death and its prevalence continues to<br />

increase. <strong>The</strong> clinical care <strong>of</strong> patients with HF encompasses a continuum from acute settings to<br />

chronic management. Chronic management in the outpatient setting provides an opportunity to<br />

improve patient care and health outcomes through early identification <strong>of</strong> symptom progression,<br />

utilization <strong>of</strong> evidence-based medication, quality-<strong>of</strong>-life evaluation, and patient education to<br />

increase adherence. HF is a leading cause <strong>of</strong> ambulatory visits and outpatient care accounts<br />

for a significant proportion <strong>of</strong> total heart failure expenditures. Observational studies have shown<br />

improved outcome if patients are being treated and followed up by specially trained providers.<br />

So “HF clinic” has become a vital element in comprehensive care <strong>of</strong> the patients with HF. It<br />

reached the level <strong>of</strong> national and international HF Guidelines.<br />

BEDSIDE ASSESSMENT AND MANAGEMENT IN ACUTE HEART FAILURE<br />

SYNDROME<br />

Hadi Skouri MD<br />

Acute Heart Failure Syndrome (AHFS) includes patient with reduced and preserved LV function.<br />

In acute settings they have similar clinical presentation. Immediate therapy to optimize<br />

hemodynamics and improve symptoms is similar or overlapping. <strong>The</strong>re are some clinical and<br />

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