January - June - nuhcs

MICA (P) 110/12/2008 Issue No. 13 • January – June 2009
New Chief of Cardiac Department
A/Prof Yeo Tiong Cheng
– read more on page 3

in this issue
02 A/Prof Tan’s awards in China
03 PULSE Interview: New Head of
Cardiac Department, NUHCS
A/Prof Yeo Tiong Cheng
04 Palliative Care in Heart Failure
05 Singapore Cardiac Society ASM
Young Investigator Award (YIA)
Being an International Medical
Student in Cardiac Department,
NUHCS
06 The New President of ASCVTS:
Congratulations to Professor
Lee Chuen Neng
proof of Concept – A Novel
Heart Valve Implantation
Mechanism: Pioneering Heart
Valve Surgery
A/Prof Tan’s
awards in China
– Visiting
Professorship and
CIT Award
08 NUHCS – 2P event
09 America College of Cardiology
ASM – Orlando experience
10 HMDP Trip to Melbourne
– Cardiac Rehabilitation
11 4th Introductory Course in
Interventional Cardiology
12 HMDP Fellowship
13 My UK Experience
14 5th Asian Interventional
Cardiovascular Therapeutics
Shanghai, China
15 Cardiac & Cardiothoracic-
Vascular Nursing Programme
16 Happenings
18 Abstracts & Publications
20 Directory & New Doctors on
Board
Editor
A/Prof Poh Kian Keong
Advisor
A/Prof Tan Huay Cheem
Contents are not to be reproduced
without the permission of NUHCS
Assoc Professor Tan Huay
Cheem, Director of NUHCS,
was conferred the China
Intervention Therapeutics
(CIT) Contribution Award
2009 at the recently held
CIT meeting in Beijing. CIT
is the largest endovascular
intervention meeting held annually in China with the participation
of more than 3000 international and local faculties and attendees.
The award is in recognition of Associate Professor Tan’s ‘outstanding
contribution and continuing dedication to the development of
interventional cardiology in China’, as was described. Assoc Prof
Tan has been working in China for the last 10 years during which
he has trained many Chinese interventional cardiologists in many
provinces, participated in live demonstration of percutaneous
coronary intervention in various physician exchange programmes,
delivered multiple lectures with his fluent command of Mandarin,
and collaborated in multicentre clinical trials.
Assoc Prof Tan was also awarded a Visiting Professorship
from Henan University affiliated HuaiHe Hospital in KaiFeng,
Henan, China, in April 2009. This is the third Chinese Visiting
Professorship title for Assoc Prof Tan who has previously also been
conferred a Visiting Professor with Beijing University and Shanghai
JiaoTong University.
THI PULSE |

PULSE Interview
– new Head of
Cardiac Department,
NUHCS
A/Prof Yeo Tiong Cheng
How do you feel about this new appointment ?
I am deeply honored to be given this opportunity to head this
great department. At the same time, I am apprehensive as the
responsibility that comes with this appointment is immense.
My predecessors are “big names” in the cardiology world and this
appointment is like a “ pair of oversized shoes”. As you know, my
feet are pretty small.
What is your vision for the department in the next five
years?
Since its formation in 1989, the department has grown both in
physical size and stature. The next 5 years will be very challenging
times especially with the recent formation of the National University
Health System (NUHS) and the National University Heart Centre,
Singapore (NUHCS). I would like the department to be recognized
for its excellent clinical service, comprehensive and structured
teaching programmes for both undergraduate and postgraduate
doctors and paraclinical staff, and equally excellent research output.
It will be the institution of choice for patients with complex cardiac
problems, a place where young doctors and nurses will choose to
be trained in, and a department where research culture is pervasive.
Lastly, I hope that it will be a cohesive department where the staff
are like members of a big family.
What are some changes that you intend to bring to the
department?
The department has expanded at a great pace in terms of the range
of services provided. I think it is time to consolidate our strengths,
reevaluate our next goals and then move on. The most important
asset to a department is its staff and I am privileged to have a group
of bright, conscientious and hardworking people to work with. Staff
development (both in terms of personal career development and
training) and staff welfare is of utmost importance. In order to
meet the challenges ahead, we will continue to increase our talent
pool at all levels. In terms of clinical services, the department
will continue to grow the 4 core clinical programmes of NUHCS.
As the department grows in size and range of services increases, coordination
of services become very important and I would like the
department to be able to provide integrated and well co-ordinated
service to our patients and partners. To be a true academic medical
centre, our clinical services must be supported by a strong research
base of basic scientists and clinical researchers. To this end, I hope to
see advancement in our basic science and translational research.
How different do you think your leadership style will
differ from your predecessors?
I have always believed in a consultative leadership style and to lead
by example. Any input from my colleagues is important and I will
listen to them. I also do not subscribe to micromanagement. You
have to trust the people you work with.
THI PULSE |

palliative care
Dr Angeline Seah
in heart failure
An increase in the number of patients with risk factors
for atherosclerosis, the ageing population, and improvements in
technology to save patients from myocardial infarction has lead to
a steady increase in patients who develop heart failure in the latter
half of their disease trajectory.
With improving medical knowledge, many patients with
heart failure can be treated and even stabilised, but a proportion of
patients will progress to end stage heart failure in spite of optimal
treatment. Comprehensive holistic patient care requires that the
care continuum extends to this final chapter, acknowledging that
death and dying is an integral part of life.
... caring for and counselling
these patients and their families
has been tremendously fulfilling
for this team in the Advance Care
Program, with reciprocal feelings
from families.
Patients with end stage heart failure suffer from a significant
symptom burden of breathlessness, confusion, fatigue, pain and
depression, with a need to contend with prognostic uncertainty
including sudden cardiac death. Families and loved ones are often
anxious and in need of information and support. A palliative
approach combined with active care where possible has much to
contribute to alleviate their suffering, and support the cardiologists’
honest sensitive communication to enable patients and their loved
ones to plan realistically for their future.
Since 2008, a dedicated team of doctors, nurses and
counsellors set up by NHG has been supporting patients with
end stage heart failure, both in medical aspects such as managing
symptoms, preventing exacerbations, and avoiding other
complications, as well as in psychosocial aspects. Many symptoms
can be controlled or reduced with judicious pharmacological
treatment or non-pharmacological interventions. A counsellor
The team in the Advance Cardiac Care Programme
conducts a life review with the patient to help him in this last phase
of psychological development, attain a sense of life completion, and
help the family and patient make sense of his life and its meaning
to them. Patients are then often ready to talk about their end of life
hopes and plans, which guides medical therapy decisions and frees
the family from the burden of having to make decisions for their
loved ones at a moment when they may be distraught and grieving.
Grief and yearning after death is often made more bearable by
the knowledge that everything had been done for their loved one,
that his wishes had been fulfilled, by open communication and the
saying of ‘goodbyes’.
End-of-life issues though still a ‘taboo’ subject in our local
culture, with many medical personnel shying of approaching the
topic until the inevitable comes, caring for and counselling these
patients and their families has been tremendously fulfilling for this
team in the Advance Care Program, with reciprocal feelings from
families. To date, much appreciation has been received in the form
of donations, cards and emails.
As the palliative care team journeys and learns with the
cardiology team in holistic approach and comprehensive care for
these patients, it is hoped that much will be gleaned to inform
future practice improving the care for patients suffering from
heart failure.
THI PULSE |

Singapore Cardiac Society ASM
Young Investigator Award (Y IA)
Dr Ye Lei
Heart failure is an enormous medical and social burden.
It is estimated that 7.6 million died from heart attack every year
world-wide, resulting in 30 to 40% of mortality from heart
failure within 1 year of diagnosis. In Singapore, more than 18% of
total death was due to ischemic heart disease (MOH). Recently,
therapeutic angiogenesis for neovascularization of ischemic
myocardium is being researched. As myocardial ischemia is a
recurring and often progressive condition, we designed a hypoxia
regulated vascular endothelial growth factor-165 gene (HRE-VEGF)
delivery system that is probably better and more appropriate
strategy compared to conventional delivery systems. This system
can respond to hypoxic signals to switch on trans-angiogenic gene
and amplify their expression to induce neovascularization and
ameliorate ischemic condition. The study is funded by BMRC and
Dr Eugene Sim is the PI.
We used nanoparticle to transfect skeletal myoblast (SKM)
with HRE-VEGF gene for therapeutic angiomyogenesis. It was
found that HRE-VEGF transfected SKM not only restored the
contractility of the ischemically weakened heart but also controlled
the expression of VEGF in ischemic myocardium. The study was
awarded Young Investigator Award (First prize, Basic research) at
The 21st Annual Meeting of Singapore Cardiac Society (March
21st - 22nd 2009) and Best Paper Award at Chinese University of
Hong Kong-Mayo Clinic-Asia Cardiovascular Summit, Hong Kong
(Feb 18th -19th 2009).
being an international medical student
in Cardiac Department, NUHCS
Laura Beck
In my first weeks as a German medical student doing
Cardiology in Singapore, I nearly got lost in a variety of
English accents and medical abbreviations. Besides the local medical
students, there were students from all over the world including
Australia, Taiwan, India, Indonesia, Canada and Sweden as well as
more German students arriving a few weeks after me.
Doing the ward rounds in the general wards or CCU or
walking around the hospital for kilometers with the overflow team
gave us an impression of the diversity of Singaporean patients and
particularities in the treatment of their conditions, including the
management of language, cultural and social problems. Further
insights were obtained from different outpatient clinics such as
those managing new cases, follow-up appointments, patients
with arrhythmias or congenital heart diseases, pacemakers and
much more. We were able to observe the performance of various
procedures like echocardiography, treadmill or nuclear scan, the
diagnostic and therapeutical procedures in the cath lab including
Laura Beck (Rightmost)
angiograms, ballooning, stenting and electrophysiology studies as
well as the management of emergency cases. These were all part
of the working day of a cardiologist. Our theoretical knowledge
was improved by daily CMEs and a lot of questions and answers.
I managed to do some research with Assoc Professor Poh Kian
Keong, my mentor and attended the Singapore Cardiac Society’s
Annual Scientific Meeting which A/Prof Poh is the organizing
chairman. Time passed by very quickly and I flew back to Germany
with a lot of new impressions and reminders of the friendly
team and atmosphere in the whole department. Thanks a lot for
everything!
THI PULSE |

the new President of ASCVTS
Congratulations!
Professor Lee Chuen Neng
Founded in 1993, the Asian Society for Cardiovascular
& Thoracic Surgery (ASCVTS) aims to promote the study
of the art, science and practice of cardiovascular and thoracic
surgery. It also seeks to facilitate the exchange of ideas in the field
of cardiovascular and thoracic surgery through scientific meetings
and by personal contact between cardiovascular and thoracic
specialists.
ASCVTS is the only Asian representative on the CTS Net
(together with the American Association of Thoracic Surgery,
the Society of Thoracic Surgeons and the European Association of
Cardio-Thoracic Surgery). Their official journal – Asian Thoracic
& Cardiothoracic Annals (of whom Professor Lee is a founding
member of the Editorial board) is also the one representing Asia
(together with the Journal of Thoracic and Cardiovascular Surgery,
the Annals of Thoracic Surgery and the European Journal of Cardio-
Thoracic Surgery).
During the recent congress and executive council meeting
held in Taiwan on 04 March 2009, Professor CN Lee was elected
as President of the Asian Society for Cardiovascular & Thoracic
Surgery (ASCVTS) for a term of 2 years (renewable). Prof Lee is
the first non-Japanese to be elected President for the ASCVTS.
Prof Lee is one of the founding executive council members
of ASCVTS. He is also an active member of the ASCVTS holding
the following positions:
(i) President of Congress:
(a) 7th Annual Congress of the ASCVS in 1999 held in
Singapore
(b) 16th Annual Congress of the ASCVS in 2007 held in
Singapore
(ii)
(iii)
Executive Council Member: 1993 to present
Committee Member:
(a) Database Committee, 1999 onwards
(b) Publication Committee, 2003 onwards
The annual congresses held in various Asian countries (from Tokyo
to Istanbul) serve as a platform for cardiovascular specialists from
different parts of the world to share their ideas and experience on
various aspects of cardiovascular sciences and practices. It has since
been considered the gold standard meeting for cardiac, thoracic
& vascular surgeons in Asia. Membership of ASCVTS has reached
1,000 and is growing rapidly across Asia’s cardiothoracic surgical
groups and regions.
Over the past 10 years, ASCVTS had developed an Asian
database and risk models for coronary and aortic surgery and would
be launching this across Asia.
THI PULSE |

proof of concept –
a novel heart valve implantation mechanism
pioneering
heart valve surgery
Assist Prof Theodoros Kofidis
Translational research should be patient centered and
immediately applicable. It should be based upon concepts that
can be taken from bedside to bench, and then back to bedside. It
should be guided by impact on patient lives.
At NUHS Department of CTVS we have designed a new
implantation mechanism for heart valves. The National Research
Foundations agreed to fund the Proof of Concept phase, towards
development of the prototype.
Whenever a human mitral valve is destroyed by disease,
mitral valve replacement may be needed. It involves removal of the
natural valve and the placement of a large number of deep stitches
into the mitral annulus. Thereby, important structures, such as
the conduction system or coronary vessels may be injured. The
procedure usually lasts 3 hours.
Our approach involves an implantable mitral ring which
constitutes the housing for the valve. The valve itself can then
simply be twisted into position, much like a bayonet or light bulb.
The bayonet housing will be made of metal parts (carbontitanium),
or it can consist of synthetic rigid or
flexible materials. The implantation procedure
will be significantly shorter (< 30 minutes) and
less risky. In this first phase we will be implanting
the prototype into pigs, and compare it to the
regular prostheses in the market.
Mitral valve disorders have a high incidence
in South East Asia, mostly due to rheumatic
disease, resulting in regurgitation or
stenosis. In the advanced state
the valve must be replaced. The
operation requires stopping the
heart for more than an hour.
Lengthy and surgically traumatic
operations in heart surgery
means higher risk, costs and
longer recovery times for the
patient. These may be reduced if
there is an implantation method
and device available which would (i) shorten the time needed to
stop the heart, (ii) require no stitches to the natural mitral valve
ring and (iii) allow easy replaceability if the patient ever requires
re-do surgery. Our new implantation device is expected to reduce
heart arrest time to 20 minutes and total operation time to a bit
more than an hour. We expect to be able to operate more than 200
patients every year from Singapore, 1,000 from South-East Asia and
around 10,000 worldwide.
Press Coverage
• Channelnews Asia, 18th Dec 2008
• Radio 93.8, 18th Dec 2008
• The Straits Times, 19th Dec 2008
• Business Times, 19th Dec 2008
• TODAY, 19th Dec 2008
• Lianhe Zaobao, 19th Dec 2008
Daily business: mitral valve replacement using sutures: soon… “forgotten Art”?
THI PULSE |

NUHCS
2P event
Mr Michael Leow
During the week of 18th to 22nd May 2009, a Process
Preparation (2P) event was held as part of the planning
process for the expansion and set-up of the National
University Heart Centre, Singapore (NUHCS) at the current
Dental Block, levels 1 and 3 in the Main Building, NUH. Renovation
works are targeted to begin in January 2010, while the entire project
is expected to be completed by May 2011.
The 2P event for NUHCS aims to plan and design the new
NUHCS layout around lean concepts. It was a collective effort and
decision making process involving all stakeholders to derive the
best layout ensuring appropriate clinic set-ups and facilities so as
to derive optimal staff and patient flow.
Facilitated by the NUHS Way team, this event was led by
Mr Michael Leow (Head, Operations and Administration, NUHCS).
With the support of Adj A/Prof Tan Huay Cheem (Director,
NUHCS and Head, Cardiac Department), Clin A/Prof Yeo Tiong
Cheng (Deputy Head and Senior Consultant, Cardiac Department),
Adj Prof Michael Caleb (Clinical Director and Senior Consultant,
Department of Cardiac, Thoracic and Vascular Surgery), and
A/Prof Peter Robless (Senior Consultant, Department of Cardiac,
Thoracic and Vascular Surgery), a combined team of clinicians,
administrators, nurses and allied health staff were brought
together. Our colleagues from Pharmacy, Rehabilitation Medicine,
Infection Control, Laboratory Medicine, Environmental Services
and Corporate Planning & Development also participated at
appropriate junctures.
The event began with an opening message by our CEO,
Mr Joe Sim. He thanked the team for participating in this event
which not only would serve to provide better care for our patients
but would also improve our work experience in NUH. Following
that, Ms Heidi Rafman (Assistant Director, NUHS Way) shared
with us the key principle of ‘Lean’ - providing the best healthcare
services with the least waste.
Thereafter, the real work began! The team started by
identifying the requirements of various rooms and facilities based
on the projected volume using the Takt Time calculations. We
studied process points, distance travelled and other factors affecting
patients and staff. In order to compare if the existing requirements
were met, patient-service takt time and resource utilizations were
also computed.
Some questions that we posed to ourselves included ‘How
could we reduce waiting time?’ and ‘How could we improve from
our existing layout to better facilitate the flow for patients in the
new set-up?’ Value Stream Mapping of the current process flows
helped us to identify the gaps in our existing processes from the
THI PULSE |

America College
of Cardiology ASM
Orlando
Dr Yeo Wee Tiong
experience
patients’ perspective. This enabled us to brainstorm improvement
initiatives for future process flows of the new NUHCS.
The most challenging part of the event was the designing
of not 1 or 2, but 5 different layouts for the new NUHCS.
There were many views, likes and preferences. As such, it was
a tedious process for all of us. However, everything went well as
we focused on our main goal of enhancing patient experience at
the new NUHCS. Subsequently, a ‘beauty’ contest based on predetermined
criteria such as patient flows, patient safety and staff
motion was carried out. The various designs for each criterion
were scored and the best overall layout was selected. We did not
stop there. We continued to improve upon the winning layout
by incorporating the best qualities from the other layouts to
obtain the hybrid “best of the best” design! In addition, physical
simulation of the proposed consultation room was also carried
out to ensure that the space requirements were feasible.
All in all, the event was an excellent opportunity for
everyone to come together as a team to learn and to apply
the 2P methodology which helped us in the development of a
preliminary framework for the set-up of the new NUHCS.
Lastly, kudos to the entire team for all their hard work
during this event!
The 2P event for NUHCS aims
to plan and design the new
NUHCS layout around lean
concepts...
This year’s American College of Cardiology Annual
Scientific Meeting was held at the Orange County Convention
Centre in Orlando, Florida. This was held in conjuction with the
Innovation in Intervention (i2) Summit. The meetings were held
over 4 days from 28th to 31st March 2009.
I had the privilege of attending this conference to present
a poster on “Long term effectiveness of drug eluting stents in the
treatment of in-stent restenosis” at the i2 Summit.
A/Prof Tan Huay Cheem was honoured to be the only
invited faculty from Singapore to speak at one of the plenary
sessions at the i2 summit. He lectured on balancing the risk between
perioperative bleeds and stent thrombosis from antiplatelet therapy
cessation in patients with drug eluting stents undergoing non cardiac
surgery. His session was well received.
The first thing that stuck me was the scale and intensity of
this meeting. Being my first conference, I was impressed by the
passion of the organizers and attendees for cardiology. I have never
thought that breakfast symposia starting from 5:30 in the morning
would attract anyone but it sure did! It truly gives new meaning to
what it is like to eat, drink and live cardiology.
This meeting was fruitful not only advancing my
understanding for cardiology. It was a great time to catch up with
friends and colleagues who are working in the United States.
A/Prof Tan organised a dinner at the Fulton Crab House where
we met up with Dr Carolyn Lam and Chen Lin Yee. The food
and company was great! I look forward to attending next year’s
conference to be held in Atlanta.
THI PULSE |

HMDP Trip to Melbourne
Cardiac
Rehabilitation
Dr Raymond Wong
Melbourne, the second city of Land Down Under,
welcomed us on a cool Sunday morning with promises of fun,
excitement, and enlightenment. In Heart Research Center (HRC)
based in the Royal Melbourne Hospital, we came to seek knowledge
in abundance and friendship in sincerity. We were rewarded lavishly
in both respects.
The Cardiac Rehabilitation (CR) contingent of four (Shuet
Ming, Suzanna, YiJun and I) had specific individual aims in mind in
embarking on this group-based training trip. Collectively though,
we intend to enhance our respective roles and performance within
the domain of our CR program, and to perfect our coordination and
cooperation in presenting a holistic lifestyle modification program
for the patients’ benefit. We can then assume the role of leaders for
Singapore at large in this subspecialty.
The 5-Day Training Course began with an ice-breaking
session by the Director of HRC, Dr Marion Worcester. She exuded
grace and authority, and instilled much confidence among the
participants of what the next few days might bring. To out initial
surprise, a third of the participants were engaged in setting up/
running of rural CR program, comprising in part of the Aboriginals
subjects. Some programs had to grapple with issues relating to
multi-ethnic environment where different cultures, mentalities and
diets presented unique problems individually. During the next five
days, starting with Dr Alan Goble who is a doyen in CR medicine,
the experienced team of lecturers covered wide ranging topics in
cardiovascular system, medications, exercise physiology, program
set-up, organization and evaluation, heart failure rehabilitation,
diabetes, psychology, nutrition, smoking cessation, and behavior
modification and motivation. We found these topics to be exquisitely
relevant to our day-to-day running of CR program; in the queerest
and uncanny fashion we learnt more about each other’s job than we
ever did at home. Streams of ideas flowed while each of us grew
in confidence as to how we could improve our own CR program.
We embraced the notion of auditing our performance measures
as well as conducting research on local mix of CR population. To
complete the training experience, the three roses of the team made
field trips to Austin and Caulfield Hospitals to personally encounter
the conduct of CR program in Melbourne.
Any stay in Melbourne is incomplete without shopping
downtown, tram rides, and dining at Lygon Street. We were
grateful for the support of Cardiac Department in landing this
group-based HMDP, and deeply touched by the hospitality of one
Dr M Worcester. We are now ever more determined to push our
CR program to greater heights for the benefit our patients with
cardiovascular conditions.
THI PULSE | 10

4th Introductory Course in
Interventional Cardiology
Dr Joshua Loh
Trainers, delegates and sponsors in the 4th Introductory Course in Interventional Cardiology
A/Prof Tan Huay Cheem in a welcome address
to the delegates
Dr Teo Swee Guan guiding the delegates during a hands-on
session in the NUHCS Cath Lab using the CoroSim Pulsatile
Simulation.
A/Prof Ronald Lee explaining coronary intervention techniques
using the CATHI Simulator
The National University Heart Centre, Singapore
(NUHCS) builds on its previous success by organising its 4th
Introductory Course in Interventional Cardiology from 18-19th
April 2009. Started in the Year 2006, we are the only South East
Asian centre to conduct this on a regular basis.
The course is run entirely by Interventional Cardiologists
from NUHCS and Alexandra Hospital. Overseas delegates from
Vietnam, Myanmar, Indonesia, Philippines, Sri Lanka and China
as well as Cardiology trainees from Singapore spent 2 full days
learning the basics of coronary intervention, with hands-on training
on vascular models and virtual reality simulators.
Dr Adrian Low gave an insightful lecture on how to obtain
optimal angiographic pictures, and Dr Teo Swee Guan explained
on how to gain vascular access and provide good vascular care.
A/Prof Ronald Lee brought the delegates through appropriate
selection of guiding catheters for coronary intervention.
A/Prof Tan Huay Cheem gave an instructive session on selection
of guide wires, balloons and stents. In addition, A/Prof Tan held
2 fascinating interactive sessions on coronary anomalies and
management of complications in the Cath Lab, which had the
audience enthralled.
The delegates had the opportunity of hands-on sessions
in small groups. We were taught coronary quantification and
strategies to reduce radiation dose exposure. The Terumo Simulator
enabled delegates to have a feel of doing trans-radial intervention.
The CATHI Simulation allowed delegates to apply the usage of
different angiographic views, catheter, guide wire, balloon and
stent selection. The CoroSim Pulsatile Simulation was held in
the NUHCS Cath Lab. In addition to practical application of
coronary intervention techniques, this simulation provided the
delegates a feel of the atmosphere and setup in a fully equipped
angiographic facility.
The feedback from all the delegates had been excellent, with
many trainees like myself benefiting greatly from this experience.
I strongly recommend this course to other Cardiology trainees
and fellows who are keen for a strong grounding and exposure in
Interventional Cardiology.
THI PULSE | 11

HMDP
Fellowship
Dr Winn Maung Maung Aye has just returned from London,
United Kingdom after completing a two year clinical fellowship
in congenital cardiac surgery at the Royal Brompton Hospital and
the Great Ormond Street Hospital for Children. His passion for
congenital cardiac surgery, which was well known to all his peers,
began early in his career in cardiothoracic surgery.
At the Royal Brompton Hospital, he worked as a senior
clinical fellow with world renowned congenital cardiac surgeons
such as Mr Daryl Shore (his main mentor), Mr B Sethia and
Mr Hediki Uemura. There, he participated in over 800 complex
congenital (adult and paediatric) cardiac surgical procedures and the
clinical management of these patients. He also had an opportunity
to work with Prof Michael Gatzoulis, a well-known adult congenital
cardiologist.
Dr Maung was also invited by Mr Victor Tsang and
Prof Marc De Level to spend a few weeks in Great Ormond
Street Hospital for Children NHS Trust, London. It was an eyeopener
to see all the great surgeons at work and to be involved in
the decision making process at various hospitals.
Dr Maung hopes to establish National University
Hospital as a national and regional referral centre for congenital
cardiac surgery in the near future. In addition to congenital
cardiac surgery, he will also provide adult cardiothoracic surgery
services. As part of his career path, he has chosen the clinicianeducator
track and will be involved in the undergraduate medical
education program at the Yong Loo Lin School of Medicine, National
University of Singapore.
Royal Brompton Hospital – a short history
From the word Brompton: a very old word dating from 1294, thought to
mean‘Town of the Broom’.
Royal Brompton Hospital has a long and distinguished
history dating from 1841 when it was established on what were
then the outskirts of London for tuberculosis sufferers. Over the
centuries the city has expanded and the location is now a prestigious
and cosmopolitan residential area in Chelsea, London. In the
1940s, after incorporation into the new National Health Service,
the hospital began developing its expertise in heart conditions
alongside the existing excellence in the treatment of lung disease.
Royal Brompton & Harefield NHS Trust is the largest specialist heart
and lung centre in the UK among the largest in Europe. This
is where many pioneer heart lung and surgical operations were
performed by many world renowned surgeons – Mr Tudor Edward
– 1st lobectomy (1928), Mr Donald Ross (Ross Operation),
Professor Sir Magdi Yacoub – numerous surgical contributions in
adult and paediatric cardiac surgeries.
The hospital has more than 1,600 staff, five operating theatres
and four catheter laboratories. There are 295 beds, including 48 for
surgery, 93 for respiratory patients, 48 for cardiology, 34 paediatric,
20 for intensive care and 12 for paediatric intensive care.
A total of 90,000 outpatients and 26,000 inpatients were
treated each year. Annually procedure performed were: 3,000
angiograms/cardiac catheterisations; 1,800 thoracic surgery
operations; 2,400 coronary angioplasties; 2,000 treatments for
respiratory failure; and 1,200 heart bypass operations, 1000
congenital heart operations.
It is a centre for foetal cardiology service where many are
scanned at just 12 weeks of gestation and also the country’s largest
centre for the treatment of adult congenital heart disease headed
by Prof Michael Gatzoulis.
It has large catchment area for paediatric cardiac patients
in North of Thames, London and is strongly supported by The
Children’s Acute Transport Service (CATS). Royal Brompton
Hospital is the main congenital surgical referral centre for Greece,
Cyprus and UAE, and a centre of referral for Paediatric ECMO
services besides Great Ormond Street Hospital for Children in
London.
THI PULSE | 12

my
UK experience
Dr Edgar Tay
I am writing this short article from the fellows’ room
of the Royal Brompton Hospital. We have just received an email
from Professor Joseph Perloff from UCLA, one of the fathers
of congenital heart disease, about how fascinated he was when
he visited us and realized we were eight fellows representing
every continent. The European Society of Cardiology (ESC) had
recognized this hospital as the main accredited training centre in
adult congenital heart disease 2 years ago.
Many pages of the history of the development of congenital
heart disease were written in this centre beginning with Dr Paul
Wood as well as other prominent cardiothoracic surgeons like
Dr Donald Ross who pioneered the Ross Procedure. It was especially
interesting to be trained in a place with such rich traditions.
On arrival to this hospital, I was immediately exposed to
the vast spectrum of Adult Congenital Heart Disease (ACHD).
The patients here have complex congenital heart disease and often
have undergone several surgical procedures. The Eisenmenger
population here is probably one of the largest in Europe. Our
training was made up of didactic lectures as well as participation
in patient care in clinics, wards, echocardiographic laboratory and
the invasive laboratory. With the vast patient load and exposure,
we were quite confidently presenting complex cases in the annual
congenital heart disease meeting held in Thessaloniki, Greece after
3 months.
During my fellowship, I also participate in research. I
studied the right ventricular physiology of patients with corrected
transposition and patients with atrial redirection surgery. I am also
currently characterizing the effects of iron therapy and Sildenafil
treatment in Eisenmenger patients. Some of these would be
presented in the ESC this year.
I am currently among my friends preparing an abstract for
the upcoming Euroecho meeting. Being able to work with peers
from such distinct cultures has allowed us to exchange ideas and
experiences. I have especially benefited a great deal from the
pediatric fellows.
I leave you a photograph of the team I work with at the
Brompton led by our charismatic Director, Professor Gatzoulis.
The friendship and bonds gained here would last me a lifetime. I am
thankful for the opportunity to train and eager to contribute when I
return. Some of the alumnus reading this article may also remember
Dr Derek Gibson, who is one of the giants in echocardiography and
is still giving much of his time to teaching.
THI PULSE | 13

Shanghai, China
5th Asian Interventional
Cardiovascular Therapeutics
The 5th Asian Interventional Cardiovascular Therapeutics
(AICT) was successfully held in Shanghai, China, in conjunction
with the 3rd Oriental Congress of Cardiology (OCC) from the
29th to 31st May 2009. Organised by Prof Ge JunBo, a founding
AICT board member, the meeting hosted more than 2000 local
and international delegates at the grand Shanghai International
Convention Centre. The meeting was officially opened by
Dr Cai Wei, Vice Chairman Chinese People’s Political Consultative
Conference, Shanghai Committee.
A/Prof Tan Huay Cheem, who is also a founding AICT
member, was one of the executive president for the event.
Besides didactic lectures and exciting live satellite transmission,
this meeting had also abstract presentation by young investigators
and interesting complex case discussion. National University Heart
Centre, Singapore (NUHCS) was the only overseas centre invited
for the transmission and we showcased complex percutaneous
coronary intervention using a wide array of technology and stateof-the-art
product to a large audience.
The AICT meeting aims to be the true representative Asia-
Pacific interventional meeting. It is an event that is jointly organized
by leading centres in the Asia-Pacific region combining resources
and expertise of interventional cardiologists in the region. It is
actively supported by the American Society of Cardiovascular
Angiography & Intervention (SCAI) since its inauguration in
Year 2005. Having now been recognized as a core meeting by
Asian-Pacific Society of Interventional Cardiology (APSIC), AICT
has slowly gained publicity and acceptance in the international
community. As a sign of progress, AICT will feature a stand-alone
symposium in the next China Interventional Therapeutics meeting
in Beijing 2010. In another development, Hong Kong College of
Cardiology has agreed to join the AICT board which strengthens
its participating members now to 16 centres from 10 countries.
A permanent secretariat will be set up at NUHCS to coordinate
future activities.
The 6th AICT will be moving to Singapore next year and
will be held from 1 to 3 July 2010. It promises to be an exciting
gathering of all AICT and international experts in this unique East-
West global interventional meeting.
THI PULSE | 14

Cardiac &
Cardiothoracic-Vascular
Nursing Programme Miss Chia Lay Hoon
With the diversification of services, and its development,
nursing professionals need to be equipped with knowledge and
skills to manage patient care and provide counselling. The Cardiac &
Cardiothoracic-Vascular Nursing Programme (CTVNP) is designed
to provide advanced knowledge on Cardiac, Thoracic and Vascular
pathophysiology and disease management. The nursing foci include
topics on nursing management and performing/assisting in clinical
procedures.
This 6 months-programme includes didactic lectures and
course participants are required to work in the cardiac care areas
so as to facilitate concepts application in daily work.
Course modules are as follows:
1. Physiology & Clinical Essentials
2. Cardiac & Cardiothoracic Nursing
3. Respiratory Alteration and Management
4. Cardiac Rehabilitation Nursing
The 1 st cycle started in Jan 09 and was completed. The
2 nd cycle will commence in Aug 09.
Critical Care Programme, NUH
This is a 2-part program that aims to equip intensive care nurses
with basic (part 1) and advanced (part 2) critical care knowledge.
The program is intended for potential critical care nurses allowing
introductory immersion in the critical care environment, and
includes didactic and clinical components.
Part 2 course modules:
7. Renal replacement therapy
8. Advanced Cardio-Respiratory modalities
9. Advanced Cardiac Care Modalities
10. Evidence-based Practice
Invasive Cardiac Laboratory Nursing Programme
(Coming Soon)
The invasive cardiac laboratory is a specialized area with extended
service provided to cardiac patients requiring interventional
cardiology procedures. The Invasive Cardiac Laboratory Nursing
Programme (ICLNP) is designed to provide advanced knowledge
on the care of patients undergoing invasive cardiac interventions.
The nursing foci include topics on preparation of patients for
interventional cardiac procedures, nursing care peri procedures
and performing/assisting in the procedures.
Course Module includes:
1. Catheter Laboratory Concepts & Techniques
2. Application of Cardiac Catheterization in Disease States
3. Therapeutic Interventions in the Catheter Laboratory
4. Nursing the Patient requiring Catheter Laboratory
Services
Part 1 course modules:
1. Respiratory Alteration & The ICU Environment
2. Cardiac Physiology & Haemodynamic Monitoring
3. Acute Coronary Syndrome, Infective Heart Disorders &
Cardiac Surgeries
4. Renal & Gastrointestinal-Hepatobiliary Alteration
5. Neuroscience
6. Shock States & End Organ Function
THI PULSE | 15

happenings
SingLive
February 2009
NUHS
Dinner &
Dance 2009
11 July 2009
Physician Exchange
Programme (PEP)
March 2009
THI PULSE | 16

AICT 2009
30 May 2009
Singapore Cardiac Society ASM
21-22 March 2009
MO Farewell
16 April 2009
THI PULSE | 17

abstracts
Anticoagulation Forum’s – 10th National
Conference on Anticoagulant Therapy, 7-9
May 2009, Manchester Grand Hyatt in San
Diego, California
1. Remote monitoring of warfarin therapy using information
technology – a novel and safe approach to conventional care
– Choong MPH, Li GY, Yong N, Yeo TC, Yip JWL.
20th Annual Scientific Sessions of the
American Society of Echocardiography
(ASE) 2009, June 6 – 10 2009, Washington,
DC, USA, Gaylord National Resort &
Convention Center on the Potomac
1. Utility of Echocardiography and Tissue Doppler Imaging
for Assessment of Left Ventricular Remodelling, Global and
Regional Function in Rabbits with Myocardial Infarction
– Poh KK, Galupo MJ, Songco G, Zhang J, Lei Y, Sim EK
2. The relative impact of obstructive sleep apnoea and
hypertension on the structural and functional changes
of the thoracic aorta – Torres MC, Lee LC, Khoo SM,
Poh KK, Lee CH, Yeo TC
European Society of Cardiology Congress
2009, 29th August – 2nd September 2009,
Barcelona, Spain
1. The use of Genous Endothelial progenitor cell(EPC)
capture stent in acute ST-Elevation myocardial infarction
(STEMI): Angiographic follow-up at 6 months – Low FH,
Lee CH, Teo SG, Tay LW, Lee YP, Co M, Chee S, Lim YT,
Poh KK, Tan HC.
2. Framingham risk score inadequately predicts cardiac risk in
young patients presenting with a first myocardial infarction
– Lee LC, Lee WY, Lee KM, Lim SL, Shi LM, Ong HY,
Lim YT, Yeo TC.
3. Combined assessment of myocardial perfusion and poststress
gated left ventricular systolic function enhances risk
stratification of normal single photon emission computer
tomography (SPECT) studies – Soo WM, Ong HY,
Wong RC
4. Left atrium of adult porcine heart as a source of progenitor
cellsn – Ye L, Su LP, Poh KK, Haider HK
5. Nanoparticle mediated hypoxia-regulated vascular
endothelial growth factor-165 gene transfection with
myoblasts for cardiac repair – Su LP, Ye L, Zhang W,
Haider HK, Poh KK, Joyce M, Zhang J, Songco G, Tan HC,
Sim EK
6. Total isovolumic time relates to exercise capacity in patients
with transposition of the great arteries after atrial switch
– Tay EL et al
7. Replacement therapy for iron deficiency improves
symptoms and exercise capacity in patients with cyanotic
heart disease and/or Eisenmenger syndrome – Tay EL et
al
8. Exercise intolerance in patients with congenitally
corrected transposition of the great arteries relates to right
ventricular filling pressures – Tay EL et al
publications
1. J Interventional Cardiology 2009; Apr;22(2):114-6. Stent
thrombosis after PCI for Bifurcation Lesion. Tan HC.
2. Ann Acad Med Singapore 2009; 38. Acute perimocaditis
masquerading as acute coronary syndrome with spontaneous
resolution of increased left ventricular wall thickness. Poh
KK, Chan E, Chia BL, Chai P.
THI PULSE | 18

Publications (cont’d)
3. Singapore Med J. 2009 Jan;50(1): 34-42. Infective
endocarditis secondary to intravenous Subutex abuse.
Chong E, Poh KK, Shen L, Yeh IB, Chai P.
4. Singapore Med J. 2009 Mar;50(3):250-4. Diabetic patients
with normal baseline renal function are at increased
risk of developed contrast-induced nephropathy postpercutaneous
coronary intervention. Chong E, Poh KK,
Shen L, Chai P, Tan HC.
5. Int J Cardiol. 2009 Jan 19. Time-dependent dynamic
mobilization of circulating progenitor cells during
percutaneous coronary intervention in diabetics. Lee LC,
Chen CS, Chong PF, Low A, Tan HC, Poh KK.
6. Int J Cardiol. 2009 Apr 6. Left atrial volume is an
independent predictor of exercise capacity in patients with
isolated diastolic dysfunction. Wong RC, Yeo TC.
7. Int J Cardiol. 2009 Jun 10. Clinical predictors of stent
thrombosis in the “real world” drug-eluting stent era. Tin-
Hay EL, Poh KK, Lim YT, Low AF, Lee CH, Teo SG, Lim
J, Lim IH, Tan HC.
8. Chest. 2009 Jun;135(6):1488-95. Obstructive sleep
apnea in patients admitted for acute myocardial infarction.
Prevalence, predictors, and effect on microvascular
perfusion. Lee CH, Khoo SM, Tai BC, Chong EY, Lau C,
Than Y, Shi DX, Lee LC, Kailasam A, Low AF, Teo SG,
Tan HC.
9. Circulation. 2009 Jun 23;119(24):3110-7. Long-term
mortality of patients undergoing cardiac catheterization for
ST-elevation and non-ST-elevation myocardial infarction.
Chan MY, Sun JL, Newby LK, Shaw LK, Lin M, Peterson
ED, Califf RM, Kong DF, Roe MT.
10. J Thromb Thrombolysis. 2009 Jul 14. Catheter thrombosis
and percutaneous coronary intervention: fundamental
perspectives on blood, artificial surfaces and antithrombotic
drugs. Chan MY, Weitz JI, Merhi Y, Harrington RA,
Becker RC
11. JACC Cardiovasc Interv. 2008 Aug;1(4):369-78.
Prevalence, predictors, and impact of conservative medical
management for patients with non-ST-segment elevation
acute coronary syndromes who have angiographically
documented significant coronary disease. Chan MY,
Mahaffey KW, Sun LJ et al.
12. Cardiovasc Res. 2009 Jul 6. Reducing Ischemia/
Reperfusion Injury through {delta}-Opioid-Regulated
Intrinsic Cardiac Adrenergic Cells: Adrenopeptidergic
Co-signaling. Huang MH, Nguyen V, Wu Y, Rastogi S,
Lui CY, Birnbaum Y, Wang HQ, Ware DL, Chauhan M,
Garg N, Poh KK, Ye L, Omar AR, Tan HC, Uretsky BF,
Fujise K.
13. J Am Coll Cardiol. 2009 Jul 28;54(5):410-8. Contractility
and ventricular systolic stiffening in hypertensive heart
disease insights into the pathogenesis of heart failure
with preserved ejection fraction. Borlaug BA, Lam CS,
Roger VL, Rodeheffer RJ, Redfield MM.
14. Circulation. 2009 May 26;119(20):2663-70. Ageassociated
increases in pulmonary artery systolic pressure
in the general population. Lam CS, Borlaug BA, Kane GC,
Enders FT, Rodeheffer RJ, Redfield MM.
15. Clin Cardiol. 2009 Jun;32(6):E67-E70. Coronary
Sarcoidosis Presenting as Acute Coronary Syndrome.
Lam CS, Tolep KA, Metke MP, Glockner J, Cooper LT
Jr.
16. J Am Coll Cardiol. 2009 Mar 31;53(13):1119-26.
Pulmonary hypertension in heart failure with preserved
ejection fraction: a community-based study. Lam CS,
Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT,
Redfield MM.
17. Eur J Cardiothorac Surg. 2009 Jun 10. Off-pump coronary
bypass grafting is safe and efficient in patients with left main
disease and higher EuroScore. Thomas GN, Martinez EC,
Woitek F, Emmert MY, Sakaguchi H, Muecke S, Lee CN,
Kofidis T.
18. Biomaterials. 2009 Apr;30(12):2241-51. Development
of cell-selective films for layered co-culturing of vascular
progenitor cells. Chong MS, Chan J, Choolani M, Lee CN,
Teoh SH.
19. Singapore Med J. 2009 Jul;50(7):674-9. Predictors of
adverse neurological outcome following cardiac surgery.
Chang G, Luo HD, Emmert MY, Lee CN, Kofidis T.
20. J Endovasc Ther. 2009 Feb;16 Suppl 1:I91-3. Global
differences in endovascular treatment of chronic aortic
dissections: a comparison of physicians in the United
States, Europe, and Asia. Muhs B, Dardik A, Verhagen H,
Robless P.
21. Asian Cardiovasc Thorac Ann. 2009 Jun;17(3):238-9.
The ideal graft of the future: a prospect of messianic
proportions? Klima U, Kofidis T.
22. Int Heart J. 2009 Jan;50(1):47-57. Aortic root and
ascending aortic replacement. Akhyari P, Bara C,
Kofidis T, Khaladj N, Haverich A, Klima U.
23. Asian J Surg. 2009 Jan;32(1):39-46. Endovascular repair
for thoracic aortic pathologies--early and midterm
results. Ting AC, Cheng SW, Ho P, Chan YC, Poon JT,
Cheung GC.
24. Eur J Cardiothorac Surg. 2009 Aug;36(2):394. Spontaneous
haemothorax from an osteochondroma. Asmat A, Tam J.
THI PULSE | 19

new doctors
on board
Dr Peter Chang
Registrar, Cardiology
Dr Saket Junagade
Registrar, Cardiology
Dr Kyu Kyu
Medical Officer (Specialist), Cardiology
Dr Upeksha De Silva
Registrar, Dept of Cardio,
Thoracic and Vascular Surgery
Dr Matthew Edward Cove
Registrar Intensivist, Dept of Cardio,
Thoracic and Vascular Surgery
Dr Clara Tolentino
Clinical Fellow (EP), Cardiology
Dr Samuel Sudanawidjaja
Clinical Fellow (Interventionist), Cardiology
Dr Maria Consolacion V.Dolor
Clinical Fellow (Imaging), Cardiology
directory
National University Heart
Centre, Singapore
5 Lower Kent Ridge Road
Singapore 119074
Tel 6779 5555
Fax 6779 5678
Cardiac Clinic H
Clinic Appointment 6772 5730
Fax 6775 1617
Cardiac Centre
Clinic Appointment 6772 5277/6772 5278
Fax 6772 5279
Feedback
Please direct your feedback to
The Editor, PULSE
c/o NUHCS
National University Hospital
Cardiac Department
Level 3, Main Building
Singapore 119074
Tel 6772 5565
Fax 6778 6057
Email Elaine_MC_Lee@nhg.com.sg