Download Instructions for Submitting Complex Cases for oral presentation and

NB: Submission of a Complex Case and presentation at the Saturday Session at the Annual Meeting does not preclude
you from submitting and presenting at the IARS or ASA Annual Meetings.
All submitted cases will be considered for oral presentation. Those not selected for oral presentation will then be
considered for poster presentation.
Instructions for Submitting Complex Cases for oral presentation and poster presentation
1. Only cases submitted on the proper form will be considered. Cases are limited to one written page.
2. Please use the format shown on the enclosed example (see page 2 of this document).
3. Font size smaller than 10 point will not be accepted.
4. All cases must be received by December 18, 2009 at 12:00pm (ET).
5. All images need to be attached as a separate JPEG File.
6. Ensure that the Disclosure Form is completed and returned with complex case. (Only the Presenting Author needs to complete
this form)
7. Complete application below.
8. Create a blinded copy on page 4.
A. Copy only the Title and Case into their respective boxes.
B. Leave the Author, Mentor and Affiliation lines blank
9. Save this document.
10. E-mail the file to [email protected]. Subject line should read: Complex Case Submission – Presenting Authors
Last Name (i.e. – “Complex Case Submission – Smith”). If your case contains any images, please include it as a separate
attachment to your email. Please make sure all figures, images, etc. are black and white.
11. These documents will be processed electronically. The blinded copy on Page 4 will be submitted to the judges. If your
document does not strictly follow the proper format it will not be processed.
12. If you have not received an email receipt confirmation within two (2) working days, please notify the SCA
Administrative Office at [email protected] or 804-282-0084.
Case Submission Application
1. Title of Case:
2. Name of Submitting Fellow or Resident and Institution (please indicate whether you are a resident or fellow):
3. Name of faculty mentor:
4. Complete name and address of where correspondence should be sent:
Address:
Phone:
Fax:
Email:
Presentations and Other Important Information:
1. All accepted cases will be presented at the 2010 Annual Meeting Session on Saturday, April 24, 2010.
2. The format for oral presentation will be PowerPoint presentation of the cases with discussion by the fellow and a
panel of experts (8-10 minutes for presentation, 5-7 minutes for discussion). It is not necessary to prepare a poster.
3. Poster presentation of cases will follow the oral case presentations on Saturday, April 24, 2010.
4. If accepted, the fellow must attend the Annual Meeting to present the case. Registration fees are NOT waived.
5. Please remember to sign the bottom of page 7 and complete the COI Disclosure.
6. Applicants must be members of the SCA.
The Successful Avoidance of Catecholamines Despite Severe Biventricular Dysfunction in a Patient Undergoing
Multivalve Surgery For Carcinoid Syndrome
Author: Mickey Mouse, MD (Fellow)
Faculty Mentor: Donald Duck, MD
Affiliation: Magic Kingdom School of Medicine
Introduction: Though recent literature suggests that the perioperative use of catecholamines in conjunction with octreotide
in patients with carcinoid heart disease may not be contraindicated, 1 their safety has not been unequivocally demonstrated.
We present a case of severe biventricular dysfunction following multiple valve surgery in a patient with severe carcinoid
syndrome where an alternative management strategy was successfully employed to avoid the issue entirely.
Case Presentation: A 61 yr old male with widely metastatic carcinoid disease and carcinoid syndrome presented for
tricuspid and pulmonic valve replacements and mitral annuloplasty. Preoperative cardiac workup revealed global hypokinesis
of the left ventricle (EF approximately 20%), a dilated but normally functioning right ventricle, severe tricuspid and
pulmonic regurgitation, moderate mitral regurgitation and mild aortic regurgitation. Carcinoid symptomatology was
controlled perioperatively with a continuous intravenous infusion of octreotide (100 mcg/hr). Following placement of a
radial arterial pressure monitoring cannula and a central venous access, anesthesia was induced with midazolam, etomidate,
fentanyl and vecuronium. Aminocaproic acid was used as the antifibrinolytic agent. No carcinoid crises were observed in
the pre-bypass period. Cardiopulmonary bypass (CPB) lasted for approximately four hours. Severe biventricular dysfunction
was evident once the aortic cross-clamp was removed. A milrinone load (50 mcg/kg) was slowly administered while still on
CPB. The patient was separated from CPB with the assistance of inhaled epoprostenol (12.5 mcg/kg/min), vasopressin (1.8
units/hr, IV), atrioventricular pacing and an intra-aortic balloon pump. At the conclusion of the case, TEE demonstrated that
the prosthetic tricuspid and pulmonic valves were intact and there was no residual mitral regurgitation. Though biventricular
function was moderately-severely depressed, the patient demonstrated good hemodynamic stability without the need for
inotropes. The patient was extubated on the first postoperative day and the IABP removed on the second postoperative day.
He was discharged from the hospital on postoperative day #9.
Discussion: Traditional anesthetic management of the patient undergoing valvular surgery to address carcinoid heart disease
revolved around the avoidance of inducing carcinoid crisis (e.g., hypotension and bronchospasm) by avoiding factors which
would trigger release of kallikreins from the carcinoid tumor, leading to the formation of bradykinins that produce
vasodilatation. Classic factors include the administration of catecholamines (e.g., epinephrine2, norepinephrine3, dopamine4,
isoproteronol5), calcium6, and medications that can cause histamine release and tumor manipulation. However, the
continuous administration of octreotide has become a mainstay of modern intraoperative management and is claimed to be
somewhat protective against the potentially deleterious effects of catecholamine administration in this population. 1
Given that this patient’s carcinoid symptomatology was adequately controlled by his octreotide infusion, we elected to
manage his severe biventricular dysfunction with selective therapies that would avoid conventional catecholamines if
possible. As predicted by the principle of ventriculo-arterial coupling, reduction of the right ventricular afterload by inhaled
epoprostenol allowed for adequate RV output despite poor intrinsic RV systolic mechanics. Intra-aortic balloon
counterpulsation and atrioventricular pacing allowed for adequate output from the left ventricle. Vasopressin infusion was
employed to provide systemic vasoconstriction without increasing pulmonary vascular resistance. Overall, this strategy
proved very effective for a patient who otherwise clearly would have been placed on catecholamines to assist separation from
CPB.
References:
1) Anesth Analg 2007;105(5):1192-99;
2) Lancet 1959;2:715;
3) Proc R Soc Med1957;50:40;
4) Lancet 1969;2:293–7;
5) J CardiothoracAnesth 1988;2:658–65;
6) Surg Gynecol Obstet 1973;137:637–44
TITLE:
AUTHOR:
FACULTY MENTOR:
AFFILIATION:
ABSTRACT BODY:
TITLE:
AUTHOR: <BLINDED COPY LEAVE BLANK>
FACULTY MENTOR: <BLINDED COPY LEAVE BLANK>
AFFILIATION: <BLINDED COPY LEAVE BLANK>
ABSTRACT BODY:
Disclosure of Relevant Financial Relationships
(Only Presenting Author needs to complete this form)
SCA 32nd Annual Meeting & Workshops
April 24-28, 2010 • New Orleans, LA
Name:
Content of Activity: Complex Case Presentation
Date of Activity: April 24, 2010
First: List the names of proprietary entities producing health care goods and services, with the exception
of non-profit or government organizations and non-health care related companies with which you or
your spouse/partner have, or have had, a relevant financial relationship within the past 12 months. For
this purpose we consider the relevant financial relationships of your spouse or partner that you are aware
of to be yours.
Second: Describe what you or your spouse/partner received (ex: salary, honorarium, etc).
SCA does NOT want to know how much you received.
Third: Describe your role.
Nature of Relevant Financial Relationship
(Include all those that apply)
Commercial Interest
What was received
For What Role?
Honorarium
Speaker
Example: Company ‘X’
I do not have any relevant financial relationships with any commercial interests.
Signature
Date
Example terminology
What was received: Salary, royalty,
intellectual property rights, consulting
fee, honoraria, ownership interest (e.g.,
stocks, stock options or other ownership
interest, excluding diversified mutual
funds), or other financial benefit.
Role(s): Employment, management
position, independent contractor
(including contracted research),
consulting, speaking and teaching,
membership on advisory committees or
review panels, board membership, and
‘other activities (please specify).
Glossary of Terms
Commercial Interest
The ACCME defines a “commercial interest” as any proprietary entity producing health care
goods or services, with the exemption of non-profit or government organizations and non-health
care related companies.
Financial relationships
Financial relationships are those relationships in which the individual benefits by receiving a
salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g.,
stocks, stock options or other ownership interest, excluding diversified mutual funds), or other
financial benefit. Financial benefits are usually associated with roles such as employment,
management position, independent contractor (including contracted research), consulting, speaking
and teaching, membership on advisory committees or review panels, board membership, and other
activities from which remuneration is received, or expected. ACCME considers relationships of
the person involved in the CME activity to include financial relationships of a spouse or partner.
Relevant financial relationships
ACCME focuses on financial relationships with commercial interests in the 12-month period
preceding the time that the individual is being asked to assume a role controlling content of the
CME activity. ACCME has not set a minimal dollar amount for relationships to be significant.
Inherent in any amount is the incentive to maintain or increase the value of the relationship. The
ACCME defines “’relevant’ financial relationships” as financial relationships in any amount
occurring within the past 12 months that create a conflict of interest.
Conflict of Interest
Circumstances create a conflict of interest when an individual has an opportunity to affect CME
content about products or services of a commercial interest with which he/she has a financial
relationship.
CME REQUIREMENTS
The Accreditation Council for Continuing Medical Education (ACCME) accredits SCA. As such, we
have made the choice to meet the ACCME’s expectations for our practice of continuing medical
education. Our accreditation is important to us. We look forward to working together to provide CME at
the highest standard.
SCA has implemented a process where everyone who is in a position to control the content of an
education activity has disclosed to us all relevant financial relationships with any commercial interest. In
addition, should it be determined that a conflict of interest exists as a result of a financial relationship
you may have, this will need to be resolved prior to the activity. This information is necessary in order
for us to be able to move to the next steps in planning this CME activity. If you refuse to disclose
relevant financial relationships, you will be disqualified from being a part of the CME activity.
The Commercial Support Standards also require that your presentation is free of commercial bias and
that any information regarding commercial products/services be based on scientific methods generally
accepted by the medical community. When discussing therapeutic options, it is our preference that you
use only generic names. If it is necessary to use a trade name, then those of several companies must be
used. Further, should your presentation include discussion of any unlabeled/investigational use of a
commercial product, you are required to disclose this to the participants. Should you determine that you
cannot comply with these requirements or any of the provisions, please contact the SCA Administrative
Office as soon as possible.
It is the Society’s policy to conduct post-activity evaluations. These evaluations ask participants to
indicate the appropriateness of presentations to their specific practices, if the presentations satisfied the
stated objectives, if they were satisfied with the faculty presentations and if there was any evidence of
commercial bias. The results of these evaluations are used to plan future CME activities and are shared
with the faculty.
Once again thank you for your willingness to participate in this event. We have worked hard to develop
a program which will meet the expressed needs of our expected participants, who we anticipate will
come from the US, Canada and overseas.
A) Generic and Trade Names – Presentations must give a balanced view of therapeutic options.
Presenter’s use of general names will contribute to this impartiality. If trade names are used,
those of several companies should be used rather than only that of a single supporting company.
B) Unlabeled Uses of Products – When an unlabeled use of a commercial product, or an
investigational use not yet approved for any purpose is discussed during an educational activity,
the presenter is required to disclose that the product is not labeled for the use under discussion or
that the product is still investigational.
My presentation will comply with sections A-B above.
SIGNATURE:________________________________________
DATE:____________________
PLEASE RETURN TO THE SCA ADMINISTRATIVE OFFICE WITH YOUR
CASE PRESENTATION SUBMISSION