dr abdul razakjr’s clinical fellowship in toronto us/publications/pulse... · clinical fellowship...

MICA (P) 174/09/2006 Issue No. 8 • July – December 2006

– READ MORE ON PAGE 14Clinical Fellowship in Toronto

Dr Abdul Razakjr’sClinical Fellowship in Toronto

Dr Abdul Razakjr’s

THI Pulse 2/2006 FA 12/12/06, 10:10 AM1

FEEDBACKWe would love to hear your feedback on PULSE.Please write toThe Editor, PULSEThe Heart Institutec/o National University HospitalDepartment of Cardiac,Thoracic & Vasular Surgery5 Lower Kent Ridge RoadLevel 2, Main Building Singapore 119074Or email us [email protected]

EDITOR

Dr Raymond Wong

ADVISOR

A/Prof Tan Huay Cheem

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

in this issuein this issue02

CARDIOTHORACIC SURGERY

SPECIALTY UPDATE COURSE

20CONGRATS

NEW DOCTORS ON BOARD

DIRECTORY

12NEW FRONTIERS IN THE

TREATMENT OF VENOUS

DISEASE

15CARDIAC GP WORKSHOP

17ABSTRACTS

11WCC 2006: NUH RUMBLES IN

EUROPE

082ND AICT: A LANDMARK

MEETING IN THE WORLD OF

INTERVENTIONAL CARDIOLOGY

04UNIVERSITY CARDIOLOGY IN

SINGAPORE

16MINISTER HENG CHEE HOW

VISITS CARDIAC CENTRE

14MY CLINICAL FELLOWSHIP IN

TORONTO

16A GLITTERING DINNER HOSTED

BY THE PROFESSORS

11TCT – THE HEART INSTITUTE

MEETS IN D.C.

13MY LEARNING EXPERIENCE AT

MAYO CLINIC, USA

07EMERITUS PROFESSOR CHIA

BOON LOCK HONORED

10LIVE TRANSMISSION TO TOPIC

18HAPPENINGS

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Cardiothoracic S gCardiothoracic S g

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THI PULSE | 3

Dr Atasha Asmat, THI @ NUH

ic Surgery Specialtyupdate courseic Surgery Specialtyupdate course

It was a great pleasure for us to host and conduct theinaugural Cardiothoracic Surgery Specialty Update Course at theClinical Research Centre, National University of Singapore onthe 17th & 18th of October 2006. The course was organized byThe Heart Institute together with the Royal College of Surgeonsof Edinburgh and the Academy of Medicine.

The course was primarily aimed at doctors who arepreparing to undergo their final specialty examination incardiothoracic surgery. Other doctors from related fields, nursesand allied healthcare professionals were also invited to attend.The faculty comprised of senior and distinguished cardiothoracicsurgeons from the United Kingdom as well as invited speakersfrom around the region. The course focused on covering topicssuch as common cardiothoracic conditions as well as applied basicsciences. Over the two days, there were a series of formal lecturesas well as group interactive seminar sessions. The interactivesessions provided the participants with the opportunity to meetwith the faculty members and discuss case management decisionsand surgical strategies for complex scenarios that a cardiothoracicsurgeon may encounter in the course of his (or her) career. Asthe course participants included nursing staff and allied healthcare professionals, separate seminar sessions on nursing-relatedissues were also conducted by two nurse practitioners from theUnited Kingdom. The topics discussed included the development

of integrated care pathways, ventilation issues and the post-operative care of cardiothoracic patients.

The course was attended by over 130 participants. Inaddition to local doctors and nursing staff, the participants alsocame from neighboring countries in the region. The two-daycourse was extremely well received by the speakers and theparticipants and we hope to organize future courses on an annualbasis.

THI PULSE | 3

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The University has been at the forefront of thedevelopment of Cardiology since the 1960s, and has been activein leading Singapore in the growth and development of thespecialty.

It started with the set-up of the first Coronary Care Unit(CCU) at Medical Unit II (subsequently University Departmentof Medicine II) at the Outram Road General Hospital, which isnow the Singapore General Hospital (SGH) by A/Prof CharlesToh and A/Prof Low Lip Ping. There was no official UniversityDepartment of Cardiology at the then University of Singapore(now the National University of Singapore) and most of theteaching, research and services were carried out by the two

Department. The other chiefs who followed includedA/Prof Christopher Chew, Prof Chia Boon Lock, A/Prof LimYean Teng and currently A/Prof Tan Huay Cheem. In 2001,further transformational change occurred with the formation ofThe Heart Institute (THI) within the National HealthCare Group(NHG) cluster comprising cardiology and cardiac surgery atNUH, Tan Tock Seng Hospital, Alexandra Hospital; and Prof LeeChuen Neng is its director.

CARDIOLOGY SERVICE

Today, the NUH Cardiac department continues to shoulder thetriple responsibilities of providing evidence-based medical care,training of undergraduates, post-graduates and paramedics; andspearheading basic and clinical research in close collaboration with

University Cardiology in S gUniversity Cardiology in S g

It started with the set-up of thefirst Coronary Care Unit at

Medical Unit II (subsequentlyUniversity Department of

Medicine II) at the Outram RoadGeneral Hospital...

University medical units at SGH, namely University Departmentof Medicine I and II. Cardiology at the University Departmentof Medicine II was under the stewardship of A/Prof Charles Tohfrom 1961 to 1975, and later Prof Chia Boon Lock from 1975 to1985. The University cardiologists led important breakthroughsand progress in cardiology at that time. These included theintroduction of cardiac catheterization in 1964 (together withProf SB Roy who was then a visiting expert), CCU in 1967, M-mode and two-dimensional echocardiography in 1976 and 1980respectively; and electrophysiology in 1981.

In 1985, all the University clinical departments movedover to the new premises at National University Hospital (NUH)at Kent Ridge. Cardiology service began as the Division ofCardiology, Department of Medicine from 1986 to 1989 withProf Chia Boon Lock as the Head. During this time, furthersignificant progress was made with the starting of cardiac surgeryand coronary angioplasty services, and ambulatory blood pressuremonitoring was introduced for the first time in Singapore. In1989, there was a milestone change in the development ofUniversity Cardiology with the formation of the NUH CardiacDepartment, with Prof Maurice Choo as its first Chief of

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various research bodies in the nation. The centre attracts a largenumber of patients, both local and abroad, who come seekinghigh quality cardiac care. The volume of patients, both subsidizedand private, continue to rise at a rapid rate annually. The servicesprovided are comprehensive and it is the only public institutionto provide a complete range of non-invasive imaging modalitiesranging from echocardiography, nuclear scintigraphic studies,magnetic resonance imaging and multidetector computedtomography (MDCT) coronary angiography. It also providesinvasive treatment in the form of percutaneous diagnostic andinterventional procedures for coronary artery disease, congenitalheart and peripheral vascular disease. In the field of pacing andelectrophysiology, the department provides cardiac pacemakerimplantation, electrophysiologic studies and radiofrequency

in Singaporein SingaporeA/Prof Tan Huay Cheem, THI @ NUH

Today, the NUH Cardiacdepartment continues to

shoulder the tripleresponsibilities of providingevidence-based medical care,

training of undergraduates, post-graduates and paramedics;and spearheading basic and

clinical research...

ablation of complex arrhythmias led by a team of well-trainedelectophysiologists. Other sub-specialized clinical servicesprovided include the treatment of patients with pulmonaryhypertension, cardiac diseases during pregnancy, hypertrophiccardiomyopathy; vascular medicine, sports cardiology and cardiacrehabilitation.

CARDIOLOGY TRAINING

As an academic institution, the department is committed toeducating and training the next generation of cardiologists. Inthe early days when structured training programmes did not existin Singapore, many Cardiologists spent their entire or part oftraining overseas. Currently, all NUH cardiology trainees arerequired to spend three years in the Advanced Specialist Training

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programme in an accreditedprogramme overseen by theAcademy of Medicine and theNUS Division of GraduateMedical Studies. Furthersubspecialty training inoverseas centers is availableunder the HMDP scholarshipscheme. There are currentlyfive NUH cardiologists whoare overseas learning theropes of research inangiogenesis, cardiac failure,cardiac epidemiology andtranslational research; andskill acquisition in the fieldsof advanced electrophysiology, positron emission tomography(PET) computed tomographic (CT) and nuclear imaging; andvascular medicine.

The department has been able to attract many internationalfellows to come to Singapore for subspecialty training ininterventional cardiology, echocardiography, coronary intensivecare, MR imaging etc. This has enabled NUH to build up a wideregional network, which helps promote cross-national sharingof technology and conduct of large-scale research. The mostsuccessful and popular interventional cardiology fellowshipprogramme attracts many applicants each year with enrollmentof five trainees annually and a waiting time of nearly two years.Many of the overseas fellows have gone on to assume leadershippositions in their countries after completion of training.

CARDIOLOGY RESEARCH

Cardiology research underpins the uniqueness and strength ofany academic department. The Singapore University Cardiologyservice is no exception. This could not have been better illustratedthan in the first successful treatment of cardiac beriberi byProf ES Monteiro in 1937. In 1959, Prof TJ Danaraj was also thefirst to report the high prevalence of coronary heart disease amongIndians in Singapore; and renal artery stenosis and hypertensionresulting from Takayasu’s disease. Prof Seah Cheng Siang and histeam carried out the first epidemiological survey of blood pressurein Singapore in 1977.

There have been a large number of publications by theUniversity department cardiologists over the past 20 years. Many

of these papers were accepted by internationally prestigiousjournals such as the American Heart Journal, Journal of theAmerican College of Cardiology, Circulation, European HeartJournal and even the New England Journal of Medicine. The areasof research are wide ranging and include echocardiography,coronary angioplasty, cardiac arrhythmias and electrophysiologyand cardiac epidemiology. In the last four years, NUH Cardiacdepartment has also abstracts accepted regularly for presentationat major international meetings such as American College ofCardiology, American Heart Association and European Societyof Cardiology. It has also won the Singapore Cardiac Society YoungInvestigators’ Award for the last three consecutive years. Facultiesof NUH Cardiac Department are frequently invited overseas todeliver lectures, present research findings and perform operativeprocedures. Just this year alone, NUH has transmitted via satelliteto three different interventional cardiology meetings held inKorea, Japan and India. It also looks forward to organizing the4th Echo Singapore meeting with Mayo Clinic in 2007. AsSingapore strives to be the biomedical hub for the region andglobally, NUH has positioned itself by having more clinicalcardiologists pursuing research in basic sciences.

Having journeyed its way through the progress ofcardiology in Singapore in the past four decades, the NUH cardiacdepartment continues to ready itself for the many challenges aheadin establishing Singapore as a world-class cardiac centre. Withthe right combination of talents and resources, planning and aboveall, human resolve and an endeavouring spirit, the future certainlylooks very bright.

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Professor Chia Boon Lock from the Yong Loo Lin Schoolof Medicine has joined the ranks of a small group ofdistinguished academics who have earned the title of EmeritusProfessor.

Prof Chia, 66, was conferred the title during theCommencement 2006 ceremony in July, in recognition for hisinternational and national achievements in the area of clinicalelectrocardiography and cardiac services, and his significantcontributions to the training of generations of doctors andcardiologists in Singapore.

A TEACHER AND FRIEND

“I would like to be remembered as a teacher and friend; and as ahumble cardiologist who has made a difference to cardiology inSingapore,” said Prof Chia, the former Chief of National UniversityHospital’s (NUH) Cardiac Department, who is frequentlyreferred to as the Doyen of Singapore Cardiology.

Now an Emeritus Consultant at the NUH CardiacDepartment and a Professorial Fellow at the Department of

Medicine at National University of Singapore (NUS), Prof Chiagraduated with an MBBS from the then University of Singaporein 1963. He subsequently obtained higher qualifications in internalmedicine and also underwent training in cardiology in Australia(under a Colombo Plan Scholarship) and in America.

AN ILLUSTRIOUS CAREER

Prof Chia’s illustrious career began in 1972, when he returnedto NUS as a Senior Lecturer in the department of Medicine.Within nine years, he was promoted to full Professor. He retiredin 1999, after 18 years as Professor of Medicine.

“My greatest contribution has been in teaching. Althoughmany regard me as a good cardiologist and I have written a lot ofpapers based on my clinical research, people remember me bestfor my teaching,” he said.

Prof Chia has published 160 papers, many of which are inleading peer-reviewed medical journals and has delivered230 presentations, including the prestigious Antonio SamiaLecture at the 14th Asian Pacific Congress of Cardiology in 2004.

He also has two well-known books to his name, ClinicalElectrocardiography and An Atlas of Two-Dimensional andDoppler Echocardiography.

In addition, he has also held the office of President forfour terms at the Singapore Cardiac Society. In 1998, the societyhonored him with the “Distinguished Member Award”. Prof Chiawas also the Founder Vice-President of the SingaporeHypertension Society from 2001 to 2006. In July this year, hebecame the society’s President.

In 1984, Prof Chia received the Dato Paduka MahkotaBrunei.

In recognition of his many contributions to the field,Prof Chia was also honored with the Lee Foundation-NationalHealthcare Group Lifetime Achievement Award last year.

“I would like to be rememberedas a teacher and friend; and as a

humble cardiologist who hasmade a difference to cardiology

in Singapore ”

Prof Chia Boon LockThis article is reproduced with kind permission from TheAlumNUS, published by the Office of Alumni Relations, NUS.


Emeritus Professor ChiaBoon Lockhonored

Emeritus Professor ChiaBoon Lockhonored

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Following the successful birth of 1st Asian InterventionalCardiovascular Therapeutics (AICT) in 2005, the torch ofAICT was passed to our cofounder, Dr Ashok Seth from MaxDevki Devi Heart and Vascular Institute this year. The secondAICT was successfully held at the fabulous Taj Palace Hotel, NewDelhi from 1st to 4th October 2006. This year’s meeting is co-organized by The Society for Cardiovascular Angiography andInterventions (SCAI) and has the active participation of AsianPacific Society of Interventional Cardiology (APSIC). The meetingbrings the best of East and West together for live casedemonstrations from seven countries across the world, state ofthe art lectures, SCAI and APSIC monitored training modulesand simulation workshops and fellowship programmes.

WONDERFUL EDUCATIONAL EXPERIENCE

As part of the founding team, The Heart Institute (THI) was proudand honored to be an active participant in this year’s meeting. Wewere privileged to be one of the outstanding live case transmissioncentres, among which include Evanston Hospital (Illinois, USA),Northern Yokohama Hospital (Tokyo, Japan), National HeartInstitute (Kuala Lumpur, Malaysia), Zhong Shan Hospital(Shanghai, China), Mayo Clinic (Minnesota, USA), and Cedars-Sinai Center (Los Angeles, USA). Our live transmission took placeon the 2nd October with the showcase of two interesting cases oncomplicated percutaneous coronary intervention by our twooutstanding AICT faculties, A/Prof Tan Huay Cheem andA/Prof Lim Yean Teng. The live transmission turned out to be awonderful educational experience and was received withthunderous positivism from the audience.

A strong team from the THI cardiac family left immediatelyafter the live transmission with a lot of enthusiasms to participatein the rest of the meeting. Having the opportunity to participateat this meeting in the wonderful land of India and metropolis ofDelhi is certainly a privilege for many of us. This is a first trip toIndia for most of us traveling there and was something all of us

have been looking forward to for a long time. So, in addition tothe scientific exchange, there is wonderful cultural opportunitywhere we can learn from each other.

A MEGA INTERVENTIONAL CARDIOVASCULAR MEETING

The meeting venue took place at the enchanting Taj Palace hotel,which was situated in a beautiful corner of Delhi. We are indebtedto Dr Ashok Seth and his teams for their wonderful planning andorganizational skills to make this meeting possible. The four-daymeeting showcased the basics and the latest advancements incoronary intervention technology in the form of livedemonstrations, didactic lectures and interactive sessions withexperts. Besides the live cases and lectures, there were concurrentcongress workshops including carotid stenting course, cardiaccatheterisation and hemodynamic course, CT coronaryangiography workshop and peripheral intervention course. Oneof the highlights of the second AICT was the honor to have theaddress from the President of India, Dr APJ Abdul Kalam.

The meeting was extremely well attended with activeparticipants approaching one thousand registrants from all overAsia Pacific region. It also marked the record number of facultiesfrom all over the world, including the participation of importantmembers from both SCAI and APSIC. This has brought AICTmeeting to new height to be among one of the mega interventionalcardiovascular meeting in the world. The second AICT was closedwith a stupendous Bollywood Night gala dinner held at theluxurious Kamal Mahal Maurya Sheration Hotel & Towers. This

Dr Soon Chao Yang, THI @ AH

2ND ASIAN INTERVENTIONALCARDIOVASCULARTHERAPEUTICSA landmark meeting in thA landmark meeting in th

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was a relaxing yet exciting opportunity for us to witness the livelyperformance from some of the best talents in this nation.

I was excited and thrilled to be at this historical meeting.This conference offered a great deal for all of us and I think it isparticularly exciting with the diversities of countries in Asia Pacificregion to see everybody coming together in a spirit of congenialityto share their thoughts, experiences and hopes. As Dr Seth has

said “Let there be LITE – Learning, Innovative, Teaching andEnjoyment”. That is what I believe this meeting has brought forall of us.

The torch of AICT has been passed to another cofounder,Dato’ Dr Robaayah Zambahari from Institute Jantung Negara,Malaysia, who will stage the next AICT at Kuala Lumpur, Malaysia in2007. We trust that AICT will continue to grow and blossom on.

in the worldof interventional cardiology

in the worldof interventional cardiology


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The TOPIC (Tokyo PercutaneousCardiovascular InterventionalConference) was held on 20th to 22nd

July 2006 at Cerulean Tower TokyuHotel, Tokyo, Japan. The Heart Institute(THI) was selected to be a part of thishighly regarded and well-attendedinternational cardiac interventionalmeeting. We were invited to transmitthree live interventional cases to Tokyoand discuss a variety of issues withintervention experts.

Patients with ischemic heart disease who requiredpercutaneous coronary intervention and who had technicallychallenging lesions were selected for this meeting. This was a goodopportunity to showcase our institute’s capability and to shareour experiences with regards to techniques and new devices.

The preparation was greeted with great enthusiasm fromthe ground crew that included the interventionists, staff nurses,technicians, fellows and the Mediacorp crew. Although I have seentransmissions in various international meetings, this was the firsttime I was directly involved and was amazed at the fluidity andthe experience of all involved.

All of us rehearsed our individual roles for the day. Somewere involved in the preparations in the catheterization laboratory.Dr Soon Chao Yang and myself were coordinating the variouscamera angles, the additional slides to be presented and how todeliver the best presentation possible from the Mediacorpcoordination and communication vehicle.

That morning started well initially with the team in highspirits. The catheterization laboratory looked almost like atelevision set-up, complete with cameras and media crew. Theprogramme started promptly at 11am with the media crew’sprompting. This started off with pomp and blazing with Dr ChaiPing’s well composed music video introducing both Singaporeand our institute to the beat of Bond’s music. Following thisA/Prof Lim Yean Teng greeted the international audience.Afterwards, Dr Adrian Low introduced the patient and the team.The first case was a percutaneous intervention to an in-stent

restenosis of a previously placed Genous(coated with monoclonal antibodies toattract endothelial progenitor cells). Thepatient’s radial artery was assessed. Uponengaging the right coronary artery (RCA)ostium, the patient went into an episodeof ventricular fibrillation which wepromptly cardioverted. This wasunexpected but hardly unnerved theoperators. After discussing the varioustechnical options, the international panelagreed with our approach. Both Dr Adrian

Low and A/Prof Lim tackled the lesion confidently andsuccessfully stented the RCA. Throughout the procedure,information regarding the types of devices used and the approachmade was transferred rapidly to a central coordinator, Dr MelissaCo (our intervention fellow) and then quickly transmitted to theMediacorp van and flashed across the television screen.

The second procedure was conducted by A/Prof Tan HuayCheem and Dr Jimmy Lim from Tan Tock Seng Hospital. This toowas a technically challenging procedure involving interventionto an occluded saphenous vein graft. Despite initial difficulties,A/Prof Tan confidently and successfully opened the occlusionand protected the myocardium from embolism using a distalprotection device.

The concluding procedure was performed by Dr RonaldLee and A/Prof Lim. This involved coronary stenting to abifurcating lesion. Although the lesion was complex, theexperienced team made the procedure looked easy and anothersuccessful intervention was completed.

The ambience in the catheterization laboratory was tensebut exciting. This was because every procedure was done andbeamed directly to Japan under close scrutiny. This was also thefirst time we were involved in this Japanese meeting. Although itwas a one and a half hour meeting, we felt time fly. When oursatellite time was declared over, we felt a sense of achievement.This was another notable event in the history of our catheterizationlaboratory and our institute’s journey towards excellence ininterventional cardiology.

Dr Edgar Tay, THI @ NUH

Live transmission toTokyo Percutaneous Cardiovascular

Interventional Conference

Live transmission toTokyo Percutaneous Cardiovascular

Interventional Conference

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European Society of Cardiology Meeting this year was acombined event with World Heart Federation Meeting,conveniently named World Congress of Cardiology (WCC). Itwas held in the beautiful Mediterranean city of Barcelona from2nd to 7th September 2006. Edgar and I had the honor of presentingour abstracts, four in total, at the meeting.

We arrived on a Saturday morning in Barcelona. Thecheaply priced Aerobus (€3.45) brought us within 20 minutes tothe heart of the city, the Placa Espanya and Placa Catalunya. Fromthere we walked to our budget hotel, enjoying the sights of somany people, flowers, pets, buskers and book stands on thetouristy street of La Rambla. This is the ancient Gothic area thatis preserved and thrives with life abundant.

The next three days we had busy schedule attendinglectures, symposia, late-breaking sessions and putting up ourposters. Edgar presented his oral abstract on Monday and attracted

Dr Raymond Wong, THI @ NUH

an admiring Chinese delegate, who invited him to deliver a lecturein Shanghai.

That evening James, Edgar and I walked to the Barcelonabeachfront and filled our oriental stomachs with mighty deliciousTapas and seafood. Though it was too dark to gaze upon deep blueMediterranean seas, the Spanish street musicians serenaded us theCatalan way. On our last day we took Bus Turistik to many scenicand symbolic sites round the city, including architectural wondersof Gaudi, the church Sagrada Familia (icon of Barcelona and Spain),Mount Tibidabo (highest point), and 14th century seminary stillinhabited by a sisterhood order.

To sum it all up, the WCC this year with more than 25,000active participants, and Barcelona were simply worth our two14-hour flights, and hours of sacrifices in putting together our fourabstracts.

WORLD CONGRESS OF CARDIOLOGY 2006

NUH rumbles in Europe


It’s been a great experience to attend the recentlyconcluded Transcatheter Cardiovascular Therapeutics (TCT)convention in Washington D.C. A great eye opener, I should say.We had the pleasure of meeting the TCT course director,Dr Gary Mintz at the Smithsonian American Art Museum wherehe threw a welcome party for Asia-Pacific doctors. Live caseswere performed by world-renowned interventionalist fromdifferent parts of the world showcasing all sorts of interestingcases from coronary to congenital to peripheral interventions.Pools of study results tried to flood up our brains with informationon the controversial drug-eluting stents as well as the future ofcardiovascular intervention. CT angiogram and cardiac magneticresonance imaging is likewise a great attraction.

The Heart Institute will not fail to share the limelight. Aswith previous years, NUH abstracts were accepted forpresentations. Four research papers made it for poster presentationwhile a paper primarily authored by Dr Ronald Lee was able to

make it for oralpresentation. Thishas also earnedDr Lee a facultyposition in thep r e s t i g i o u ssociety, Congrat-ulations!!! Ourchief, A/Prof TanHuay Cheemwho was a longtime faculty member served as one of the panel during livetransmission from Italy and also presented interesting cases on SVGinterventions, Wow!!! You should have seen the faces of the audienceand co-speakers; they were so taken aback by the success despitethe complexity of the cases presented. For all these achievements,let’s give a toast to the cardiac department of NUH. Cheers!!!

Dr Melissa Co Sia, THI @ NUH

NUH rumbles in Europe

The Heart Institute meets in D.C.TRANSCATHETER CARDIOVASCULAR THERAPEUTICS 2006TRANSCATHETER CARDIOVASCULAR THERAPEUTICS 2006

The Heart Institute meets in D.C.

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Chronic venous disease is a common problem whichincludes a spectrum of clinical presentations ranging fromvaricose veins to recurrent venous ulcers. They consumesignificant healthcare resources and can complicate other medicaland surgical conditions. They are also associated with a diminishedquality of life for the patient. Traditional treatment of varicoseveins has been surgical ligation and stripping of the vein. This isassociated with some morbidity and a recurrence rate of 30% atfive years. This may be a result of neovascularisation followingtraditional ligation of the tributaries at the sapheno femoraljunction. Newer percutaneous endovenous treatment modalitieshave emerged for the management of chronic venous insufficiency(CVI) and deep vein thrombosis (DVT).

The Heart Institute recently organised a seminar andworkshop on minimally invasive endovenous treatment whichwas well received and attended by doctors from around the regionincluding India, Taiwan and Indonesia. We welcomed our invitedexpert Dr Ravi Rajagopalan, Director of the Arizona HeartInstitute Vein Centre, Arizona, USA. Dr Ravi fielded a livelydiscussion and live demonstration of endovenous techniques onthree patients.

TREATING VARICOSE VEINS

The indications that a person may need their veins seen to arewhen they start experiencing:

• Heaviness

• Tension

• Aching

• Itching

• Swelling

• Pain

• Inflammation

• Bleeding

• History of blood clots (DVT)

• Ankle sores or skin ulcers

For less severe cases, lifestyle changes such as exercising, weightloss, avoiding long periods of standing and elevating the feet aswell as the wearing of compression hosiery are advised.

A/Prof Peter Robless, THI @ NUH

ENDOVENOUS LASER TREATMENT

(ELT) was introduced at NUH in January 2006. Patient demandand satisfaction has been encouraging as the procedure is doneunder local anaesthesia with minimal scarring and downtime. Theside effects of the surgery are minimal and include slight bruisingor tightness over the treated area. The success rate of ELT is highercompared to traditional surgery both in terms of symptom reliefand recurrence. Less than 10% of patients who have undergoneELT suffer from a recurrence of varicose veins, compared to one-third of patients who underwent traditional surgery.

The Heart Institute offers a comprehensive one stop non-invasive venous ultrasound assessment and minimally invasive ELTunder local anaesthesia in a day surgery setting, performed byfully trained vascular surgeons. At The Heart Institute we treat awhole range of patients with cardiovascular disease so we are verymindful of preserving healthy veins and only treat diseased ordamaged varicose veins.

PERCUTANEOUS TREATMENT FOR DEEP VEIN

THROMBOSIS (DVT)Conventional treatment of DVT includes bed rest, elevation andanticoagulation to prevent further progression. Howeverdissolution of the thrombus or preservation of the venous valvesis not addressed. Unfortunately some of these patients developchronic venous insufficiency and the post phlebitic syndrome.Recent advances have allowed a more pro-active strategy toprevent these chronic complications. These comprisepharmacological and mechanical thrombolysis to prevent postphlebitic syndrome. The window for therapeutic intervention isthought to be up to two weeks following the onset of symptoms.Contraindications to thrombolysis include recent surgery strokeor bleeding disorders. Patients should be carefully evaluated andcounselled for treatment.

New frontiers in thetreatment of venous disease

New frontiers in thetreatment of venous disease

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Dr Carolyn Lam, THI @ NUH

When I received this invitation to share my work andlearning experience here at the Mayo Clinic in Rochester,Minnesota, I thought a good place to start would be to recountmy first two thoughts as I stepped off the plane in late 2004:“Wow, there’s so much open space here – cornfields everywhere!”and “My goodness, it’s cold!” With that backdrop in place allowme to share my early experience here.

My first workplace was at the Cardiorenal Laboratory inthe Guggenheim Building at the Mayo Clinic. I was assigned tostart with murine laboratory. I watched in awe as echo-cardiography was performed on a mouse, whose whole heartwas no bigger than the tip of my little finger; and as a tinyconductance catheter, no thicker than a fine strand of hair, wasinserted via the carotid artery into the left ventricle of the mouseallowing beautiful pressure-volume loops to be recorded. It struckme that I had to learn all these procedures as quickly as possible!

With the guidance of my supervisor Dr Margaret Redfieldand the support of colleagues I now call my “lab family”, I wrotemy first protocol, obtained my first animal ethics approval andperformed murine echocardiography, catheterization, histologicalexamination (semi-quantification of fibrosis) and biochemicalanalysis (natriuretic peptides, signaling molecules, geneticmarkers). While the mouse work occupied my days, I passed thenights writing a chapter on “Heart Failure with Normal EjectionFraction” for the textbook Diagnosis and Management of

Congestive Heart Failure (3rd Edition) edited by BH Greenberg.With all the work there was to do, I didn’t suffer the bitter wintermuch.

As I began to get more comfortable with the mouse work,I became engaged in a human protocol for strain imaging in heartfailure patients. My experience in the Mayo echo lab made merealize how much grounding I had been given at NationalUniversity Hospital that enabled me to focus on learning the newtechniques and exploring exciting emerging areas. The highlightof my time in the patient echo lab was when Dr Liv Hatle visitedthe lab for a few days and spent time sitting with us and discussingcases.

“My experience in the Mayo echolab made me realize how muchgrounding I had been given atNational University Hospital...”

In my second year I had the opportunity to present findingsregarding alternative circulating forms of BNP in the populationas well as the utility of another biomarker, pulmonary surfactantprotein-B, in the diagnosis of ventricular dysfunction at theAmerican College of Cardiology 55th Annual Scientific Sessionsin Atlanta, Georgia. Further findings regarding matrixmetalloproteinases and their endogenous inhibitors werepresented at the Heart Failure Society of America 10th AnnualScientific Meeting in Seattle, Washington. At this meeting, I alsohad the privilege of presenting echo-based findings on ventricular-vascular stiffening and remodeling in diastolic heart failure, whichwas awarded the top prize at the Jay N Cohn New InvestigatorClinical Award Competition.

The Mayo Clinic truly offers a valuable setting for mindsfrom all over the world to exchange ideas, and I cannot even beginto express how thankful I am for this stint at Mayo. My experiencehas taught me to appreciate where I came from, the excellentgrounding in Cardiology that I was given and the support fromhome, not to mention the daily warmth, sunshine and Singaporeanfood that I miss so very much.

My learning experience atMayo Clinic, USA

My learning experience atMayo Clinic, USA

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All of my life, I have received myeducation in Singapore. Though I havetraveled widely around the world, thenatural feeling of apprehension and anxietybesieged me as I touched down in LesterPearson International Airport, Toronto,Ontario, Canada. The experience that Igained for that one year will be sweetlymemorable.

Toronto was unlike any westerncity that I have been. Firstly I lived in thedowntown Toronto (five minutes walk tothe Toronto General Hospital) and yet it issafe. Secondly, the multi culture, race andreligion reminded you of Singapore.Thirdly I could easily find Asian and Halalfood and also the mosque is only fiveminutes away from my home. Finally,Torontonian are such polite and helpful lottherefore not surprising, in the recentReaders Digest Survey, Toronto wasranked as the second most courteous city!All these set the stage for a successfulfellowship despite the initial naturallyunderstanding apprehension and fear.

My clinical fellowship inelectrophysiology and pacing wasperformed in Toronto General Hospital,within the department of medicine of the

Dr Abdul Razakjr Bin Omar, THI @ NUH

University of Toronto. This involvedclinical rotation in the invasiveelectrophysiology/device laboratory,wards, clinics and research.

During my attachment in theinvasive electrophysiology/devicelaboratory, I was involved in diagnosticevaluation and catheter ablation ofdysarrhythmia. I performed 150 suchprocedures over the period of one year.The complexity of the cases is mindblowing and I am only too glad to beinvolved. Also I was involved with130 device surgical procedures (inclusiveof device (pacemakers & ICD)implantation, replacement, repositioning(single, dual or cardiac resynchronizationsystem) and device laser lead extraction.

The attachment in the wards andclinics exposed you to clinical managementof patients with dysarrhythmia before and/or after electrophysiology or devicesurgical procedure. These made the clinicaltraining more complete.

I also had the opportunity to beinvolved in research. A recent research thatjust ended was entitled PrincipalComponent Analysis: A novel method ofdifferentiating Isthmus Dependant AtrialFlutter (IDAF) from Non IsthmusDependent Atrial Flutter (NIDAF). Thisinvolved obtaining intracardiac signal inatrial flutter patient, signal averaged it

through a custom software developedin MATLAB, presenting it as a

vector loop, Green’s Theoremarea of the loop and

principal componentanalysis. Personally, I

have never beenexposed to suchcomplex andrigorous research.

Euphoric is a term that I will use todescribe this research experience. Theresearch experience did not end there, Iwas also given the opportunity to observeswine heart ventricular fibrillationmapping using the Langerdoff apparatusin the animal laboratory. It was amazingto see how a mere contact of the 9 Voltsbattery to a swine heart set off ventricularfibrillation. I remember in my childhood,I used to place such battery on my tongueto feel the tingling sensation!Retrospectively, it was a foolish act. It wasalso amazing to realize that ventricularfibrillation is in fact a regular rhythm andnot as chaotic as it was perceived.

Through the research performed, Ihad two abstracts accepted for presentation

1. Heart Rhythm Society meeting inMay 2006 – WPW and Fabry’sDisease: Evidence for atrio-ventricular and atriohisianaccessory pathway conduction.Omar AR, Harris L, Cameron DA,Chauhan VS in Heart Rhythm2006. Abstracts of the 27th AnnualMeeting of the Heart RhythmSociety, Boston, Massachusetts,USA

2. Canadian CardiovascularConference in Vancouver,September 2006 – BrugadaSyndrome: A Non SpecificPhenotype? Omar AR,Dhospehwarkar R, Downar E,Nanthakumar K

and I had two manuscripts accepted forpublications

1. Wide complex beats withventricular hypertrophy: what isthe mechanism? Omar AR, HarrisL, Cameron DA, Chauhan VS JCardiovasc Electrophysiol. 2006Oct;17(10):1150-2

My Clinical Fellowshipin Toronto

My Clinical Fellowshipin Toronto

THI Pulse 2/2006 FA 12/12/06, 10:17 AM14

This year the Cardiac Department conducted its annual GPsymposium in July 2006. It was very well received, as evidenced by theattendance of 120 GPs. Interesting series of talks were put up by the speakersthat concern day-to-day primary care cardiology. The Chief, A/Prof Tan HuayCheem and Dr Adrian Low welcomed the participants who were treated to asumptuous lunch prior to that.

Dr James Yip began the symposium with a gleeful talk on CT Angiogram,its principle and application. Those present were wowed by the detailed andlifelike pictures flashed on the screen, and the talk duly invited questions afterquestions on the latest imaging technique. I had a feeling that NUH will soon getan influx of CT angiogram requests.

Dr Chai Ping then dwelled on the difficult topic of cardiac stressinvestigations. While there are many tests that one could order to excludecoronary ischaemia, choosing the right one for the right patients at the rightprice could be a challenge. Dr Chai did well to dissect each of the stress modalityavailable in NUH.

I then presented echocardiography movies to showcase the power of thetechnique in unraveling diseases that affect the myocardium, valves andpericardium. Finally, Dr Razak breezed through the difficult topic ofelectrophysiology and gave excellent illustration of the diseases, investigationsand treatment NUH Cardiac Department had in store for suitable patients.

The GP symposium was drawn to a close at 4.30 pm. It had been enrichingand educational for all attendees, and the NUH Cardiac Department is certainto organize another session next year.


Cardiac GPworkshopCardiac GPworkshop


2. A review of the efficacy ofcardioverter-defibrillator in olderadults.Omar AR, Nanthakumar K.Geriatrics & Ageing, 2006Apr:9(4):257- 63.

Continuing medical education wasalso conducted through weekly journalclub, conferences and workshop. Theweekly journal club, topics related tocardiac electrophysiology were presentedand discussed by fellows and staff.

I had the opportunity of attendingHeart Rhythm Society advance ablationcourse in San Francisco. In addition therewere three fellows weekend conferencesfor cardiac pacemaker and catheterablations organized within Canada. Allthese educational meetings andconferences update you on the latest incardiac electrophysiology.

The clinical fellowship had beenrigorously exhaustive but excellent inmany ways. In my view, it transformed afellow into a competent cardiacelectrophysiologist. Personally, I feel thatI am now a competent cardiac electro-physiologist with the ability to provideclinical management of dysarrhythmia atthe level of a world-class center likeToronto General Hospital. This willdefinitely benefit NUH cardiacdepartment and NHG cluster. In addition,I was introduced to the latest and advancetechnology in cardiac electrophysiologywhich on the same note, will positively addto position NUH and NHG as a world classmedical institution.

THI Pulse 2/2006 FA 12/12/06, 10:18 AM15


On 20th October 2006, we were treatedto a sumptuous “Promotion dinner” co-hosted by Emeritus Professor Chia BoonLock, Associate Professor Tan Huay Cheemand Associate Professor Yeo Tiong Cheng

16th October was a special day for all at Cardiac Centreas we prepared for Minister of State for Health, Mr Heng CheeHow’s visit. The visit was part of Mr Heng’s familiarization ofpublic healthcare institutions and it was his first briefing by NHG

Ms Ng Bee Ling, Cardiac Dept @ NUH

and NUH. After about an hour of anxious waiting, Mr Heng andhis officials arrived with CEO (NHG), Dr Lim Suet Wun, CEO(NUH) Mr Chua Song Khim and COO (NUH) Mr Joe Sim at5.30pm. At the entrance of Cardiac Centre, Mr Heng was greetedby Cardiac Chief, A/Prof Tan Huay Cheem and our staff. He wasthen brought around the Centre, where A/Prof Tan explained indetail the range of services provided by Cardiac Centre as well asthe yearly workload of the department.

Apart from his visit to Cardiac Centre, Mr Heng was alsobrought to Clinic D, EMD and some inpatient wards. Overall,Mr Heng found the visit very fruitful and he was especiallyimpressed with NUH’s passion and commitment towardsexcellence, as well as our “can do” spirit. A big thank you toA/Prof Tan and all the staff of Cardiac Centre who hadcontributed towards this very special visit!

at the Noble House restaurant. Notice theillustrious designations that gloss the namesof the brilliant clinicians who contibutedso much to Cardiology Singapore.A/Prof Tan embraced the guests with

warm generosity and charm; Prof Chia was‘lost for words’ momentarily, andA/Prof Yeo was more generous than usualfor words. The outgoing medical officersalso received their deserved parting dinnerconcurrently. It was, on the whole, aglittering dinner with our own BradPitts, Steven Spielbergs, and a doyen ofCardiology.

Minister Heng Chee Howvisits Cardiac Centre

Minister Heng Chee Howvisits Cardiac Centre

A glittering dinnerhosted by the Professors


A glittering dinnerhosted by the Professors

THI Pulse 2/2006 FA 12/12/06, 10:19 AM16


abstractsabstracts

1. Acute occlusion of the left anterior descending artery following intravascularultrasound examination of left main coronary artery. Lee CH, Lim IH, TanHC. International Journal of Cardiology

2. Dilemma of drug-eluting stent implantation in a patient with systemic lupuserythematosus. Lee CH, Chan MY. International Journal of Cardiology

3. Oral sildenafil therapy improves health-related quality of life and functionalstatus in pulmonary arterial hypertension Wong RCC, Koh GM, ChoongPH, Yip JWL. International Journal of Cardiology

4. Severe aortic regurgitation: An exceptional cardiac manifestation ofCongenital Rubella Syndrome Tay E, Yang H, Ling LH. International Journalof Cardiology

5. Type A aortic dissection: a hidden and lethal cause for failed thrombolytictherapy in acute myocardial infarction.Lee CH, Lim J. Heart

6. CYPHER versus TAXUS stent for bifurcation lesions beyond 30 days – long-term follow-up results.Lee CH, Low A, Lim J, Wong HB, Lim YT, Tan HC.International Journal of Cardiology

7. Incidence, predictors and outcomes of Device Failure of X-sizerthrombectomy. Experience of 200 cases in five years.Lee CH, Tan HC, WongHB, Zhang XL, Fun S, Gay M, Qu L, Lim J, Low A, Lim YT. American HeartJournal

8. An inverse relation between diastolic blood pressure and long-term outcomesin patients undergoing pharmacoinvasive therapy for myocardial infarction:J-shape relation in contemporary era of revascularization.Lee CH, Foo D,Wong HB, Hong E, Seow SC, Ng KS, Lim YT, Tan HC. Journal ofCardiovascular Medicine

9. Wide Complex Beats with Ventricular Hypertrophy: What is the mechanism?Omar AR, Harris L, Cameron DA, Chauhan VS J Cardiovasc Electrophysiol.2006 Oct;17(10):1150-2


17TH ANNUAL SCIENTIFIC SESSION, AMERICAN

SOCIETY OF ECHOCARDIOGRAPHY, BALTIMORE

3-7 JUN 20061. Stroke-Work Loss underestimates hemodynamic significance of Aortic

Stenosis in patients with Hypertension. Poster presentation, Wong RCC, YeoTC

2. Left atrial volume is an independent predictor of exercise capacity in patientswith isolated diastolic dysfunction. Moderated poster presentation PenafielHP, Wong RCC, Yeo TC

WORLD CONGRESS OF CARDIOLOGY,BARCELONA, SPAIN, 2-5 SEP 20061. Stroke-Work Loss underestimates hemodynamic significance of Aortic

Stenosis in patients with Hypertension. Poster presentation Wong RCC, YeoTC

2. Left atrial volume is an independent predictor of exercise capacity in patientswith isolated diastolic dysfunction. Moderated poster presentation PenafielHP, Wong RCC, Yeo TC

3. Impact of anemia and thrombocytosis on mortality following acute myocardialinfarction. Poster presentation.Tay E, Ho KT, Tan WD, Sim LL, Yip JWL,Chia BL, Chan MYY, Yeo TC

4. Impact of combination evidence-based therapy on mortality followingmyocardial infarction in elderly patients. Oral presentation Tay E, Chan MYY,Tan V, Sim LL, Ho KT, Yeo TC

ANNUAL SCIENTIFIC CONGRESS, NATIONAL

HEALTHCARE GROUP, 30 SEP-1 OCT 2006Characteristics, treatment modalities and short-term outcome for ST-elevation myocardial infarction (STEMI) in the elderly: A single centercase-control study. Oral presentation

17TH ANNUAL SCIENTIFIC SESSION, AMERICAN

SOCIETY OF ECHOCARDIOGRAPHY, BALTIMORE

3-7 JUN 2006

WORLD CONGRESS OF CARDIOLOGY,BARCELONA, SPAIN, 2-5 SEP 2006

ANNUAL SCIENTIFIC CONGRESS, NATIONAL

HEALTHCARE GROUP, 30 SEP-1 OCT 2006

TRANS-CATHETER THERAPEUTICS,WASHINGTON, DC, 22-27 OCT 20061. Sirolimus-eluting, bioabsorbable polymer-coated constant stent (Curatm)

in acute ST-elevation myocardial infarction – a clinical and angiographicstudy. Oral presentation Lee CH, Lim J, Low A, Zhang XL, Kyaing TT,Chan MY, Wong HB, Lim, YT, Tan HC

2. Pretreatment with intracoronary adenosine reduces the incidence ofmyonecrosis after non-urgent percutaneous coronary intervention – aprospective randomized study. Poster presentation Lee CH, Low A, TaiBC, Co M, Chan MY, Lim J, Lim YT, Tan HC

3. Use of Endothelial Progenitor Cell Capture Stent (Genous® Bio-Engineered R Stent) in Acute Myocardial Infarction M Co, HC Tan, CHLee, J Lim, AFH Low, YT Lim

4. Clinical outcomes following implantation of second generationSirolimus- versus Paclitaxel-eluting stent for complex coronary arterydisease in an unselected population: Real life results of the heart institutedrug eluting stent interventional result evaluation (THI-DESIRE)registry CY Soon, D Singh, YH Chan, YT Lim, HC Tan

5. Atrial septal defect closure improves right ventricular size but notexercise capacity or NT-proBNP levels Eric Chong, GM Koh, PHChoong, SC Quek, William Yip, James Yip

6. Clinical outcomes and incidence of adverse events in patients undergoingprimary percutaneous coronary inetrvention for ST-segment elevationmyocardial infarction given 600mg loading dose of clopidogrel withoutroutine glycoprotein Iib/IIIa inhibitor use. Jimmy Lim, Dinesh Nair,Brian Khoo, Pow-Li Chia, Chee Keong Ng

7. Efficacy of Primary Percutaneous Coronary Intervention for AcuteMyocardial Infarction Secondary to Acute Left Main CoronaryOcclusion. Pow-Li Chia, Dinesh Nair, Beloso Randy, Lim Alynn, FazilahSiti, Wilkinson Neil, Jimmy Lim, Chee-Keong Ng

TRANS-CATHETER THERAPEUTICS,WASHINGTON, DC, 22-27 OCT 2006

publicationspublications

THI Pulse 2/2006 FA 12/12/06, 10:19 AM17


happeningshappeningsCARDIAC GP WORKSHOP, SINGAPORE29 JULY 2006

NATIONAL HEART FAIRAT TIONG BAHRUPLAZA, SINGAPORE23 – 24 SEPTEMBER 2006

CARDIOTHORACIC SURGERY

SPECIALTY UPDATE COURSE,

SINGAPORE

17 – 18 OCTOBER 2006

CHARITY TREADMILLCHALLENGE, NUH30 JUNE 2006

LIVE TRANSMISSION TOTOPIC (TOKYOPERCUTANEOUSCARDIOVASCULARINTERVENTIONALCONFERENCE), JAPAN20 – 22 JULY 2006

NEW FRONTIERS IN THE

TREATMENT OF VENOUS

DISEASE: MINIMALLY

INVASIVE ENDOVENOUS

WORKSHOP, SINGAPORE

15 AUGUST 2006


SIGNING OF MOUBETWEEN THE HEARTINSTITUTE ANDSINGAPORE HEARTFOUNDATION FORREFERRAL OF PATIENTS TOHEART WELLNESS CENTRE29 SEPTEMBER 2006

THI Pulse 2/2006 FA 12/12/06, 10:20 AM18


2ND ASIAN INTERVENTIONAL CARDIOVASCULARTHERAPEUTICS, INDIA1 – 4 OCTOBER 2006

VISIT TO CARDIAC CENTRE BY

MINISTER OF STATE FOR HEALTH,

MR HENG CHEE HOW

16 OCTOBER 2006

CARDIAC FAMILY DAY, SAFRA MOUNT FABER11 NOVEMBER 2006

A/PROF TAN HUAY CHEEM’S LECTURE INCHINA

A/PROF TAN HUAY CHEEMOPERATING AT UNIVERSITY TEXASMEDICAL CENTRE


HEART FAILURE SUPPORT GROUP OUTING,NATIONAL ORCHID GARDEN AT SINGAPOREBOTANICAL GARDEN18 NOVEMBER 2006

THI Pulse 2/2006 FA 12/12/06, 10:21 AM19

THE HEART INSTITUTE,NATIONAL HEALTHCARE GROUP

Secretariat Officec/o Department of Cardiac, Thoracic & Vascular SurgeryNational University HospitalLevel 2, Main BuildingSingapore 119074Tel 6772 5565Fax 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

directorydirectory

Cardiac Dept, National University Hospital

Dr Tan Huay Cheem has been appointed asAdjunct Associate Professor,

Yong Loo Lin School of Medicine,National University of Singapore

Professor Chia Boon Lock has been conferredthe title of Emeritus Professor by the

National University of Singapore

Dr Yeo Tiong Cheng has been appointed asClinical Associate Professor,


Tan Tock Seng Hospital

Dr David Foo Chee Guan has been promotedfrom Registrar to Associate Consultant

NATIONAL UNIVERSITY HOSPITAL5 Lower Kent Ridge RoadSingapore 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

congrats!congrats! new doctorson board

new doctorson board


Dr Chen Lin Yee – Associate ConsultantDr Cuyco Ronald – Echo fellow

Dr Eduardo Tin Hay – Interventional fellowDr Melissa Co Sia – Interventional fellow

Cardiac, Thoracic & Vascular Surgery Dept,National University Hospital

Asst Prof John Tam Kit Chung – Consultant Thoracic,Esophageal & Minimally Invasive Surgeon

Prof Uwe Klima – Cardiothoracic & Vascular SurgeonAsst Prof Theodoros Kofidis – Cardiothoracic Surgeon

Dr Hardip Singh – RegistrarDr Gimao Caesar Lopez – Clinical FellowDr Eliana C Martinez – Research Fellow


Dr Chen Lin Yee – Associate ConsultantDr Cuyco Ronald – Echo fellow

Dr Eduardo Tin Hay – Interventional fellowDr Melissa Co Sia – Interventional fellow

Cardiac, Thoracic & Vascular Surgery Dept,National University Hospital

Asst Prof John Tam Kit Chung – Consultant Thoracic,Esophageal & Minimally Invasive Surgeon

Prof Uwe Klima – Cardiothoracic & Vascular SurgeonAsst Prof Theodoros Kofidis – Cardiothoracic Surgeon

Dr Hardip Singh – RegistrarDr Gimao Caesar Lopez – Clinical FellowDr Eliana C Martinez – Research Fellow


Dr Tan Huay Cheem has been appointed asAdjunct Associate Professor,


Professor Chia Boon Lock has been conferredthe title of Emeritus Professor by the

National University of Singapore

Dr Yeo Tiong Cheng has been appointed asClinical Associate Professor,


Tan Tock Seng Hospital

Dr David Foo Chee Guan has been promotedfrom Registrar to Associate Consultant

THI Pulse 2/2006 FA 12/12/06, 10:21 AM20

dr abdul razakjr’s clinical fellowship in toronto us/publications/pulse... · clinical fellowship...

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