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Background: Mechanical PR Interval (MPRI) is an important parameter in the fetus as a surrogate for PR interval. Normal values of MPRI have been reported with controversial effects of Fetal Heart Rate (FHR) and Gestational Age (GA). However, the effect of HR-correction on PR interval is unknown. Objectives: This study aimed to obtain the reference values of fetal MPRI in a large series of normal fetuses by pulsed-Doppler fetal echocardiography. This was done to determine the influence of fetal sex, Heart Rate (HR), GA, and maternal age on MPRI and to calculate the novel HR-Corrected Mechanical PR Interval (CMPRI) to investigate whether HR-correction of PR interval can decrease the influence of HR. Materials and Methods: This cross-sectional study was performed on 516 consecutive normal singleton fetuses. By extrapolation from Bazett's formula, we corrected the MPRI for HR. Impact of fetal sex, HR, and GA on MPRI and CMPRI was studied. Mean ± standard deviation, 5th, 50th, 95th, and 99th percentiles of MPRI and CMPRI were also calculated. Then, the data were entered into Stata, version 12 and analyzed using t-test, ANOVA, and linear regression. Results: Reference values of MPPR and CMPRI were provided in four GA groups; i.e., 14 - 18, 19 - 22, 23 - 26, and 27 - 38 weeks. Fetal sex and maternal age had no influence on either MPRI or CMPRI. After adjustment for fetal sex, GA, and maternal age, there was a 0.14-millisecond (ms) decrease in MPRI and a 8.06-ms increase in CMPRI for every single increase in FHR. Additionally, adjusted linear regression model indicated a 0.43-ms increase in MPRI and a 2.53-ms increase in CMPRI per gestational week. The results of paired t-test showed no significant difference between fetal MPRI and neonatal PR interval. Conclusions: This study provided reference values for MPRI and CMPRI in fetus from 14 to 38 weeks of gestation from the 5th to the 99th percentile. The results also revealed significant correlations between both FHR and GA and MPRI and CMPRI. Furthermore, HR correction of MPRI did not add any advantage in terms of HR-independency of mechanical PR interval. [ABSTRACT FROM AUTHOR]

Background: Surgical Aortic Valve Replacement (SAVR) is the gold standard method for treatment of symptomatic severe senile Aortic Valve Stenosis (AS). For inoperable patients, due to severe co-morbidities, Transcatheter Aortic Valve Implantation (TAVI) has been suggested as a new and safe alternative with significant follow up superiority to medical treatment; recently, it was suggested for patients at intermediate risk, as well. Since its introduction in 2002, TAVI has well developed in more than 40 countries. Objectives: We made an attempt to transfer this technology to Tehran University for the first time and then evaluated the feasibility and safety of this new technique with midterm closed clinical and echocardiographic follow up. Patients and Methods: Eight patients (5 males), with a mean age of 77 ± 6.7 years old underwent transfemoral TAVI from 2010, as the first sequential patients in Tehran University, by Balloon expandable bioprosthetic Edwards SAPIEN transcatheter heart valve, under general anesthesia in hybrid operation room. Results: There were 7 tricuspid valves and one bicuspid aortic valve (AV). All the patients had symptomatic severe senile valvular AS with severe co-morbidities so that the surgeons did not agree with open SAVR. Closed preprocedural, procedural, in hospital, one and 6 months clinical and echocardiographic assessments and follow up were done. Results: Procedural success rate was 100% with good implantation of the valve. A decrease in the AV mean gradient (MG) from preprocedural mean AVMG 52.2 ± 19.7 mm Hg to 9.8 ± 3.7 mm Hg was observed in the 6 month follow up. One patient had procedural papillary muscle damage and moderate mitral regurgitation (MR), which needed hemodynamic support. No in hospital mortality or major complications were seen. In the follow up period, one patient had unexplained sudden death in sleep 3 weeks after the discharge. The other 7 patients had good 6 months of follow up with improvement of Functional Class (FC) and Left Ventricle Ejection Fraction (LVEF) from mean 43 ± 13.5 % preprocedural to 50.7 ± 7.8% within 6 months. Conclusions: Inoperable symptomatic senile valvular AS could be treated safely with TAVI. In- hospital results of the first sequential experience of TAVI in Tehran University of Medical Sciences were successful. TAVI in bicuspid AS and concomitant MR patients needs more caution in the procedure and follow up. [ABSTRACT FROM AUTHOR]

Idiopathic right atrial dilation is known as a congenital anomaly in the absence of obvious causes that produce right ventricular pressure or volume overload. Congenital giant right atrium can cause functional tricuspid regurgitation, arrhythmia, and right-sided heart failure. A massive Idiopathic Dilation of Right Atrium (IDRA) was reported in a 30-year-old man presented with intermittent palpitation and dyspnea on effort. Transthoracic echocardiography revealed huge right atrium leading to severe tricuspid regurgitation, moderate right ventricular enlargement with moderate dysfunction, and no evidence of other valvular heart diseases increasing the right ventricular pressure or volume, left to right shunt, and Ebstein anomaly. Cardiac Magnetic Resonance Imaging (MRI) confirmed the right atrial enlargement. The estimated right atrium volume by MRI was about 700 mL. With regard to the patient's symptoms, he was scheduled for surgical treatment. The patient underwent partial surgical resection of the dilated right atrium wall and mechanical tricuspid valve replacement because the tricuspid valve was unrepairable on the operation table. Idiopathic right atrial enlargement is a very rare disease and may be easily confused with other anomalies that lead to right atrial enlargement, such as Ebstein anomaly. Hence, the probability of this pathology should be kept in mind when the usual etiologies of right atrial enlargement are excluded. Partial surgical resection of the dilated right atrium is an effective therapeutic option in symptomatic patients. [ABSTRACT FROM AUTHOR]

Objectives: Transposition of Great Arteries (TGA) is a serious congenital heart disease and anatomic correction in the first few weeks of life has revealed good outcomes nowadays. In this study, we aimed to evaluate the myocardial and valvular function at midterm postoperative follow-up. Patients and Methods: In this study, thirty-three patients with TGA and Arterial Switch Operation (ASO) were evaluated by 2-dimensional, M-mode, Doppler, and pulsed Tissue Doppler. These patients were compared with 33 healthy children of the same age and gender as the normal control group. Student's t-test and Pearson correlation were used to analyze the data. Besides, P<0.05 was considered as statistically significant. Results: The mean follow up time was 40.9±5.6 months. Among the 33 patients with ASO, 6% had mild pulmonary stenosis, while 3% had mild pulmonary insufficiency. Aortic stenosis and aortic insufficiency of trivial to mild degree was seen in 12% and 12% of the patients, respectively. The patients' systolic velocity of tricuspid (S), early diastolic velocity of tricuspid (Ea), and late velocity of tricuspid valve (Aa) were significantly different from those of the controls (P<0.001). Also, pulmonary annulus diameter was significantly dilated in the patients compared to the controls (1.67±0.41 vs. 1.29±0.28, P⩽0.001). Besides, aortic annulus diameter (1.56±0.42 vs. 1.24±0.21, P=0.001) and also aortic sinus diameter (2.06±0.41 vs. 1.44±0.34, P=0.002) were significantly dilated, while sinutuboar junction diameter (1.65±0.5 vs. 1.28±0.29, P=0.094) was not dilated. Left ventricular function was in the normal range. Conclusions: This study showed good left ventricular function, but some abnormalities in lateral tricuspid tissue Doppler velocities. Neoaortic and pulmonary diameters were significantly dilated, while aortic and pulmonary insufficiencies were clinically insignificant in most of the patients. Long-term follow-up is necessary in these patients. [ABSTRACT FROM AUTHOR]

We report a case of idiopathic nonsustained ventricular tachycardia (VT) originating from the aortic sinus cusp referred for presyncope and LV dysfunction and frequent premature ventricular complex with no response to 3 months anti-arrhythmic medication for heart failure and arrhythmia. She was then referred to us for frequent PVC's and runs of nonsustained VT. ECG recorded during the nonsustained VT showed a left bundle branch block pattern in the precordial leads and an inferior axis and early transition in precordial leads in V3-V4. QS morphology in lead V1 was noticed with notching on the downward deflection. Electrophysiologic study was conducted to map ventricular outflow tract as a classic method, although pace map failed to find any matched QRS with the spontaneous PVCs. The mapping of aortic cusps was also performed. The best potential was recorded in a region located at the commissure of left-right aortic cusps. A single radiofrequency energy was delivered which resulted in immediate elimination of PVCs. The patient was discharged the day after ablation without any PVC recorded on monitor. Left ventricular ejection fraction(LVEF) improved to normal level two months later. There was no PVC detected at serial holter monitoring. It seems logical not to overlook even an isolated or nonsustained ventricular arrhythmia considering the available and effective treatments such as ablation rather than congestive heart failure(CHF) therapy especially in a young patient. [ABSTRACT FROM AUTHOR]

Objectives: Dilated cardiomyopathy is the most prevalent type of cardiomyopathy in children, which results in congestive heart failure and causes significant morbidity and mortality. This study, aims to investigate the effect of supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFA) on heart function and oxidative stress biomarkers in these patients. Methods: The present research was a case-control study on pediatric patients with dilated cardiomyopathy, who received n-3 PUFA and anti-failure therapy for 6 months (group 1, n = 6), or anti-failure therapy alone for 6 months (group 2, n = 6), as well as age matched normal individuals (group 3, n = 6), and evaluated the cardiac function and biomarkers of oxidative stress. Results: Echocardiographic parameters, such as left ventricular ejection fraction, shortening fraction, tissue Doppler Ea and Aa waves of lateral annulus of tricuspid valve, and Ea and S wave of septum, were significantly improved in group 1 after n-3 PUFA compared to pre- treatment status, while they were not changed after treatment in group 2. Antioxidant enzymes, including catalase and glutathione peroxidase activities in erythrocytes were slightly decreased, while plasma 8-iso-prostaglandin F2ct concentrations were somewhat increased in group 1 compared to groups 2 and 3, however these changes were not statistically significant. Total antioxidant capacity of plasma was similar in all 3 groups. Conclusions: The results indicate that some echocardiographic parameters were significantly improved in patients receiving omega-3 fish oil. However, omega-3 had no significant effect on oxidative stress biomarkers. [ABSTRACT FROM AUTHOR]

Six female patients aged from 19 to 73 years, with ostium secundum atrial septal defect underwent closure procedure with Amplatzer septal occluder device. Three-dimensional Echocardiography (3D-TEE) was done during the procedure or one day after the procedure. 3D-TEE provides incremental value over Two- dimensional trans-esophageal echocardiography in measuring Amplatzer septal occluder disc sizes and correlates well with manufacture device size. 3D-TEE will surely prove to increase the technical efficiency and it will become an important tool for the interventionists for periprocedural evaluation of device closures. [ABSTRACT FROM AUTHOR]

Background: A paucity of data exists regarding the prevalence and relationship of hypomagnesaemia with clinical symptoms of mitral valve prolapse (MVP) in pediatric patients. Objective: In this study we evaluated the prevalence of magnesium (Mg) deficiency in pediatric patients with MVP syndrome and attempted to clarify the effect of Mg therapy on alleviating their symptoms. Methods: The present study was conducted from April 2010 to January 2012, and included 230 patients (90 males and 140 females) with symptoms of mitral valve prolapse and mean age of 11.6±3.66. Serum magnesium (Mg) level less than 1.5 mg/dl was defined as hypomagnesaemia. Patients with 2 mm leaflet displacement and maximum leaflet thickness of 5 mm in echocardiography were considered to have classic MVP, while those with leaflet thickness less than 5 mm were considered as non-classic MVP. Patients with hypomagnesaemia were orally treated with 4.5 mg/kg/day Mg chloride for 5 weeks followed by re-evaluation of symptoms of chest pain, palpitation, fatigue and dyspnea. Results: Hypomagnesaemia was found in 19 (8.2 %) of 230 patients with mitral valve prolapse. The re-evaluation of patients with Hypomagnesaemia after 5 weeks of Mg therapy, showed statistically significant relief of chest pain (P=0.01). However, no significant changes was detected in regard to palpitation (P=0.06), fatigue (P= 0.5) and dyspnea (P=0.99). Conclusion: This study revealed that the prevalence of hypomagnesaemia in pediatric patients with mitral valve prolapse is relatively low compared to adults, but treatment with oral Mg in patient with hypomagnesaemia decreases chest pain. [ABSTRACT FROM AUTHOR]

Background: Left ventricular twist/torsion is believed to be a sensitive indicator of systolic and diastolic performance. To obtain circumferential rotation using tissue Doppler imaging, we need to estimate the time-varying radius of the left ventricle throughout the cardiac cycle to convert the tangential velocity into angular velocity. Objective: The aim of this study was to investigate accuracy of measured LV radius using tissue Doppler imaging throughout the cardiac cycle compared to two-dimensional (2D) imaging. Methods: A total of 35 subjects (47±12 years-old) underwent transthoracic echocardiographic standard examinations. Left ventricular radius during complete cardiac cycle measured using tissue Doppler and 2D-imaging at basal and apical short axis levels. For this reason, the 2D-images and velocity-time data derived and transferred to a personal computer for off-line analysis. 2D image frames analyzed via a program written in the MATLAB software. Velocity-time data from anteroseptal at basal level (or anterior wall at apical level) and posterior walls transferred to a spreadsheet Excel program for the radius calculations. Linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the tissue Doppler and 2D-measured radii throughout the cardiac cycle. Results: There was significant correlation between tissue Doppler and 2D-measured radii and the Pearson correlation coefficients were 0.84 to 0.97 (P<0.05). Bland-Altman analysis by constructing the 95% limits of agreement showed that the good agreements existed between the two methods. Conclusion: It can be concluded from our experience that the tissue Doppler imaging can reasonably estimate radius of the left ventricle throughout the cardiac cycle. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the short- term effects of percutaneous mitral valvuloplasty (PMV) on coexisting AR. Methods: Clinical, echocardiographic and catheterization data from hospital records of a total of 327 patients with rheumatic mitral stenosis who underwent PMV at a tertiary centre were retrospectively reviewed and aortic regurgitation changes 48 hours post PMV was recorded. Results: The study population consisted of 282 females and 45 males. Mean age at the time of intervention was 47.13±11 years. Before PMV, 142 (43.3%) patients had no AR, 124 (37.9%) had mild AR and 61 (18.7%) had moderate AR. There was no change in AR severity in post- PMV follow-up. AR progression after PMV and during the follow-up was not significant and there was no increase in the need for aortic valve replacement (AVR) procedures. Conclusions: Our findings indicated that a considerable number of patients with rheumatic mitral stenosis had concurrent AR. At the time of PMV concomitant AR does affect procedural success and is not associated with inferior outcomes. Patients with moderate degrees of AR remain good candidates for PMV. [ABSTRACT FROM AUTHOR]

Aorto-left ventricular tunnel (ALVT) is a congenital anomaly of aortic root which is an extra cardiac connection between the aorta and the left ventricle. It is usually short and direct but this report describes an aneurysmal aorto-ventricular tunnel which due to large left ventricular and small aortic hole culminated in aneurysm. This type of ALVT might be misdiagnosed as other cardiac lesions. [ABSTRACT FROM AUTHOR]