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Background: The initial trial in tricuspid surgery is repair; however, replacement is done whenever the valve is badly diseased. Tricuspid valve replacement comprises 1.7% of all tricuspid valve surgeries. Materials and Methods: The present retrospective study was performed using the medical records of 21 cases who underwent tricuspid valve replacement from January 2002 until the end of December 2010. The mean age of the participants was 52.3±8.8 years and 66.7% were females. In addition, tricuspid valve replacement was associated with mitral valve surgery, aortic valve surgery, and both in 14.3%, 4.8%, and 33.3% of the cases, respectively. Yet, isolated tricuspid valve replacement and redo surgery were performed in 10 cases (47.6%) and 8 cases (38.1%), respectively. Besides, trial of repair was done in 14 cases (66.7%). Moreover, biological and mechanical valves were used in 76.2% and 23.8% of the patients, respectively. Results: According to the results, early mortality was 23.8% and one year survival was 66.7%. Moreover, early mortality was caused by right ventricular failure, multiorgan failure, medistinitis, and intracerbral bleeding in 42%, 28.6%, 14.3%, and 14.3% of the cases, respectively. In addition, 57.1% of the deaths had occurred in the cases where the biological valve was used, while 42.9% of the deaths had taken place where the mechanical one was utilized. Conclusions: The patients who require tricuspid valve replacement are usually high risk surgical candidates with early and long term mortality. The findings of the current study showed no significant hemodynamic difference between mechanical and biological valves. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine whether Diabetes Mellitus (DM) is a predictor of short term mortality ; morbidity, or early readmission to hospital after Coronary Artery Bypass Graft (CABG). Methods: We analyzed a large cohort of 952 patients who had undergone isolated CABG. The preoperative, intera operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and nondiabetics. Among the 952 patients; 734 ones (77.1%) were in non-diabetic group and 218 (22.9%) were diabetics. Results: Having DM did not increase the risk of 30-day mortality. In addition, DM did not affect the major complications; arrhythmia, Myocardial Infarction(MI), infective complications, neurological complications, Pulmonary Embolism (PE) except renal complications that was higher in the diabetics (5.5% vs 1.4%; P<0.001, OR=4.2) However reoperation for bleeding was higher in non-diabetic patients (7.9% vs 4.6%; P=0.009, OR=l.7). Nevertheless ,no significant difference was observed between the two groups regarding mechanical ventilation time (hour), reintubation, length of ICU stay (day), length of hospital stay (day), and readmitting as postoperative variables. Conclusions: Except for renal complications, DM was not associated with adverse outcomes in the patients undergoing isolated CABG. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was: Is primary Arterio-venous fistula the vascular access of choice for adequate dialysis and better patient outcome in end stage renal disease. Materials and Methods: "The present study was done in the department of cardiovascular and thoracic surgery at Sber-i-Kashmir institute of medical sciences, Soura, Srinagar Kashmir. Native Arterio-Venous (AV) fistulas were made in the patients with end stage renal disease for performing hemodialysis. They were followed for patency and adequacy of blood flow during hemodialysis. All the patients were operated under local anesthesia. Results: The results showed that 77% of the AV fistulas based on radial artery with side-to-side anastomosis and 80% of those with end-to-side anastomosis were functionally patent after one year. After two years, the patency rate in side-to-side and end-to-side anastomosis was 50% and 55%, respectively. In addition, the patency rate was 90% in brachial artery based AV fistula with end-to-side anastomosis, whether done primarily or secondarily, at the end of one year. However, a rapid decline was observed in the patency rate during the third year in both radial artery based and brachial artery based AV fistulas. Conclusions: We concluded that Arterialised arm superficial veins after primary AV fistula was the optimal and rational vascular access for hemodialysis providing adequate blood flow during this process. Besides, failure of primary AV fistula should be replaced by secondary AV fistula preferably based on brachial artery. [ABSTRACT FROM AUTHOR]

Background: Thalassemia is a hereditary hemoglobinopathy whose most common complication is cardiac involvement which ends up in these patients' death. Since troponin is a sensitive and specific marker for the detection of microinfarct, we studied the relationship between troponin and ferritin serum levels for early diagnosis of cardiac involvement in these patients. Materials and Methods: This case-control study was performed on 80 patients, including 40 patients with major thalassemia and normal echocardiography and 40 healthy volunteers ranging from 6 months to 16 years old. All the children were examined and the eligible children who were not infected with known heart disease, iron deficiency anemia, kidney disease, diabetes, fever, and systemic diseases were enrolled into the study after obtaining written informed consents from their parents. At 8:00 A.M. before breakfast, 5cc blood was drawn from these children. After collecting the samples, ferritin and troponin serum levels were evaluated using ELISA and electrokymonolonsense methods, respectively. The gathered data were analyzed through the SPSS statistical software (v. 20) and T-test. Besides, P value<0.05 was considered as statistically significant. Results: The study results revealed a significant difference between the two groups regarding the mean of the serum levels oftroponin (P=0.045) and ferritin (P=0.001). In this study, no significant correlation was observed between serum troponin and ferritin levels and age and BMI in the two groups. Also, no significant relationship was found between serum troponin level and sex (P=0.264). Conclusions: In microinfarct, troponin increases independent of ferritin; therefore, it can be used for early detection of cardiac involvement in thalassemia patients to determine the sub-clinical effects. [ABSTRACT FROM AUTHOR]

Background: Traditional cardiovascular risk factors are strong predictors of an increased likelihood for premature CHD. Considering the benefits of risk factors" management, it is imperative to find and treat them before looking for more unknown and weak risk factors. Objectives: Limited information is available about the demographic and historical characteristics of the patients with premature Coronary Heart Disease (CHD) in IR Iran. The main objective of this study was to determine the prevalence of the traditional risk factors in these patients. Also, the researchers hypothesized that there are insufficient risk assessment and preventive intervention methods for the asymptomatic adult population. Methods: This study was conducted on 125 patients with premature CHD (age<50 years) who were admitted in two academic hospitals with acute coronary syndromes. The patients were accepted since they had a definite CHD on the basis of acute myocardial infarction (elevated cardiac enzymes) or documented CAD in coronary angiography. Results: The mean age of the study population was 42.50+5.65 (26 to 49 years). Among the patients,92 (73.6%) were male, 113 (90.4%) were married, 58 (46.4%) were smokers,19 (15.2%) were opium users, 97 (77.6%) had dyslipidemia, 44 (35.2%) had hypertension, and 33 (26.4%) had diabetes mellitus. In addition, family history was presented in 54 patients (43.2%). Among the study population, 120 patients (96%) had at least one of the traditional risk factors, including dyslipidemia, hypertension, diabetes mellitus, cigarette smoking, and family history of CHD. However, none of the dyslipidemic patients had controlled total cholesterol, LDL, HDL, and triglyceride. Also, none of the diabetic patients had hemoglobin A1C<7%. Among the 44 hypertensive patients, blood pressure of 15 ones (34%) was within the normal range. Besides, only 3 patients (2.4%) had regular physical activity (at least 30 minutes, three times a week). Conclusions: Premature Coronary Heart Disease is a public health problem. However, there is lack of effective and intensive treatments of well-defined traditional risk factors and prevention methods for the majority of the patients experiencing premature CHD. In sum, there is still plenty of room for improvement of risk management in IR Iran. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the renal tubular function in the patients with congenital heart disease using β²-microglobulin. Methods: In this case-control study, based on oxymetry, the patients with congenital heart disease were divided into two groups of cyanotic (n=20) and acyanotic (n=20). Congenital heart disease was diagnosed by echocardiography. Healthy individuals within the same age and sex groups were used as controls. Na+, β²-micro globulin, creatinine (Cr), and β²-microglobulin/Cr ratio were measured in random urine samples and the results were compared to the same parameters in the control group using Tukey, One-Way ANOVA, and X² tests. Results: Based on the study results, urine sodium in the patients with cyanotic heart disease was significantly different from that of the controls (P=0.023). The results also revealed a significant difference between the two groups with congenital heart disease regarding urine β²-microglobulin (P=0.045). In addition, the patients with cyanotic heart disease were significantly different from those with acyanotic heart disease and the controls regarding urine β²-micro globulin/Cr ratio (P=0.012 and P=0.026, respectively). Conclusions: The results of this study demonstrated that renal tubular dysfunction began in the patients with congenital heart disease, especially in those with cyanotic congenital heart disease. Besides, early diagnosis before cardiac surgery leads to better control of renal tubular disease. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the differences of obesity rate among three ethnic groups in northern adults in IR Iran in 2010. Methods: The present cross-sectional, analytical study was conducted on 2994 cases of the same age and sex in three ethnic proportions (Fars-native=1625, Turkman=977, and Sisstani=392). The subjects aged between 15 and 65 years old and were selected by multistage cluster sampling techniques including 150 clusters each containing 20 subjects in urban and rural areas in 11 districts in Golestan province (northern IR Iran). Obesity was defined after WHO classification by BMI (Body Mass Index) equal or over 30 kg/ m². SPSS 16.0 software was used for statistical analysis and P value<0.05 was considered as statistically significant. Results: Mean±SD of BMI in Fars-native, Turkman, and Sisstanish ethnic groups was 26.72±5.56, 26.18±5.34, and 24.59+6.72 kg/m², respectively. Averagely, obesity was common in 22.8% of the subjects and was significantly higher among the females compared to males (32.3% vs13.3%) (P=0.001). Also, its prevalence was estimated as 25%, 22.6%, and 14% in Fars-native, Turkman, and Sisstanish ethnic groups, respectively. Statistical differences were significant among the three ethnic groups (P=0.001). The risk of obesity was 2.041 [95% CI, 1.502-2.722] in Fars-native and 1.781 [95% CI, 1.298-2.472] in Turkman groups compared to Sisstanish ethnic group. Conclusions: Over one out of five adults in northern IR Iran suffer from obesity and an alarming rate was shown among the women. Among the three ethnic groups, the highest and the lowest rates were seen in Fars-native and Sisstanish ethnic groups, respectively. Variation of obesity among the three ethnic groups should be studied in future studies. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the effect of amiodarone and metaprolol in prevention of atrial fibrillation in patients, following open heart surgery. Methods: This prospective study was carried out between May 2008 to Nov. 2010, and comprised a total of 50 patients with normal preoperative sinus rhythm undergoing open heart surgery using cardio pulmonary bypass. Results: Mean age of patients was 47 ± 2.7 years, of which 60% who developed atrial fibrillation aged from 51 to 60 years. Most patients (62%) were in NYHA Class III. Patients who received amiodarone showed significant improvement in LVEF compared to those treated with Metaprolol. Amiodarone treated group exhibited lesser incidence and short-lasting atrial fibrillation, lower ventricular rate, shorter hospitalization, a n d lesser cost of care than those in metaprolol group. Conclusions: The present study showed that amiodarone was more efficient in controlling post-operative atrial fibrillation as compared to metaprolol. However, a larger randomized controlled trial is needed to corroborate the result of this study. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective study is to identify intraoperative patients characteristics predicting the need for blood transfusion during CABG in our local cardiac surgical service. Methods: This study included 1835 consecutive patients, 1311 males and 524 females with mean age 5 8.8 ± 9.9 years, undergoing coronary artery bypass grafting. Risk factors detected by univariate study were entered in a multivariate logistic regression model of the relationship between preoperative variables and blood transfusion. Results: Blood transfusion was used in 435 patients (29.9%). Univariate analysis identified hemoglobin, smoking, hypertension, sex, diabetes, BMI and use of cardiopulmonary bypass (CPB) as significant predictors. Multivariate analysis revealed hemoglobin (OR: 0.8; CI: 0.74-0.86; P<0.001), CPB use (OR: 12.2; CI: 8.2-18.1; P<0.001) and female gender (OR: 2.29; CH.72-3.04; P<0.001) as independent risk factors for blood transfusion. Conclusions: The predictors of RBC transfusion after isolated CABG were performing CPB, preoperative hemoglobin and female gender. These factors can be used as a clinical tool to preserve blood bank resources without increasing patients risk. [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: The aim of this study was to evaluate the clinical outcomes, one year after primary percutaneous coronary intervention(PCI). Patients and Methods: From September 2009 to March 2012, primary PCI was performed on 70 cases, and the data relating to their catheterization were recorded. Peri-interventional treatment data included PCI with drug-eluting or bare-metal stent or balloon angioplasty alone. Results: The mean age of the patients was 61.34+11.31 years, and 72.9% of them were males. The ratios of patients with diabetes, hypertension and, hyperlipidemia were 61.4%, 71.4%, and 52.9% respectively. In clinical follow-up, total incidence of death was 4.3%, with no death occurring during 30 days. However, 3 patients died after one-year, of which one patient (1.4%) had cardiac problem and the other 2 (2.9%) died because of non-cardiac reasons. Target vessel revascularization, reinfarction within 30 days, and mechanical complication or stroke were not found in any of the patients. Patients with hypertension (6%) and those with LAD ST-elevation myocardial infarction (5%) died after one year (P= 0.263 and P= 0.319 respectively). However, no mortality was reported in patients with RCA and LCX ST-elevation myocardial infarction. Of subjects with multivessel disease, 7% died after one-year (P= 0.161), but there was no reported mortality in those with single vessel disease. Conclusions: The prognosis was satisfactory in patients undergoing PCI after one year clinical follow up. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to compare and analyze the results of right anterolateral thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement, length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU) stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness. Methods: The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department of Cardiovascular and Thoracic Surgery at Sher-i-Kashmir Institute of Medical Sciences from September 2009 to August 2011. Results: This study comprised 64 patients with 23 (35.9%) males and 41 (64.1%) females. Sternotomy group had 10 males (31.3%) and 22 females (68.7%). Thoracotomy group had 13 males (40.6%) and 19(59.4%) females. The length of incision between the two groups was statistically significant (P<0.0001). Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001). Scar visibility was 100% in sternotomy and around 25% in thoracotomy( P<0.0001). Conclusions: Thoracotomy through a right anterolateral aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross-clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional relief to the family. [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]

Background: The effect of opium on glycemic control in diabetics is a controversial issue, as some studies have shown glucose lowering effect of opium in diabetes while the results of other studies do not support this idea. The possible role of opioid peptides in the regulation of food intake has been previously investigated. However, there is no data available about relationship between opium using and dietary pattern. Objectives: The aim of the present study was to determine the daily intake of different nutrients in opium addict with diabetes diagnosed with coronary artery disease (CAD). Methods: This study comprised 232 consecutive diabetic patients with CAD, and candidates for isolated coronary artery bypass surgery in Tehran Heart Center. Of these, 26 patients were opium addicts. Nutritional assessment was obtained by a validated semiquantitative food frequency questionnaire (FFQ). Results: In opium addicts compared to non-addicts, consumption of carbohydrates (360.0±120.9 versus 447.8±249.8 Gr/day, P=0.016) and vitamin A (1170.4±570.2 versus 1496.3±889.6 ?g/d as Retinol Activity Equivalent (RAE), P=0.040) was lower than nonaddicts and intake of other nutrients were similar across two group of patients. Conclusions: Opium addiction in diabetic patients may lead to decrease of vitamin A and carbohydrate intake. This study showed that carbohydrate intake in addicted diabetic patients is lower than their non-addict counterpart. Thus, the so called lowering effect of opium on blood sugar may be due to nutritional habit of addicted patients. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery is associated with some degree of myocardial injury. Preconditioning first described in 1986 was pharmacologic and non- pharmacologic. Among the long list of anesthetic drugs, isoflurane as an inhaling agent along with midazolam and propofol as injectable substances have been documented to confer some preconditioning effects on myocardium. Objectives: In this study cardiac Troponin T (cTnT) ,as a reliable marker, was used for evaluating myocardial injury. Methods: This prospective double blind study was comprised of 60 patients scheduled for CABG and were randomly assigned into three groups who received infusion of propofol or midazolam or isoflorane. Surgical procedures and anesthetics were similar for 3 groups. cTnT measured preoperatively and at 12, 24 and 36hr after arrival in ICU. Results: There were no statistically significant differences in mean cTnT levels between three groups in the preoperative period and 12-24 hours after arrival in ICU. However, mean cTnT in 3 groups at 36 hours after arrival in ICU were different (P< 0.013) and cTnT level was significantly higher in midazolam group (P<0.001) and lowest in isoflurane group (P=0.002). Conclusion: There were significant differences on cTnT levels between anesthetic groups of isofluran, midazolam and propofol at 36 hr after surgery. Preconditioning effect of isoflurane was higher than the other two groups. [ABSTRACT FROM AUTHOR]

Background: The most effective and accurate treatment of hypertensive patients reduces cardiovascular events and improves the quality of life. Objective: This study compared the efficacy and safety of combined (combination therapy) with an angiotensin-receptor blocker (ARB) a calcium-channel blocker (CCB) (Losartan / Amloidipine 50/10mg) vs maximal combination doses of ARB with hydrochlorothiazide (Losartan /HCTZ 100/25 mg) and maximal combination doses of CCB with HCTZ (Amlodipine /HCTZ 10/25 mg) in the management of stage 2 hypertension. Methods: This randomized clinical trial (RTC) comprised 478 hypertensive patients with mean age 50.5?5.21 years, and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar. Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position ? 160 and <200 mmHg in systole and ? 100 and <110 mmHg in diastole were randomized into three groups: Losartan / Amlodipine 50/10 mg (n =164) , Losartan / HCTZ 100/25 mg (n =155) and Amlodipine / HCTZ 10/25 mg (n =159). The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group. Results: There was a significant difference in systolic blood pressure reductions between treatment groups (P<0.001) and also there was a significant difference between groups in reducing diastolic blood pressure (P<0.01). The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group. The ANCOVA analysis revealed that only treatment regimen had a significant effect (P=0.01) and other factor including Age, Gender, Diabetes Mellitus, Smoking and High serum cholesterol didn't have significant effect on blood pressure reduction. Conclusion: ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study. [ABSTRACT FROM AUTHOR]

Background: Retrospective studies and clinical trials have indicated that beta-receptor blockers have an influential role in improving survival and reducing risk of recurrent infarction in patients with myocardial infarction. However, there is still controversy regarding the effects of beta-receptor blockers on the markers of myocardial infarction following percutaneous coronary interventions (PCI). Objective: The aim of this study was to evaluate the pre-treatment effect of Carvedilol on markers of myocardial injury in patients undergoing elective PCI. Method and Materials: In this clinical trial patients undergoing elective PCI were categorized randomly in the Carvedilol group including 100 patients who received two doses of 12.5 mg, 6 and 12 hours prior to PCI, and the control group (105 patients). Blood samples were obtained to analyse cardiac biomarker, 12 and 24 hours after PCI. Results: The clinical features were not significantly different between the two groups. A increase in the level of Troponin I was observed in the control group 24 hours following PCI (P=0.042), whereas this rise in troponin I was slight and insignificant in the Carvedilol group (P>0.05). some difference was observed between the two groups in regard to the level of CPK-MB after PCI (P=0.041). Conclusion: The findings of our study indicate that pre-treatment with Carvedilol confers cardio-protection by limiting the rise of markers of myocardial injury following PCI. [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]

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 retrospective study was conducted to determine whether obesity is a predictor of mortality, morbidity or early readmission to hospital after coronary artery bypass graft (CABG). Method: We analyzed a large cohort of 1057 patients who had undergone isolated CABG. BMI (body mass index) was used as the measure of obesity. The preoperative, intera operative and postoperative risk factors as well as the complication and 30-day mortality rates were compared between the two groups (624 (65.5%) normal-weight and 328 (34.5%) obese patients). Chi square test and logistic regression were used in univariate and multivariate respectively. Results: Of the 1057 patients, 59% had a normal weight and 31% were obese. An increased BMI did not increase the risk of 30-day mortality. In addition, increased BMI was not a predictor of the major complications; arrhythmia, renal complications, neurological complications, pulmonary embolism (PE) except myocardial infarction(MI) (1.8% vs 0.3% with p-value= 0.015). Also investigation on mechanical ventilation time, Reintubation, length of stay in ICU, length of stay in hospital, and readmitting as postoperative variables revealed no significant difference on these two groups( normal-weight and obese patients) Conclusion: Obesity increased myocardial infarction after CABG, but it did not affect the other situations. [ABSTRACT FROM AUTHOR]

Background: The incidence of cardiovascular disease (CVD) is rapidly increasing worldwide. Occupation-related stress such as military parachuting has been considered to be a potentially important cardiovascular risk factor. The present study was performed to determine the prevalence of cardiovascular risk factors and metabolic syndrome among military parachutists which provides a guideline to prevent catastrophic cardiovascular events. Methods: This is a cross-sectional study among 96 military parachutists in southern IR Iran; who were evaluated in the military clinic in Shiraz, Southern IR Iran. Information regarding demographic and life style were obtained from each subject. Arterial blood pressure, weight, height, body mass index (BMI), waist circumference (WC) and hip circumference (HC), fasting blood glucose, lipid profile consisting of total cholesterol, LDL, HDL and triglyceride were measured by standard methods. Results: The mean age of participants was 37.4±6.4 years. There were 5 (5.2%) cases under treatment for cardiovascular diseases, 4 (4.2%) participants were pre-diabetics and 5 (5.2%) suffered from diabetes mellitus. Hypertriglyceridemia and hypercholesterolemia were seen in 23 (24%) and 46 (47%) military parachutists respectively. Conclusions: Although war-related stressors and high intensity physical activities are associated with both acute cardiac events and cardiac risk factors, our data is in favor of lower frequency of cardiovascular risk factors among military parachutists. However, routine monitoring of military parachutists is necessary to find the cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: Increased right atrial pressure due to pulmonary hypertension may impair venous drainage with resultant coronary sinus dilatation. The aim of this study was to search for correlations between coronary sinus diameter and estimated pulmonary artery pressure in children. Methods: In a prospective study, 100 children who were referred consecutively for transthoracic echocardiography were included in this study. Ratios of coronary sinus diameter to weight, body surface area and aortic annulus were calculated for in each patient. Correlation between coronary sinus diameter and estimated pulmonary artery pressure was studied by person correlation. A tricuspid regurgitation peak gradient more than 36 mmHg or pulmonary regurgitation peak gradient more than 25 mmHg were considered as pulmonary hypertension. Results: Sixty-eight of our participants had no pulmonary hypertension and 32 did. Mean age was 7.6 years in the patients without pulmonary hypertension and 8.0 years in the patients with pulmonary hypertension (P=0.11). Mean coronary sinus diameter to aortic annulus diameter ratio was 0.49 ± 0.13 in the patient with pulmonary hypertension versus 0.38 ± 0.12 in the patient without pulmonary hypertension (P<0.001). The coronary sinus diameter to body surface area ratio was 1.3 ± 0.59 versus 0.7 ± 0.28 (P<0.001), and coronary sinus diameter to weight ratio was 0.06 ± 0.03 versus 0.02 ± 0.01 (P<0.001). Conclusion: coronary sinus dilation was documented in pediatric patients with pulmonary hypertension. The ratios of coronary sinus diameter to aortic annulus diameter, body surface area and weight correlated significantly with pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Background: The burden of non-communicable diseases is rising globally. The present study was carried out to examine the relationship between different anthropometric indices and blood pressure in the Iranian population. Methods: A cross-sectional descriptive study was conducted on 3916 subjects including 1976 males and 1940 females, aged 15- 64 years from a healthy population in Shiraz, IR Iran. Anthropometric variables of each person including weight, height, waist circumference (WC), waist to height ratio (WHR) and body mass index (BMI) were calculated along with measuring systolic and diastolic blood pressures (BP). The relationship between blood pressure and different anthropometric variables was determined in both genders. Results: The mean±SD systolic blood pressures were 123.9±20.0 and 121.2±17.7 mmHg while the mean diastolic blood pressures were 78.3±11.9 and 77.4±12.9 mmHg in men and women respectively (P<0.001). The prevalence of hypertension in men (23.8 %) was significantly more than that of women (21.1 %). Mean systolic and diastolic blood pressures increased with age and BMI in both genders. Anthropometric indices showed a positive association with systolic and diastolic blood pressures. Conclusion: The BMI and WC showed a strong association with systolic and diastolic blood pressure. The suggested lower cut-off values of the anthropometric indicators will cover maximum of the population with higher odds of having hypertension and may help reduce the levels of population's mean blood pressure. [ABSTRACT FROM AUTHOR]

Background: The use of radial access for diagnostic coronary angiogram and percutaneous coronary intervention (PCI) has increased during the last few years, especially due to its benefit regarding reduction in site vascular complication compared with femoral approach. Objectives: To evaluate the safety and feasibility of diagnostic coronary angiography in patients on chronic anticoagulation therapy without drug interruption and to study the impact of this strategy in terms of bleeding complication as first endpoint and length of hospitalisation as second endpoint. Methods: This is a retrospective study of 53 patients on chronic anticoagulation therapy with coumarin derivatives who underwent diagnostic coronary angiography in our centre between January 2003 and July 2011, compared with a control group of 53 patients without anitcoagulation therapy. The international normalised ratio (INR) in the anticoagulated group with uninterrupted anticoagulation therapy was >2. Thrombolysis In Myocardial Infarction (TIMI) classification was used for the evaluation of bleeding complication. Hospitalisation stay was also compared between two groups. Results: Baseline characteristics were similar in both groups except for diagnostic which motivated coronary angiogram and INR level during the procedure. A minimal bleeding occurred in the acenocoumarol group compared with 0 event in control group (1.9% vs. 0%, P=NS). The average of hospitalisation was 6±4.9 days in the acenocoumarol group and 6.3 ±4.1 in the control group (P=NS). Conclusions: This study reveals that diagnostic coronary angiography by radial approach in patients on chronic coumarin derivative therapy without drug interruption is a safe strategy and is not associated with a significant increase in bleeding complication and length of hospitalisation. [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]

Background: Different pharmacological agents may decrease the inflammatory response during cardiac surgery. The aim of this study was to evaluate the effect of ascorbic acid as an antioxidant on inflammatory markers (interleukins 6 and interleukin 8) released during cardiopulmonary bypass. Method: Forty patients scheduled for elective coronary artery bypass grafting surgery, were randomly assigned to two groups. The patients in the case group were given 3 grams ascorbic acid 12-18 hours before operation and 3 grams during CPB initiation. The patients in the control group were given the same amounts of normal saline at similar times. Blood samples were collected 6 hours preoperatively and postoperative serum interleukin 6 and 8 were measured using enzyme-linked immunosorbent assay (ELISA). Result: In both groups CPB caused an increase in IL6 and IL8 plasma concentrations compared with baseline levels, but the pattern of changes at such levels were similar in both groups after receiving ascorbic acid or placebo. Ascorbic acid did not reduce the inflammatory cytokines during CPB. Compared to the placebo, ascorbic acid had no significant effect on hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, arterial blood gases, BUN, Creatinine and WBC and platelet counts. Conclusion: Ascorbic acid has no effect on the reduction of IL6 and IL8 during CPB. Also, it causes no improvement in hemodynamics, blood gas variables, and the outcomes of patients undergoing CABG. [ABSTRACT FROM AUTHOR]

Background: Fasting and calorie restriction have some cardioprotective effects. In view of the effect of fasting on peripheral benzodiazepine receptors and widespread administration of benzodiazepines in medicine, the present study was designed to evaluate whether fasting may affect myocardial vulnerability to cardiac ischemiaDSreperfusion (I/R) following repeated diazepam administration. Methods: Rats were divided into six groups of 8 or 10 animals. Groups I and II were controls which received intra peritoneal injection of normal saline solution for 5 days. Also, Control II underwent fasting on 5th day of experiment. Four test groups received intra peritoneal injection of diazepam for 5 days (groups I and II 1mg/kg; groups III and IV 5 mg/kg). Also, test groups II and IV fasted on 5th day of experiment. The Langendorff isolated hearts were subjected to 25 minutes ischemia and 25 minutes reperfusion. Cardiac parameters including left ventricular developed pressure and rate pressure product were determined. Infarct size was measured by Triphenyltetrazolium staining. Results: Recovery of the left ventricular developed pressure in diazepam groups were significantly lower than control I and II (P=0.049 and P=0.046 respectively). But there was no significant difference among the controls and test group II, which fasted following diazepam administration. This showed the preservation of the cardiac performance in the fasting animals following administration of diazepam (1 mg/kg). Conclusion: The results obtained showed the exacerbation of ischemia reperfusion injury in the presence of diazepam and demonstrated the protective effect of fasting which is probably due to modulation of the mitochondrial permeability transition pore. [ABSTRACT FROM AUTHOR]

Background: QT dispersion, defined as the difference between maximum and minimum QT interval measured at 12 lead ECG, is the most simple and widely used index of ventricular dispersion. Increased ventricular dispersion predicts predisposition to cardiac arrhythmia and therefore affects the prognosis of patients after myocardial infarction. Methods: In this study we evaluated whether QT dispersion can predict the arrhythmogenic potential in acute myocardial infarction (AMI) and whether it can behave as a risk stratification tool in such patients. Results: In all, 124 patients were included in the study. Mean QT dispersion at presentation was 112±5.4 ms. Those who were thrombolysed, or survived or did not develop significant ventricular arrhythmias had significantly lower QT dispersion than their comparative groups (P<0.001). Conclusion: In our study we found that measuring QT dispersion from presentation till hospitalisation can provide a method of risk stratification of AMI patients and can detect patients who are at increased risk of developing ventricular arrhythmias and increased cardiac mortality ?Implication for health policy/practice/research/medical education [ABSTRACT FROM AUTHOR]

Carotid stenosis is seen in about 10% of patients with ischemic stroke. Many studies have been performed that provide insight into the natural history, diagnosis, and optimal management of carotid disease. Both medical management and surgery have advanced to the point that patients and their providers have many options when considering treatment. Over the last several years, carotid artery stenting has been shown to be a viable treatment choice in selected patients. Both stenting and endarterectomy are superior to medical management alone in stroke prevention when patients are properly selected. In this article we try to review the most recent data regarding the two procedures in the treatment of carotid stenosis and also discuss the controversies in carotid artery revascularization. [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]

Morgagni hernia is a rare diaphragmatic hernia usually due to congenital defects in the diaphragm. It is rarely associated with cardiac anomalies, most commonly atrial (ostium secundum) or ventricular septal defects. We report a rare case of Morgagni hernia occurring in association with partial atrio-ventricular septal defect (ostium primum), and its successful surgical correction. [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]

The window ductus in adults is a rare, anatomical anomaly, successful closure of which is more challenging both to surgeons and interventional cardiologists. Eventhough various strategies are available, optimal method of repair of patent ductus arteriosus in adults remains controversial. We report the case of an adult female patient with window patent ductus arteriosus (2.5cmx0.5mm) with severe pulmonary artery hypertension, in whom circulatory arrest was used successfully as a surgical option for transpulmonary closure of the duct. Post operatively patient recovered well without any complications and is doing well in follow up. [ABSTRACT FROM AUTHOR]

We reported a young male with knife assault to his chest. He was transferred to the hospital without manipulating the knife. He was completely conscious and had sinus tachycardia and regular breathing. Emergency thoracotomy was performed and the knife was removed. No organ was damaged. This case presentation showed that in this kind of trauma, it is mandatory not to manipulate the penetrating foreign body during the transfer to the hospital. [ABSTRACT FROM AUTHOR]

Coronary embolisation, spontaneous coronary artery dissection, and myocardial bridges are rare causes of Myocardial Infarction (MI) in the youth. Here, we report a young male who developed myocardial infarction at the age of 19. Investigations revealed that he had mitral stenosis, myocardial bridge, and angiographic features of healed coronary dissection. [ABSTRACT FROM AUTHOR]

Balloon valvulotomy is the procedure of choice for relief of mitral stenosis. Inoue technique is the most widely accepted technique which uses the right femoral vein to access the interatial septum. Due to technical issues, left femoral vein approach is less recommended. We report an unusual case in which the right femoral vein was not accessible and mitral balloon valvulotomy was done via left femoral approach. Left femoral vein may be used in special cases where the right femoral vein is not accessible. [ABSTRACT FROM AUTHOR]

The article comments on the diagnosis of Left Bundle Branch Block (LBBB) using different techniques. The authors acknowledge the correct diagnosis of LBBB using electrocardiography (ECG) after 40 years but warn that the procedure may be accompanied by some errors as high as 30 percent of cases. Some studies are cited to show the effectiveness of intracardiac mapping techniques in the diagnosis of LBBB.