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Introduction: Myocardial bridge (MB) is a congenital anomaly in which a segment of a coronary artery is surrounded by myocardium. In our study, we want to use conventional coronary angiography (CCA) to describe morphologic characteristics of MB (unidentified or identified) in the patients with documented evidence of MB in coronary computed tomography angiography (CCTA). Methods: The present study was designed as cross-sectional and was conducted on 47 patients with documented evidence of MB in CCTA, who were referred to Nemazee and Faghihi hospitals for performing coronary angiography during a one year period. We compared the morphologic characteristics of tunneled segments, which were missed at CCA (unidentified), and the tunneled segments which were identified with CCA. Results: In sum, MB was found in 16 (34%) patients at CCA (identified), and it was not found in 31 (66%) patients (unidentified) based on compression sign. No significant correlation was found between the percentage of systolic compression and the length and depth of the tunneled segment in identified group (r=0.73, P = 0.18; r=1.09, P = 0.15; respectively). Degree of atherosclerotic plaque formation (diameter stenosis, percentage) (mean, 0.25 (25%) ±0.29; range, 0-0.98) of the tunneled segments in unidentified group was significantly more than the same degree (mean, 0.07 (7%) ±0.13; range, 0-0.41) of the identified group (P = 0.03). The measurement of the trapezoid area under the tunneled segment with this formula [(MB length+ intramyocardial segment) ×depth/2] had significant relation with systolic compression (r=0.304, P = 0.03) and defined the cut-off value of 250 mm2 as the value of significant difference in detecting myocardial bridging with CCA. Conclusion: Our results showed that in most of identified MBs in CCA the tunneled segment area was equal and more than 250 mm2. In addition, the degree of atherosclerotic plaque of the tunneled segments at CCA was significantly more in unidentified group.

Introduction: Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test. Methods: This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test. Results: Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P 0.05). Conclusion: This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.

Introduction: Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention. Methods: Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery. Results: The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal. Conclusion: The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.

Introduction: Myocardial infarction (MI) has a deleterious effect on quality of life (QoL), which can affect cardiac prognosis after MI. Thus, new strategies have to be identified for improving the QoL. To our knowledge, no studies have been conducted on the impact of therapeutic lifestyle change (TLC) diet and L-carnitine plus Q10 supplementation on QoL after MI. Methods: The study aimed to measure 128 MI patients’ QoL using MacNew QoL questionnaire (global scales and physical, emotional, and social subscales) before and 3 months after the intervention. The patients were divided into 4 groups. Group A received TLC diet, group B orally received Q10 150 mg/d and L-carnitine 1200 mg/d, and group C received a combination of carnitine plus Q10 and TLC diet. Finally, group D, as the control group, only underwent the routine care. Results: The results showed a significant increase in MacNew questionnaire’s physical, emotional, and social subscales in the four groups after the intervention. The results of within-group analysis showed that the physical and emotional subscales changed significantly (P

Spontaneous coronary artery vasospasm is one of the important causes of acute chest pain syndromes. The diagnosis of diffuse multifocal spasm can be quite challenging and it could be easily mistaken for diffuse coronary artery disease. The use of intracoronary nitroglycerin can relieve spasm and reveal the real extent of coronary artery disease. Herein we present a case presenting with acute myocardial infarction due to severe coronary artery spasm that had even received fibrinolytic therapy. Multiple narrowing was shown during coronary angiography and the patient was scheduled for percutaneous coronary intervention (PCI). But after intracoronary (IC) injection of nitroglycerin, all of lesions disappeared completely and the diagnosis of coronary spasm was confirmed.

Introduction: Successful closure of atrial septal defect (ASD) improves patients’ functional class and exercise capacity. In this study we evaluate the safety and feasibility of percutaneous device closure of ASDs. Methods: Two hundred fifty six patients with significant ASD according to our criteria were enrolled. The patients were treated using nitinol wire mesh transcatheter devices. Complications were followed for a median of 2.5 years. Results: Success rate was 98.4% with 3 unsuccessful cases and a mean hospital stay of 1.007 ± 0.0004 days. Complication rate was 7.42%. Size of the right ventricle (RV) annulus was significantly decreased 24 hours after intervention (P=0.005). Conclusion: The present report demonstrates that transcatheter closure of ASD is safe and effective.

Introduction: High sensitive C-Reactive Protein (hs-CRP) is increased in acute and chronic rheumatic fever (RF), but is unknown whether serum levels of hs-CRP is correlated with late restenosis of mitral valve (MV) after Percutaneous transvenous mitral commissurotomy (PTMC). The aim of this study is to determine relationship between hs-CRP and MV restenosis 48-36 months after performing PTMC. Methods: A total of 50 patients who had undergone PTMC due to rheumatic etiology (41 female, 9 male; mean age 46 ± 11, range 27-71), all followed up on an out patients basis 36 months after PTMC, were included in the study. The hs-CRP was measured using an enzyme-linked immunosorbent assay (ELISA) kits. Results: No association was found between hs-CRP level and mean transmitral valve gradient 36 months after PTMC, MV area by planimetry, pulmonary artery systolic pressure, mitral regurgitation grade, left atrial diameter, atrial fibrillation (AF) rhythm and Wilkins score. Conclusion: Our study have shown that there is no association between hs-CRP and MV restenosis in patients with rheumatic heart disease (RHD) who underwent PTMC. Therefore, it has been postulated that inflammation is not a cause of post PTMC restenosis.

A newly described immediate complication after percutaneous pulmonary valvuloplasty is acute lung injury. Here we report a case of fatal acute lung injury after pulmonary valvuloplasty.The patient was a 26-year-old woman, referred to a general hospital with the diagnosis of livercirrhosis. In her work-ups severe pulmonary stenosis was detected and so a decision was madeto relieve the valve stenosis. Despite the procedural success, the patient developed severe dyspneaand desaturation a few hours later and died within 3 days due to shock state. Although the definition, incidence or severity of acute lung injury after pulmonary balloon valvuloplasty is not yet clear, this is as far as we know the first mortality reported in literature. This presentation in our patient should prompt clinicians to consider a more aggressive approach at the first sight of this previously considered innocent complication.